Research on Homeless Vets Suggests Ways to Target Services Based on Risk Factors

Abstract

FEAR THAT US VETERANS RETURNING from Iraq and Afghanistan would be disproportionately affected by homelessness because of posttraumatic stress disorder (PTSD) and blast-related injuriesmaybemisplaced,suggestedStephen Metraux, PhD, associate professor of health policy and public health at the UniversityoftheSciencesinPhiladelphia. Metraux spoke in an April webcast on homelessnessamongveteranssponsored bytheSubstanceAbuseandMentalHealth Administration (SAMHSA). Rather, evidence suggests that poverty, substance abuse, and mental illness—the same factors that drive homelessness in the general population— may pose greater risks to veterans than the so-called signature injuries of the wars in Iraq and Afghanistan. Metrauxisamongagroupofresearchers tryingtobetterunderstandthecauses ofhomelessnessamongveterans inorder to prevent the problem and to better tailorservicestoveteransfacingit.Theirfindings so far offer some surprises. For example,womenveteransarenotathigher riskofhomelessness than theirmalecolleagues,butwhentheydofacehomelessness, they have unique needs stemming fromahighlikelihoodofhavingchildren or having experienced sexual trauma. Metrauxandcolleaguesanalyzeddata from the Department of Defense and the DepartmentofVeteransAffairs(VA)and foundthatofveteransdischargedbetween July 1, 2005, and September 30, 2006, 1.8%(5694of310 685)hadrecordsofreceivinghomelessservices.“It’saboutwhat you’d expect in the general population,” he said. “It’s not consistent with some of thealarmist languagepeoplehaveused.” Veterans who had been deployed to Iraq or Afghanistan did have a somewhat higher risk of homelessness (odds ratio [OR]=1.3), and PTSD was associated with a higher risk of homelessness only among veterans who were deployed (OR=1.2 among male veterans and OR=1.6 among female veterans), according to research presented by Metraux. Still, a veteran’s pay grade prior to discharge appears to be a better predictor of the risk of homelessness, with individuals in the lowest pay grade making up 44% of this cohort of veterans but 72% of the homeless group. Individuals with behavioral health problems made up 17.8% of the discharge cohort but made up 44% of the homeless group. “We hope this represents the beginning steps of developing a system to identify persons at risk,” said Metraux. Although female veterans are not at greater risk of homelessness than their male colleagues, they are at greater risk of homelessness than nonveteran women. Additionally, women veterans appear to have their own set of risk factors for homelessness. For example, sexual trauma is a greater risk factor for homelessness among women than men, said Jack Tsai, PhD, an investigator for the Veterans Affairs New England Mental Illness Research, Education, and Clinical Center and an assistant professor of psychiatry at Yale University.