Tsai Jack, Szymkowiak Dorota, Beydoun Hind
United States Department of Veterans Affairs, Homeless Programs Office, Washington, DC, USA.
Department of Management, Policy, and Community Health, University of Texas Health Science Center at Houston, 1200 Pressler St., Houston, TX, 77030, USA.
Sci Rep. 2025 Apr 30;15(1):15185. doi: 10.1038/s41598-025-99394-x.
Housing can be an important social determinant of mental health, which is why it is important to understand how mental health disorders (MHDs) and substance use disorders (SUDs) cluster and vary by housing instability. This study examined rates of comorbid MHDs and SUDs among three groups of U.S. veterans: those experiencing homelessness, those in supported housing, and those independently housed. Administrative data on a national cohort of 5,402,062 veterans (including 181,131 homeless veterans and 29,166 veterans in supported housing) enrolled in the U.S. Department of Veterans Affairs (VA) healthcare system from 2021 to 2023 were analyzed. Among homeless veterans, 28.3% had a SUD diagnosis, 62.9% a MHD diagnosis, and 24.7% comorbid MHD/SUD. Among veterans in supported housing, 38.2% had a SUD diagnosis, 67.3% a MHD diagnosis, and 32.0% comorbid MHD/SUD diagnoses. Among independently housed veterans, 7.9% had a SUD diagnosis, 41.6% a MHD diagnosis, and 5.8% comorbid MHD/SUD diagnoses. Homeless veterans with comorbid MHD/SUD used significantly more outpatient, inpatient, and emergency department care than veterans in supported housing; in turn, supported housing veterans with comorbid MHD/SUD used significantly more outpatient, inpatient, and emergency department care than independently housed veterans. Among homeless veterans with comorbid MHD/SUD diagnoses, those with addiction to central nervous system (CNS) stimulants used more outpatient, inpatient, and emergency department care than those with addiction to CNS depressants. In conclusion, the psychiatric epidemiology and comorbidity of veterans varies by housing situation, and there is continued need for psychiatric treatment among homeless veterans who enter supported housing.
住房可能是心理健康的一个重要社会决定因素，这就是为什么了解心理健康障碍（MHDs）和物质使用障碍（SUDs）如何因住房不稳定而聚集和变化很重要。本研究调查了三组美国退伍军人中MHDs和SUDs的共病率：经历无家可归的退伍军人、接受支持性住房的退伍军人和独立居住的退伍军人。分析了2021年至2023年在美国退伍军人事务部（VA）医疗系统登记的5,402,062名退伍军人（包括181,131名无家可归的退伍军人和29,166名接受支持性住房的退伍军人）的全国队列行政数据。在无家可归的退伍军人中，28.3%有SUD诊断，62.9%有MHD诊断，24.7%有MHD/SUD共病。在接受支持性住房的退伍军人中，38.2%有SUD诊断，67.3%有MHD诊断，32.0%有MHD/SUD共病诊断。在独立居住的退伍军人中，7.9%有SUD诊断，41.6%有MHD诊断，5.8%有MHD/SUD共病诊断。患有MHD/SUD共病的无家可归退伍军人比接受支持性住房的退伍军人使用门诊、住院和急诊科护理的次数明显更多；反过来，患有MHD/SUD共病的支持性住房退伍军人比独立居住的退伍军人使用门诊、住院和急诊科护理的次数明显更多。在患有MHD/SUD共病诊断的无家可归退伍军人中，对中枢神经系统（CNS）兴奋剂成瘾的人比那些对CNS抑制剂成瘾的人使用门诊、住院和急诊科护理的次数更多。总之，退伍军人的精神疾病流行病学和共病情况因住房状况而异，进入支持性住房的无家可归退伍军人仍然需要持续的精神治疗。
