Rosenheck R, Fontana A
Northeast Program Evaluation Center, VA Medical Center, West Haven, CT 06516.
Am J Psychiatry. 1994 Mar;151(3):421-7. doi: 10.1176/ajp.151.3.421.
This study explored a multifactorial model of vulnerability to homelessness among male veterans of the Vietnam war generation.
Data from 1,460 male veterans who participated in the National Vietnam Veterans Readjustment Study were used to evaluate hypotheses about the causes of homelessness grouped into four sets of sequential variables: 1) premilitary risk factors, 2) war related and non-war-related traumatic experiences, 3) lack of social support at the time of discharge from military service, and 4) postmilitary psychiatric disorder and social dysfunction. Structural equation modeling was used to explore the posited model of risk factors for homelessness.
Postmilitary social isolation, psychiatric disorder, and substance abuse had the strongest direct effects on homelessness, although substantial indirect effects from stressors related to being in the war zone and from premilitary conduct disorder were observed. Several premilitary factors--year of birth, childhood physical or sexual abuse, other childhood traumas, and placement in foster care during childhood--also had direct effects on homelessness.
Individual vulnerability to homelessness is most likely due to a multiplicity of psychiatric and nonpsychiatric factors, with independent influences emerging at each of four discrete time periods. In view of this complex pattern of influences, prevention efforts directed at individuals must address a very broad range of adjustment problems.
本研究探讨了越战一代男性退伍军人中易致无家可归的多因素模型。
来自1460名参与全国越战退伍军人重新适应研究的男性退伍军人的数据，用于评估关于无家可归原因的假设，这些原因分为四组连续变量：1）入伍前风险因素，2）与战争相关和与战争无关的创伤经历，3）退伍时缺乏社会支持，4）退伍后精神障碍和社会功能障碍。采用结构方程模型来探究所假定的无家可归风险因素模型。
退伍后的社会孤立、精神障碍和药物滥用对无家可归有最强的直接影响，尽管观察到来自战区相关应激源和入伍前品行障碍的显著间接影响。几个入伍前因素——出生年份、童年期身体或性虐待、其他童年创伤以及童年期被寄养——也对无家可归有直接影响。
个体易致无家可归很可能是由于多种精神和非精神因素，在四个不同时间段各有独立影响。鉴于这种复杂的影响模式，针对个体的预防措施必须解决非常广泛的适应问题。
