A positive screen for military sexual trauma among recently discharged male and female veterans may be a predictive factor for homelessness. In addition, the association between military sexual trauma and homelessness is stronger among male veterans, results of a retrospective study published April 20 show.
Emily Brignone, Dr. Adi V. Gundlapalli, and their associates examined health care data from the Veterans Health Administration’s 2011 Operation Enduring Freedom and Operation Iraqi Freedom official roster of veterans. All of the veterans separated from the military between fiscal years 2001 and 2011, and used Veterans Health Administration (VHA) services between fiscal years 2004 and 2013 (JAMA Psychiatry. 2016 Apr 20. doi: 10.1001/jamapsychiatry.2016.0101).
The total study population included 601,892, 590,989, and 262,589 U.S. veterans who screened positive for military sexual trauma at 30 days, 1 year, and 5 years, respectively, after their initial VHA visit, reported Ms. Brignone and Dr. Gundlapalli, both of whom are affiliated with the Informatics, Decision Enhancement, and Analytic Sciences Center at the VA Salt Lake City Health Care System.
They found that the incidence of homelessness in this population was 1.6%, 4.4%, and 9.6% within 30 days, 1 year, and 5 years, respectively. The rates for male veterans were higher than for their female counterparts, as evidenced by 30-day, 1-year, and 5-year homelessness rates of 2.3%, 6.2%, and 11.8%, respectively, compared with 1.3%, 3.9%, and 8.9%. About 25% of female veterans report experiencing sexual trauma during their military service, compared with 1% of male veterans, research shows (Am J Public Health. 2007;97[12]:2160-6).
Meanwhile, the rates of positive military sexual trauma screens among homeless veterans were almost twice as high, compared with the rates of veterans who were not homeless (0.7%, 1.8%, and 4.3%, respectively).
Logistic regression analysis models adjusted for mental health and substance use diagnoses showed that military sexual trauma screen status remained significantly associated with homelessness, such that veterans with a positive military sexual trauma screen were roughly 1.5-fold more likely to be homelessness than those with a negative screen. The adjusted models also showed that the interaction between military sexual trauma status and sex remained significant for the 30-day and 1-year cohorts.
Ms. Brignone, Dr. Gundlapalli, and their associates cited several limitations. For example, a positive screen for military sexual trauma is a self-reported marker rather than a diagnosis. “Because a positive screen for [military sexual trauma] is associated with increased service use, there may be more opportunities to detect homelessness among veterans with a positive screen,” they wrote.
The investigators said further research is needed to understand the temporal associations between sexual trauma, mental health diagnoses, and sex-dependent differences. Understanding those associations might be useful in attempts at prevention and intervention of postdeployment homelessness, they wrote.
A U.S. Department of Veterans Affairs grant funded this project. The authors disclosed no conflicts of interest.