Clinical and demographic factors associated with homelessness and incarceration among VA patients with bipolar disorder.
OBJECTIVE
We assessed the association between homelessness and incarceration in Veterans Affairs patients with bipolar disorder.


METHODS
We used logistic regression to model each participant's risk of incarceration or homelessness after we controlled for known risk factors.


RESULTS
Of 435 participants, 12% reported recent homelessness (within the past month), and 55% reported lifetime homelessness. Recent and lifetime incarceration rates were 2% and 55%, respectively. In multivariate models, current medication adherence (based on a 5-point scale) was independently associated with a lower risk of lifetime homelessness (odds ratio [OR] = 0.80 per point, range 0-4; 95% confidence interval [CI] = 0.66, 0.96), and lifetime incarceration increased the risk of lifetime homelessness (OR = 4.4; 95% CI = 2.8, 6.9). Recent homelessness was associated with recent incarceration (OR = 26.4; 95% CI = 5.2, 133.4). Lifetime incarceration was associated with current substance use (OR = 2.6; 95% CI = 2.7, 6.7) after control for lifetime homelessness (OR = 4.2; 95% CI = 2.7, 6.7).


CONCLUSIONS
Recent and lifetime incarceration and homelessness were strongly associated with each other. Potentially avoidable or treatable correlates included current medication nonadherence and substance use. Programs that better coordinate psychiatric and drug treatment with housing programs may reduce the cycle of incarceration, homelessness, and treatment disruption within this vulnerable patient population.
Copeland
Laurel A
LA
Department of Veterans Affairs, San Antonio, TX, USA. copelandl@uthscsa.edu
Miller
Alexander L
AL
Welsh
Deborah E
DE
McCarthy
John F
JF
Zeber
John E
JE
Kilbourne
Amy M
AM
D000928:Antidepressive Agents / Q000627:therapeutic use; D018692:Antimanic Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000188:drug therapy / Q000453:epidemiology*; D016001:Confidence Intervals; D019548:Crime Victims / Q000706:statistics & numerical data*; D006703:Ill-Housed Persons / Q000706:statistics & numerical data*; D006787:Hospitals, Veterans / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D015233:Models, Statistical; D015999:Multivariate Analysis; D016017:Odds Ratio; D011329:Prisoners / Q000706:statistics & numerical data*; D011594:Psychometrics; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D014728:Veterans / Q000706:statistics & numerical data*
D000928:Antidepressive Agents; D018692:Antimanic Agents