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.
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.
Disabil Health J. 2017 Oct;10(4):592-599. doi: 10.1016/j.dhjo.2017.03.003. Epub 2017 Mar 10.
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.
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.
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.
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).
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.
美国退伍军人的兵役相关残疾、医疗福利、心理健康障碍和部署后无家可归之间的关系存在许多动态，这些动态还没有得到很好的理解。
确定是否因兵役相关残疾而退伍的退伍军人更有可能无家可归，退伍军人健康管理局（VHA）服务相关残疾福利是否减轻了这种风险，以及与退伍类型、服务相关残疾或它们之间的相互作用相关的风险是否因心理健康障碍而有所不同。
这是一项对 2005 年至 2013 年间有残疾相关或常规退伍和初次 VHA 就诊的 364997 名退伍军人进行的回顾性队列研究。使用逻辑回归和生存分析来估计无家可归风险与退伍状态、心理健康障碍以及 VHA 残疾福利的关系。
与常规退伍军人相比，残疾退伍军人的无家可归率更高（残疾退伍军人每 1000 人年风险 15.1 例，而常规退伍军人 9.1 例）。在初次 VHA 就诊时，与常规退伍军人相比，残疾退伍军人的心理健康障碍与无家可归的风险差异更大。在 VHA 服务使用的第一年，更高水平的残疾福利对常规退伍军人的无家可归风险具有保护作用，但对残疾退伍军人则没有。到第 5 年，残疾退伍成为无家可归的一个风险因素（AOR=1.30）。
从长期来看，残疾退伍是无家可归的一个独立风险因素。虽然 VHA 残疾福利有助于减轻常规退伍军人在早期重新融入社会期间的无家可归风险，但它们可能无法为残疾退伍军人提供足够的保护。
