Jamison D Fargo1, Emily Brignone2, Stephen Metraux3, Rachel Peterson2, Marjorie E Carter4, Tyson Barrett2, Miland Palmer4, Andrew Redd4, Matthew H Samore4, Adi V Gundlapalli4. 1. Salt Lake Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS 2.0) Center, VA Salt Lake City Health Care System, UT, USA; Department of Psychology, Utah State University, Logan, UT, USA; National Center for Homelessness Among Veterans, VA Philadelphia Health Care System, PA, USA. Electronic address: jamison.fargo@usu.edu. 2. Salt Lake Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS 2.0) Center, VA Salt Lake City Health Care System, UT, USA; Department of Psychology, Utah State University, Logan, UT, USA. 3. National Center for Homelessness Among Veterans, VA Philadelphia Health Care System, PA, USA; Health Policy and Public Education, University of the Sciences, Philadelphia, PA, USA. 4. Salt Lake Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS 2.0) Center, VA Salt Lake City Health Care System, UT, USA; Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.
Abstract
BACKGROUND: Many dynamics in the relationship among military service-related disabilities, health care benefits, mental health disorders, and post-deployment homelessness among US Veterans are not well understood. OBJECTIVES: Determine whether Veterans with a disability-related discharge from military service are at higher risk for homelessness, whether Veterans Health Administration (VHA) service-connected disability benefits mitigates that risk, and whether risks associated with discharge type, service-connected disability, or the interaction between them vary as a function of mental health disorders. METHODS: Retrospective cohort study of 364,997 Veterans with a disability-related or routine discharge and initial VHA encounter between 2005 and 2013. Logistic regression and survival analyses were used to estimate homelessness risk as a function of discharge status, mental health disorders, and receipt of VHA disability benefits. RESULTS: Disability-discharged Veterans had higher rates of homelessness compared to routine discharges (15.1 verses 9.1 per 1000 person-years at risk). At the time of the first VHA encounter, mental health disorders were associated with differentially greater risk for homelessness among Veterans with a disability discharge relative to those with a routine discharge. During the first year of VHA service usage, higher levels of disability benefits were protective against homelessness among routinely-discharged Veterans, but not among disability-discharged Veterans. By 5-years, disability discharge was a risk factor for homelessness (AOR = 1.30). CONCLUSIONS: In the long-term, disability discharge is an independent risk factor for homelessness. While VHA disability benefits help mitigate homelessness risk among routinely-discharged Veterans during the early reintegration period, they may not offer sufficient protection for disability-discharged Veterans.
BACKGROUND: Many dynamics in the relationship among military service-related disabilities, health care benefits, mental health disorders, and post-deployment homelessness among US Veterans are not well understood. OBJECTIVES: Determine whether Veterans with a disability-related discharge from military service are at higher risk for homelessness, whether Veterans Health Administration (VHA) service-connected disability benefits mitigates that risk, and whether risks associated with discharge type, service-connected disability, or the interaction between them vary as a function of mental health disorders. METHODS: Retrospective cohort study of 364,997 Veterans with a disability-related or routine discharge and initial VHA encounter between 2005 and 2013. Logistic regression and survival analyses were used to estimate homelessness risk as a function of discharge status, mental health disorders, and receipt of VHA disability benefits. RESULTS: Disability-discharged Veterans had higher rates of homelessness compared to routine discharges (15.1 verses 9.1 per 1000 person-years at risk). At the time of the first VHA encounter, mental health disorders were associated with differentially greater risk for homelessness among Veterans with a disability discharge relative to those with a routine discharge. During the first year of VHA service usage, higher levels of disability benefits were protective against homelessness among routinely-discharged Veterans, but not among disability-discharged Veterans. By 5-years, disability discharge was a risk factor for homelessness (AOR = 1.30). CONCLUSIONS: In the long-term, disability discharge is an independent risk factor for homelessness. While VHA disability benefits help mitigate homelessness risk among routinely-discharged Veterans during the early reintegration period, they may not offer sufficient protection for disability-discharged Veterans.