Hargrave Anita S, Kimberg Leigh, Machtinger Edward L, Kushel Margot B, Cohen Beth E
Department of Internal Medicine, University of California San Francisco, San Francisco, CA 94110, USA.
UCSF Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, CA 94110, USA.
Mil Med. 2022 Jan 8;188(7-8):e2143-9. doi: 10.1093/milmed/usab557.
Despite programs to address housing for Veterans, they continue to be at high risk of unstable housing. Interpersonal violence is also highly prevalent among Veterans and may contribute to unstable housing. Our study aimed to determine whether interpersonal violence was associated with unstable housing among Veterans, and how this association was influenced by common co-occurring conditions such as substance use and mental illness.
Veterans in the Mind Your Heart Study (N = 741) completed survey data on history of interpersonal violence and access to housing in the prior year. Interpersonal violence was defined as experiencing sexual violence, physical violence, or mugging/physical attack using the Brief Trauma Questionnaire. Multivariable models examined associations between interpersonal violence and unstable housing. Primary models were adjusted for age and sex. Potential explanatory factors were added in subsequent models, including marital status, education, income, substance use disorder, PTSD, and other mental illness.
Veterans who had experienced interpersonal violence had almost twice the odds of unstable housing after adjustment for age and sex (AOR 1.9, 95% CI 1.2-3.0). This association was attenuated in the fully adjusted model including substance use, PTSD, and other mental illness, illustrating the interdependence of these factors (AOR 1.5, 95% CI 0.91-2.5). Subtypes of interpersonal violence were individually associated with increased odds of unstable housing after adjustment for age and sex (physical abuse AOR 1.7, 95% CI 1.2-2.5; mugging/physical attack AOR 1.8, 95% CI 1.2-2.7; sexual violence AOR 1.4, 95% CI 0.89-2.2), but were no longer significant in the fully adjusted model.
Previous experiences of interpersonal violence were associated with unstable housing among Veterans. Substance use, PTSD, and other mental illness played an important role in this relationship-highlighting the potential to improve health outcomes through trauma informed approaches that address mental health, substance use, and housing concurrently.
尽管有针对退伍军人住房问题的项目，但他们仍面临住房不稳定的高风险。人际暴力在退伍军人中也非常普遍，可能导致住房不稳定。我们的研究旨在确定人际暴力是否与退伍军人的住房不稳定有关，以及这种关联如何受到物质使用和精神疾病等常见并发状况的影响。
“关爱你的心”研究中的退伍军人（N = 741）完成了关于人际暴力史和上一年住房情况的调查数据。人际暴力被定义为使用简短创伤问卷经历性暴力、身体暴力或抢劫/身体攻击。多变量模型检验了人际暴力与住房不稳定之间的关联。主要模型根据年龄和性别进行了调整。在后续模型中加入了潜在的解释因素，包括婚姻状况、教育程度、收入、物质使用障碍、创伤后应激障碍和其他精神疾病。
在根据年龄和性别进行调整后，经历过人际暴力的退伍军人住房不稳定的几率几乎是未经历者的两倍（调整优势比1.9，95%置信区间1.2 - 3.0）。在包括物质使用、创伤后应激障碍和其他精神疾病的完全调整模型中，这种关联减弱了，说明了这些因素之间的相互依存关系（调整优势比1.5，95%置信区间0.91 - 2.5）。在根据年龄和性别进行调整后，人际暴力的亚型分别与住房不稳定几率增加相关（身体虐待调整优势比1.7，95%置信区间1.2 - 2.5；抢劫/身体攻击调整优势比1.8，95%置信区间1.2 - 2.7；性暴力调整优势比1.4，95%置信区间0.89 - 2.2），但在完全调整模型中不再显著。
以前的人际暴力经历与退伍军人的住房不稳定有关。物质使用、创伤后应激障碍和其他精神疾病在这种关系中起重要作用——突出了通过同时解决心理健康、物质使用和住房问题的创伤知情方法改善健康结果的潜力。
