Table 1.
More Rigorous Published Studies on Risk Factors for Veteran Homelessness, 1994–2013
| First Author, Year (Reference No.) | Design | Data Source | Total No. | No. of Homeless | Sampling Frame | Study Period | Identified Risk Factors |
|---|---|---|---|---|---|---|---|
| Rosenheck, 1994 (28) | Cross-sectional study using structural equation modeling | National Vietnam Veterans Readjustment Study | 1,460 | 123 | Male Vietnam veterans | 1986–1987 | Four premilitary factors included year of birth (total effect = 0.10), childhood physical or sexual abuse (total effect = 0.10), other childhood trauma (total effect = 0.07), and foster care (total effect = 0.06). Four postmilitary factors included psychiatric disorders (total effect = 0.08), substance abuse (total effect = 0.06), being unmarried (total effect = 0.14), and low levels of social support 1 year after military discharge (total effect = 0.30). |
| O'Connell, 2008 (44) | Retrospective cohort study | Randomized controlled trial of the HUD–VASH Program | 392 | 172 subsequently homeless | Formerly homeless veterans in supported housing | 1992–1995 | Drug use upon entry into housing (RR = 12.33) and a diagnosis of PTSD (RR= 1.85) were predictive of subsequent homelessness. |
| Washington, 2010 (43) | Matched case-control study | Local survey data | 198 | 33 | Female veterans | 2005–2006 | Being unemployed (OR = 13.1), disabled (OR = 12.5), in fair or poor health (OR = 3.2), unmarried (OR = 0.1), having less than a college education (OR = 0.2), and screening positive for post-traumatic stress disorder (OR = 4.9). |
| VA Office of Inspector General, 2012 (36); Metraux, 2013 (37) | Population-based retrospective cohort study | Administrative data from VA and DoD maintained by the Office of Inspector General | 310,685 | 5,574 | Iraq and Afghanistan era veterans | 2005–2006 | Lower military pay grade (HR = 0.13–0.43), diagnosed mental illness in the military, especially psychotic disorders (HR = 1.57–4.22) and substance use disorders (HR = 1.85–2.72), traumatic brain injury (HR = 1.20–1.64), problematic military discharges (HR = 1.79–8.18), service in OEF/OIF (HR = 1.34), and active duty vs. reserves (HR = 0.74–1.34). |
| Blackstock, 2012 (42) | Population-based case-control study | Administrative data from VA | 445,319 | 7,431 | OEF/OIFVA service users | 2001–2009 | Age, 18–35 years (HR = 1.51–1.66), black (HR = 2.53), unmarried (HR = 1.32), high school education or lower (HR = 1.76), urban location (HR = 0.77), enlisted vs. military officer (HR = 2.66), VA service connection (HR = 1.45–2.35), and nearly all mental health diagnoses, especially substance use disorders and schizophrenia (HR = 1.17–3.38). |
| Edens, 2011 (45) | Population-based case-control study | Administrative data from VA | 1,120,424 | 109,056 | VA mental health service users | 2008–2009 | Diagnoses of alcohol and drug use disorders (OR = 2.0–3.3), schizophrenia (OR = 1.1), bipolar disorder (OR = 1.0), pathological gambling (OR = 2.4), personality disorders (OR = 1.6), male, urban-dwelling (OR = 0.3–0.5), lower income (OR = 0.3–0.8), age, 40–49 years (OR = 1.7), and being black (OR = 1.4). |
| Protective characteristics were VA service connection (OR = 0.3), age, ≥65 years (OR = 0.2–0.6), and service in OEF/OIF (OR = 0.4). | |||||||
| Elbogen, 2013 (41) | Retrospective cohort study | National Postdeployment Adjustment Baseline and Follow-up Survey | 1,090 | 39 | Iraq and Afghanistan era veterans | 2009–2011 | Criminal history (OR = 2.65), mental health diagnosis (OR = 2.59), income level (OR = 0.30), and money mismanagement (OR = 4.09). |
Abbreviations: DoD, Department of Defense; HR, hazard ratio; HUD–VASH, Housing and Urban Development–Veterans Affairs Supportive Housing Program; OEF, Operation Enduring Freedom; OIF, Operation Iraqi Freedom; OR, odds ratio; PTSD, post-traumatic stress disorder; RR, risk ratio; VA, Department of Veterans Affairs.