Jamison D. Fargo, Ph.D., M.S.Epi., Emily Brignone, B.S., Stephen Metraux, Ph.D., Rachel Peterson, M.S., Marjorie E. Carter, M.S.P.H., Tyson Barrett, B.S., Miland Palmer, M.P.H., Andrew Redd, Ph.D., Matthew H. Samore, M.D., Adi V. Gundlapalli, M.D., Ph.D.
Disability and Health Journal, Vol. 10, Issue 4, p592–599
DOI: http://dx.doi.org/10.1016/j.dhjo.2017.03.003
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.