Table 2.
Less Rigorous Published Studies on Risk Factors for Veteran Homelessness, 1997–2014
| First Author, Year (Reference No.) | Design | Data Source | Total No. | No. of Homeless | Sampling Frame | Study Period | Identified Risk Factors |
|---|---|---|---|---|---|---|---|
| Rosenheck, 1997 (39) | Case-control study | VA's Homeless Chronically Mentally Ill veterans program, 1987 Third Survey of Veterans, a 1990 national survey of VA outpatient mental health clinic users, and the NVVRS | 98,371 | 34,711 | Homeless veterans engaged in VA services | 1986–1992 | Military combat exposure was associated with lower likelihood for homelessness (OR = 0.48–0.85). PTSD was not associated with greater likelihood for homelessness among veterans with other mental health diagnoses (OR = 0.41–0.96). |
| Wenzel, 1993 (46) | Cross-sectional study on duration of lifetime homelessness | Domiciliary care for homeless veterans in Los Angeles | 343 | 343 | Homeless veterans enrolled in a VA domiciliary care program | 1988–1992 | Being white and having a longer period of recent homelessness, a greater number of homeless episodes, a poorer employment history, greater mental and substance use problems, and weaker social support were associated with longer term homelessness. |
| Douyon, 1998 (48) | Cross-sectional study | Assessment battery on homeless VA inpatient service users | 53 | 33 | Homeless veterans enrolled in acute inpatient care | Unknown | Neurological deficits (frontoparietal, cerebellar, and frontal lobe functions). |
| Gamache, 2000 (29) | Case-control study | ACCESS evaluation and the NVVRS | 1,676 from NVVRS; 616 from ACCESS | 616 | Homeless male veterans with mental illness | 1995–1998 for ACCESS | 6.8% of homeless veterans with mental illness had either a bad conduct or dishonorable discharge. |
| 1986–1988 for NVVRS | The relative risk for homelessness among veterans who served in the Vietnam era and had a bad conduct or dishonorable discharge is 9.9 times as great as among veterans without such discharges. | ||||||
| Tsai, 2013 (49) | Cross-sectional study on severity of homelessness | National data from the HUD–VASH Program | 1,161 | 1,161 | Homeless veterans enrolled in VA-supported housing | 1992–2003 | Conduct disorder behaviors (Cohen's d = 0.16–1.13), family instability during childhood (d = 0.47–1.43), and childhood abuse (d = 0.05–0.40) were each weakly associated with lifetime homeless episodes. |
| Mares, 2004 (47) | Cross-sectional study on perceived military risk for homelessness | Therapeutic Employment Place and Support Program evaluation | 631 | 631 | Homeless veterans enrolled in VA vocational rehabilitation | 2001–2003 | 31% of sample reported that military service increased their risk for becoming homeless. |
| Perceived risk factors included substance abuse and health problems in the military, inadequate preparation for civilian employment, loss of structured lifestyle after military, weakened social connections, and interrupted education. | |||||||
| Younger age at military discharge, greater childhood problems, and less social support were associated with more rapid homelessness after military discharge. | |||||||
| van den Berk-Clark, 2013 (51) | Cross-sectional study | VA-funded specialized transitional living programs | 59 | 33 chronically and 26 acutely homeless | Homeless elderly veterans in Los Angeles | 2003–2005 | Chronically homeless veterans were less educated and had a smaller social network, particularly for “instrumental support” than acutely homeless veterans. |
| Kasprow, 2011 (50) | Population-based cross-sectional study | VA administrative data and “VetPop 2007” | 18,997,936 | 73,740 | OEF/OIF veterans who had contact with the VA homeless services | 2001–2007 | OEF/OIF veterans were seen in VA homeless programs at a lower rate in all age categories than other veterans (OR = 0.09–0.69), except for veterans less than 25 years of age (OR = 2.22). |
| Tsai, 2014 (21) | Cross-sectional study | Administrative data from the VA's HCRV Program | 30,348 | 9,201 | Incarcerated veterans in state or federal prisons | 2007–2011 | Rate of lifetime homelessness among incarcerated veterans is 5 times the rate in the general population (30% vs. 6%). |
| Incarcerated veterans with homeless histories reported more mental health and substance abuse problems, especially drug abuse/dependence (OR = 1.55–1.984), more times arrested in their lifetime (OR = 1.01–1.02), and were more likely to be incarcerated for a nonviolent offense than other incarcerated veterans (OR = 1.44–1.60). |
Abbreviations: ACCESS, Access to Community Care and Effective Services and Supports; HCRV, Health Care for Reentry Veterans Program; HUD–VASH, Housing and Urban Development–Veterans Affairs Supportive Housing Program; NVVRS, National Vietnam Veterans Readjustment Study; OEF, Operation Enduring Freedom; OIF, Operation Iraqi Freedom; OR, odds ratio; PTSD, post-traumatic stress disorder; VA, Department of Veterans Affairs.