Association of Substance Use and VA Service-Connected Disability Benefits with Risk of Homelessness among Veterans
ABSTRACT Recent public attention on homelessness has shifted beyond emergency services and supportive housing to primary prevention. This study compares a national sample of homeless and nonhomeless Veterans Affairs (VA) mental health services users to determine risk and protective factors for homelessness. Using VA administrative data, veterans were identified as homeless (ie, used VA homeless services or received a diagnostic code for "lack of housing") or nonhomeless and compared using logistic regression. Additional analyses were conducted for two low-risk subgroups: veterans who served in current Middle East wars (Operation Enduring Freedom [OEF]/Operation Iraqi Freedom [OIF]) and veterans with ≥50% service-connected disability. Among all VA mental health users, OEF/OIF (odds ratio [OR]) = 0.4) and ≥50% service-connected (OR = .3) veterans were less likely to be homeless. In the overall and subgroup analyses, illicit drug use (OR = 3.3-4.7) was by far the strongest predictor of homelessness, followed by pathological gambling (PG) (OR = 2.0-2.4), alcohol use disorder (OR = 1.8-2.0), and having a personality disorder (OR = 1.6-2.2). In both low-risk groups, severe mental illness (schizophrenia or bipolar disorder), along with substance use disorders, PG, and personality disorders, increased homelessness risk. Substance use, PG, and personality disorders confer the greatest modifiable risk of homelessness among veterans using VA services, while service-connected disability conferred reduced risk. Clinical prevention efforts could focus on these factors.
SourceAvailable from: Richard K Simons[Show abstract] [Hide abstract]
ABSTRACT: Screening for acute stress is not part of routine trauma care owing in part to high variability of acute stress symptoms in identifying later onset of posttraumatic stress disorder (PTSD). The objective of this pilot study was to assess the sensitivity, specificity, and power to predict onset of PTSD symptoms at 1 and 4 months using a routine screening program in comparison to current ad hoc referral practice.Journal of Trauma Management & Outcomes 05/2014; 8:5. DOI:10.1186/1752-2897-8-5
[Show abstract] [Hide abstract]
ABSTRACT: Abstract Objective: While there has been considerable concern about veterans dually diagnosed with both posttraumatic stress disorder (PTSD) and comorbid substance use disorders, a national study of clinical characteristics, service utilization and psychotropic medication use of such veterans in Veterans Affairs (VA) has yet to be conducted. We hypothesized that veterans having both PTSD and substance use disorder would have lower socioeconomic status, greater medical and psychiatric comorbidity, higher medical service utilization, and more psychotropic pharmacotherapy fills. Methods: National VA data from fiscal year 2012 were used to compare veterans dually diagnosed with PTSD and substance use disorder, to veterans with PTSD without substance use disorder on socio-demographic characteristics, psychiatric and medical comorbidities, mental health and medical service utilization and psychotropic pharmacotherapy. Comparisons were based on bivariate and Poisson regression analyses. Results: The sample included all 638,451 veterans who received the diagnosis of PTSD in the VA in fiscal year 2012: 498,720 (78.1%) with PTSD alone and 139,731 (21.9%) dually diagnosed with PTSD and a comorbid substance use disorder. Veterans with dual diagnoses were more likely to have been homeless and to have received a VA disability pension. Medical diagnoses that were more strongly associated with veterans who were dually diagnosed included seizure disorders, liver disease and human immunodeficiency virus (HIV). Psychiatric comorbidities that distinguished veterans with dual diagnoses included bipolar disorder and schizophrenia Veterans dually diagnosed with PTSD and substance use disorder also had a greater likelihood of having had mental health inpatient treatment. There were no substantial differences in other measures of service use or prescription fills for psychotropic medications. Conclusions: Several substantial differences were observed, each of which represented more severe medical and psychiatric illness among veterans dually diagnosed with PTSD and substance use disorder compared to those with PTSD alone. However, effective treatments are available for these disorders and special efforts should be made to ensure that veterans who are dually diagnosed receive them.Journal of Dual Diagnosis 12/2014; 11(1). DOI:10.1080/15504263.2014.989653 · 0.80 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: As more women serve in the U.S. military, the proportion of females among homeless veterans is increasing. The current study compares the individual characteristics and 1-year outcomes of homeless female and male veterans in the Housing and Urban Development-Veterans Affairs Supportive Housing (HUD-VASH) program nationally. Administrative data on 43,853 veterans (10.69% females; 89.31% males) referred to HUD-VASH were analyzed for gender differences at baseline and over a 1-year period. Homeless female veterans were younger, had shorter homeless and incarceration histories, and were less likely to have substance use disorders than men. However, despite being less likely to report combat exposure, female veterans were more likely to have posttraumatic stress disorder. Homeless female veterans were also much more likely to have dependent children with them and to plan to live with family members in supported housing. Once admitted to HUD-VASH, there were no gender differences in attrition or main housing outcomes. Case managers were faster to admit female veterans to the program, reported better working alliances, and provided more services related to employment and income than male veterans. These findings suggest homeless female veterans may have certain strengths, including being younger, less involved in the criminal justice system, and more adept at relating to professional and natural supports; but special attention to noncombat trauma and family-oriented services may be needed. (PsycINFO Database Record (c) 2014 APA, all rights reserved).Psychological Services 04/2014; 11(3). DOI:10.1037/a0036323 · 1.08 Impact Factor