Homelessness following disability-related discharges from active duty military service in Afghanistan and Iraq.
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.


OBJECTIVE
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.
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.
Jamison D
JD
Fargo
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.
Emily
E
Brignone
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.
Stephen
S
Metraux
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.
Rachel
R
Peterson
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.
Marjorie E
ME
Carter
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.
Tyson
T
Barrett
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.
Miland
M
Palmer
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.
Andrew
A
Redd
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.
Matthew H
MH
Samore
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.
Adi V
AV
Gundlapalli
D000328:Adult; D055826:Afghan Campaign 2001-; D000346:Afghanistan; D006233:Persons with Disabilities; D005260:Female; D006703:Ill-Housed Persons; D006801:Humans; D007493:Iraq; D054542:Iraq War, 2003-2011; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000150:complications; D008875:Middle Aged; D008889:Military Personnel; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans; D014729:Veterans Disability Claims
Disability; Homelessness; Risk; Veterans