Military Sexual Trauma is Independent Risk Factor for Homelessness among Veterans, Particularly Male Veterans
BACKGROUND:
In 2004, VA initiated screening for military sexual trauma (MST) for all Veterans seeking healthcare in its facilities. MST is related to adverse outcomes following separation from the military, including PTSD, depressive disorders, and substance use disorder, in addition to lower quality of life. However, to date no study has systematically evaluated MST as a risk factor for post-deployment homelessness. Thus, this retrospective cohort study examined the relationship between MST and post-deployment homelessness among a large cohort of OEF/OIF Veterans, including whether the relationship varied by sex, and whether MST was a predictor of homelessness independent of other risk factors (i.e., mental health and/or substance use disorders). Using both VA and DoD administrative data, investigators identified 601,892 Veterans (approximately 88% male and 12% female) who separated from the military between 2001 and 2011, and used VA care between 2004 and 2013.
FINDINGS:
- A positive MST screen was independently related to post-deployment homelessness. In unadjusted models, Veterans with a positive screen had odds for homelessness that were approximately double those who screened negative. Moreover, findings in the 30-day and 1-year follow-up cohorts suggested a greater risk for homelessness among men with a history of MST than among women.
- After adjusting for mental health and substance use diagnoses, MST screening status remained a significant predictor of homelessness, with Veterans who had a positive MST screen having approximately 1.5 times greater odds for homelessness than those who screened negative. Findings of greater risk among men also remained.
- Among Veterans with a positive MST screen, the incidence of homelessness was 2% within 30 days, 4% within one year, and 10% within five years.
LIMITATIONS:
- A positive MST screen is a self-reported marker of having experienced MST and not a diagnosis. Also, Veterans may choose not to disclose MST for a variety of reasons.
- The exclusive use of administrative data to determine housing status may result in an underestimation of homelessness rates.
IMPLICATIONS:
- The stronger risk conferred by MST for homelessness among men suggests that men with a positive MST screen are a particularly vulnerable group.
- Findings underscore the relevance of the MST screen as a marker of clinical and prognostic significance regarding reintegration outcomes, and emphasize the importance of trauma-informed care and trauma-specific interventions for Veterans with a positive MST screen.
AUTHOR/FUNDING INFORMATION:
This study was funded by HSR&D (IIR 12-084). All authors are with HSR&D's Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0) located in Salt Lake City, UT.
Brignone E, Gundlapalli A, Blais R, et al. Differential Risk for Homelessness among U.S. Male and Female Veterans with a Positive Screen for Military Sexual Trauma. JAMA Psychiatry. June 1, 2016;73(6):582-89.
