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PURPOSE: The Veterans Health Administration (VHA) is the largest integrated healthcare system in the U.S. While preventive healthcare services are high priority in the VHA, low-income U.S. Veterans experience adverse life circumstances that may negatively impact their access to these services. This study examined lifetime prevalence as well as demographic, socioeconomic, military-specific, and clinical correlates of colorectal cancer (CRC) screening among low-income U.S. Veterans ≥ 50 years of age. METHODS: Cross-sectional data on 862 participants were analyzed from the 2021-2022 National Veteran Homeless and Other Poverty Experiences study. RESULTS: Overall, 55.3% (95% confidence interval [CI] 51.3-59.3%) reported ever-receiving CRC-screening services. In a multivariable logistic regression model, never-receivers of CRC screening were twice as likely to reside outside of the Northeast, and more likely to be married (odds ratio [OR] = 1.86, 95% CI 1.02, 3.37), have BMI < 25 kg/m2 [vs. 25- < 30 kg/m2] (OR = 1.75, 95% CI 1.19, 2.58), or ≥ 1 chronic condition (OR = 1.46, 95% CI 1.06, 2.02). Never-receivers of CRC screening were less likely to be female (OR = 0.53, 95% CI 0.29, 0.96), aged 65-79y [vs. ≥ 80y] (OR = 0.61, 95% CI 0.40, 0.92), live in 5 + member households (OR = 0.33, 95% CI 0.13, 0.86), disabled (OR = 0.45, 0.22, 0.92), with purchased health insurance (OR = 0.56, 95% CI 0.33, 0.98), or report alcohol-use disorder (OR = 0.10, 95% CI 0.02, 0.49) and/or HIV/AIDS (OR = 0.28, 95% CI 0.12, 0.68). CONCLUSION: Nearly 55% of low-income U.S. Veterans reported ever screening for CRC. Variations in CRC-screening behaviors according to veteran characteristics highlight potential disparities as well as opportunities for targeted behavioral interventions.
ABSTRACT
Screening for viral hepatitis is considered a high-priority area in the Veterans Health Administration (VHA). Yet, few studies have examined viral hepatitis screening test use among low-income veterans who are considered high-risk with limited healthcare access. Using cross-sectional data from 933 participants in the 2021-2022 National Veteran Homeless and Other Poverty Experiences (NV-HOPE) study, we examined rates and correlates of lifetime screening for hepatitis B (HBV) and hepatitis C (HCV) infections. Multivariable logistic regression models evaluated characteristics associated with HBV/HCV screening. Nearly 16% and 21% reported lifetime HBV and HCV screening, respectively. These rates are considerably lower than HBV (47.3%) and HCV (92.9%) screening rates documented among contemporaneous veterans in VHA electronic health records. In the NV-HOPE data, veterans 50-79 years were more likely than those ≥80 years of age to ever-screen for HBV/HCV. Whereas, household income was inversely related to lifetime screening behaviours, veterans reporting 'other' employment types (vs. full-time/part-time employment) were more likely to ever-screen for HBV/HCV. Ever-screening for HBV was more likely among veterans reporting non-Hispanic 'other' (vs. non-Hispanic 'white') race, housing instability, Medicaid insurance, as well as drug use and cognitive disorder histories. Living with ≥5 members (vs. alone), histories of alcohol use, cancer, and liver disorders were also correlated with ever-screening for HCV. HIV/AIDS history correlated with ever-screening for HBV/HCV. In conclusion, fewer than one-third of low-income US veterans ever-screened for HBV/HCV, with lower screening rates among those less likely to be exposed to viral hepatitis, thereby informing interventions aimed at promoting available screening, treatment and vaccinations for HBV/HCV.
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BACKGROUND: The Elixhauser Comorbidity Index (ECI) is widely used, but its performance in homeless populations has not been evaluated. OBJECTIVES: Using a national sample of inpatients, this study compared homeless and nonhomeless inpatients on common clinical diagnoses and evaluated ECI performance in predicting mortality among homeless inpatients. RESEARCH DESIGN: A retrospective study was conducted using 2019 National Inpatient Sample (NIS) data, the largest publicly available all-payer inpatient health care database in the United States. SUBJECTS: Among 4,347,959 hospitalizations, 78,819 (weighted 1.8%) were identified as homeless. MEASURES: The ECI consists of 38 medical conditions; homelessness was defined using the International Classification of Diseases Tenth Revision Clinical Modification (ICD-10-CM) diagnostic code, and clinical conditions were based on the Clinical Classifications Software Refined (CCSR) for ICD-10-CM. RESULTS: Leading clinical diagnoses for homeless inpatients included schizophrenia and other psychotic disorders (13.3%), depressive disorders (9.4%), and alcohol-related disorders (7.2%); leading diagnoses for nonhomeless inpatients were septicemia (10.2%), heart failure (5.2%), and acute myocardial infarction (3.0%). Metastatic cancer and liver disease were the most common ECI diagnoses for both homeless and nonhomeless inpatients. ECI indicators and summary scores were predictive of in-hospital mortality for homeless and nonhomeless inpatients, with all models yielding concordance statistics above 0.80, with better performance found among homeless inpatients. CONCLUSIONS: These findings underlie the high rates of behavioral health conditions among homeless inpatients and the strong performance of the ECI in predicting in-hospital mortality among homeless inpatients, supporting its continued use as a case-mix control method and predictor of hospital readmissions.
Subject(s)
Comorbidity , Hospital Mortality , Ill-Housed Persons , Humans , Ill-Housed Persons/statistics & numerical data , Female , Male , United States/epidemiology , Retrospective Studies , Middle Aged , Adult , Aged , Hospitalization/statistics & numerical data , International Classification of DiseasesABSTRACT
With annual point-in-time counts indicating a rise in unsheltered homelessness in the United States, much attention has been paid to how to best provide care to this population. Mobile medical units (MMUs) have been utilized by many programs. However, little is known regarding the evidence behind their effectiveness. A scoping review is conducted of research on MMU provision of medical services for populations experiencing homelessness in the USA to examine the extent and nature of research activity, summarize available evidence, and identify research gaps in the existing literature. Following guidelines for scoping reviews, PubMed and Google Scholar were used to identify an initial 294 papers published from January 1, 1980, to May 1, 2023, using selected keywords, which were distilled to a final set of 50 studies that met eligibility criteria. Eligible articles were defined as those that pertain to the provision of healthcare (inclusive of dental, vision, and specialty services) to populations experiencing homelessness through a MMU in the United States and have been published after peer review. Of the 50 studies in the review, the majority utilized descriptive (40%) or observational methods (36%), with 4 review and 8 controlled studies and no completed randomized controlled trials. Outcome measures utilized by studies include MMU services provided (58%), patient demographics (34%), health outcomes (16%), patient-centered measures (14%), healthcare utilization (10%) and cost analysis (6%). The studies that exist suggest MMUs can facilitate effective treatment of substance use disorders, provision of primary care, and services for severe mental illness among people experiencing homelessness. MMUs have potential to provide community-based healthcare services in settings where homeless populations reside, but the paucity of randomized controlled trials indicates further research is needed to understand if MMUs are more effective than other care delivery models tailored to populations experiencing homelessness.
Subject(s)
Ill-Housed Persons , Mobile Health Units , Humans , United States , Mobile Health Units/organization & administrationABSTRACT
INTRODUCTION: It is unclear whether interventions designed to increase housing stability can also lead to improved health outcomes such as reduced risk of death and suicide morbidity. The objective of this study was to estimate the potential impact of temporary financial assistance (TFA) for housing-related expenses from the US Department of Veterans Affairs (VA) on health outcomes including all-cause mortality, suicide attempt, and suicidal ideation. METHODS: We conducted a retrospective national cohort study of Veterans who entered the VA Supportive Services for Veteran Families (SSVF) program between 10/2015 and 9/2018. We assessed the association between TFA and health outcomes using a multivariable Cox proportional hazards regression approach with inverse probability of treatment weighting. We conducted these analyses on our overall cohort as well as separately for those in the rapid re-housing (RRH) and homelessness prevention (HP) components of SSVF. Outcomes were all-cause mortality, suicide attempt, and suicidal ideation at 365 and 730 days following enrollment in SSVF. RESULTS: Our analysis cohort consisted of 41,969 unique Veterans with a mean (SD) duration of 87.6 (57.4) days in the SSVF program. At 365 days following SSVF enrollment, TFA was associated with a decrease in the risk of all-cause mortality (HR: 0.696, p < 0.001) and suicidal ideation (HR: 0.788, p < 0.001). We found similar results at 730 days (HR: 0.811, p = 0.007 for all-cause mortality and HR: 0.881, p = 0.037 for suicidal ideation). These results were driven primarily by individuals enrolled in the RRH component of SSVF. We found no association between TFA and suicide attempts. CONCLUSION: We find that providing housing-related financial assistance to individuals facing housing instability is associated with improvements in important health outcomes such as all-cause mortality and suicidal ideation. If causal, these results suggest that programs to provide housing assistance have positive spillover effects into other important aspects of individuals' lives.
Subject(s)
Veterans , Humans , Housing , Cohort Studies , Health Expenditures , Retrospective Studies , Suicidal IdeationABSTRACT
As homelessness remains an urgent public health crisis in the United States, specific programs in the US Department of Veterans Affairs (VA) system may serve as a roadmap for addressing it. We examine lessons learned from the first decade (2012-2022) of the Supportive Services for Veteran Families (SSVF) program, a cornerstone in the VA continuum of homeless services aimed at both preventing homelessness among those at risk and providing rapid rehousing for veterans and their families who are currently experiencing homelessness. Drawing on information from annual reports and other relevant literature, we have identified 3 themes of SSVF that emerged as features to comprehensively deliver support for homeless veterans and their families: (1) responsiveness and flexibility, (2) coordination and integration, and (3) social resource engagement. Using these strategies, SSVF reached nearly three quarters of a million veterans and their families in its first decade, thereby becoming one of the VA's most substantial programmatic efforts designed to address homelessness. We discuss how each feature might apply to addressing homelessness in the general population as well as future research directions. (Am J Public Health. 2024;114(6):610-618. https://doi.org/10.2105/AJPH.2024.307625).
Subject(s)
Ill-Housed Persons , United States Department of Veterans Affairs , Veterans , Humans , United States , United States Department of Veterans Affairs/organization & administration , Family , Social SupportABSTRACT
BACKGROUND: Studies have emerged about a syndrome of persistent symptoms of Coronavirus Disease-2019 (COVID-19) infection called 'Long COVID', which have mostly focused on the first 3 months. This study examined rates and predictors of Long COVID symptoms lasting beyond 3 months (termed Long2 COVID). METHODS: A longitudinal cohort study using a population-based sample of 511 adults in San Antonio, Texas with laboratory-confirmed cases of COVID-19 were assessed for Long2 COVID. Inverse probability weighting was used. RESULTS: In the sample, 19.18-59.10% met criteria for Long2 COVID depending on the definition. In general, Long COVID symptoms decreased after 3 months with the notable exception of an observed increase in loss of taste and smell. White Hispanic (adjusted odds ratio (aOR) = 7.66; 95% confidence interval (CI) = 1.78, 32.87) background and baseline depression symptoms (aOR = 1.30; 95% CI = 1.03, 1.65) were predictive of Long2 COVID. Long2 COVID was also associated with greater anxiety symptoms 6 months after onset of COVID-19. CONCLUSIONS: A sizable proportion report COVID-19 symptoms lasting more than 3 months and some symptoms even increased over time. Adults who are Hispanic white adults or have depression may be at greater risk for Long2 COVID. Further research is needed on why some adults experience Long COVID and how to reduce the duration of illness.
Subject(s)
COVID-19 , Post-Acute COVID-19 Syndrome , Adult , Humans , COVID-19/epidemiology , Incidence , Texas/epidemiology , Longitudinal StudiesABSTRACT
PURPOSE: Persistent residual effects from Coronavirus Disease-2019 (COVID-19) have been observed with varying definitions of "Long COVID" and little comprehensive examination. This study examined the incidence and psychosocial correlates of Long COVID using different definitions. METHODS: Data were analyzed from a citywide sample of 3595 adults with lab-confirmed cases of COVID-19 that were surveyed over 3 months. Rates of Long COVID were examined in terms of Post-Acute COVID (PAC), defined as at least one symptom lasting for 4 weeks, and three levels of Post-COVID Syndrome (PCS) that included experiencing at least one symptom for 3 months (PCS-1), experiencing three or more symptoms for 3 months (PCS-2), or experiencing at least one of the same symptoms for 3 months (PCS-3). RESULTS: Among the 686 participants who completed baseline, 1-month, and 3-month follow-up assessments, 75.7% had PAC, 55.0% had PSC-1, 26.5% had PSC-2, and 19.0% had PSC-3. Comparing participants with PAC and PSC-3 in the total sample with inverse probability weighting, multivariable analyses revealed being female, Asian or Native American, greater reported longlines, and less social support were predictive of PCS-3. CONCLUSION: Residual effects of COVID-19 are very common and nearly one-fifth of our sample met the most restrictive definition of Long COVID warranting concern as a public health issue. Some demographic and social factors may predispose some adults to Long COVID, which should be considered for prevention and population health.
Subject(s)
COVID-19 , Adult , Humans , Female , Male , COVID-19/epidemiology , Post-Acute COVID-19 Syndrome , Incidence , Surveys and QuestionnairesABSTRACT
PURPOSE: Mental health trajectories during the COVID-19 pandemic have been examined in Veterans with tenuous social connections, i.e., those with recent homelessness (RHV) or a psychotic disorder (PSY), and in control Veterans (CTL). We test potential moderating effects on these trajectories by psychological factors that may help individuals weather the socio-emotional challenges associated with the pandemic (i.e., 'psychological strengths'). METHODS: We assessed 81 PSY, 76 RHV, and 74 CTL over 5 periods between 05/2020 and 07/2021. Mental health outcomes (i.e., symptoms of depression, anxiety, contamination concerns, loneliness) were assessed at each period, and psychological strengths (i.e., a composite score based on tolerance of uncertainty, performance beliefs, coping style, resilience, perceived stress) were assessed at the initial assessment. Generalized models tested fixed and time-varying effects of a composite psychological strengths score on clinical trajectories across samples and within each group. RESULTS: Psychological strengths had a significant effect on trajectories for each outcome (ps < 0.05), serving to ameliorate changes in mental health symptoms. The timing of this effect varied across outcomes, with early effects for depression and anxiety, later effects for loneliness, and sustained effects for contamination concerns. A significant time-varying effect of psychological strengths on depressive symptoms was evident in RHV and CTL, anxious symptoms in RHV, contamination concerns in PSY and CTL, and loneliness in CTL (ps < 0.05). CONCLUSION: Across vulnerable and non-vulnerable Veterans, presence of psychological strengths buffered against exacerbations in clinical symptoms. The timing of the effect varied across outcomes and by group.
Subject(s)
COVID-19 , Veterans , Humans , Mental Health , Pandemics , Emotions , Anxiety/epidemiology , Depression/epidemiologyABSTRACT
To provide a comprehensive examination of different types of social support and associations with mental health among U.S. military veterans, a group vulnerable to psychosocial dysfunction. Using a nationally representative sample of 1,004 low-income U.S. veterans, this study examined the prevalence and mental health correlates of emotional, informational/tangible, positive social interaction, and affectionate social support. In the sample, 49-60% of participants perceived the four types of social support "most of the time" with the lowest prevalence being positive social interaction and the highest being affectionate support. Multivariable analyses found higher levels of all four types of social support were significantly associated with being married and greater mental health functioning. Some types of social support were uniquely associated with income level and positive screens for specific psychiatric disorders. Low social support is common among low-income U.S. veterans, and there is a need for community health interventions that target different types of social support to improve mental health and community integration.
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Studies in veterans have yet to examine interconnections between homelessness, financial debt, and suicidal ideation. We analyzed data from a nationally-representative study conducted in 2021 of low-income U.S. veterans (N = 1,004). Analyses revealed veterans who were younger, male, had a history of criminal arrests, met criteria for posttraumatic stress disorder (PTSD), reported greater loneliness, or had both a history of homelessness and higher debt were more likely to endorse suicidal ideation. We found an interaction between a history of homelessness and current debt: 40% of veterans with both past homelessness and higher debt reported suicidal ideation, whereas only 10% of veterans with either past homelessness or higher debt reported suicidal ideation. As past homelessness and current debt interacted to increase the odds of suicidal ideation in a national sample of veterans, these results inform policy and clinical decision-making for suicide prevention and in programs serving veterans experiencing homelessness.
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The purpose of this study was to explore (1) the prevalence of physical and mental health conditions among veterans stratified by homelessness and unstable housing (HUH) in several Midwestern states, and (2) the correlation between HUH and sociodemographic, military, financial, risky behavior, health, and geographical characteristics. The study cohort consisted of 7260 HUH veterans and stably housed veterans in 2018-2022 in Veterans Integrated Service Network (VISN) 23. A multivariate logistic regression analysis was performed which revealed the strongest associations with HUH were any incarceration experience (adjusted odds ratio [AOR] = 0.21) and rural location (AOR = 0.33). Frontier and remote location scores (AOR = 1.23) were associated with increased risk of HUH among veterans. Our results suggest potential differences in risk for HUH among veterans living in rural versus frontier and remote locations, which may be important to consider to provide care to the many veterans in these areas.
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BACKGROUND: Military veterans often encounter multiple obstacles to mental health care, such as stigma, practical barriers (e.g., high cost), and negative beliefs about mental health care. To date, however, nationally representative data on the prevalence and key correlates of these barriers to care are lacking. Such data are critical to informing population-based efforts to reduce barriers and promote engagement in mental health treatment in this population. METHODS: Data were analyzed from the National Health and Resilience in Veterans Study, which surveyed 4,069 US veterans, 531 (weighted 15.0%) of whom screened positive for a mental disorder but never received mental health treatment. Multivariable logistic regression and relative importance analyses were conducted to identify key predisposing, enabling, and need-based factors associated with endorsement of stigma, instrumental barriers, and negative beliefs about mental health care. RESULTS: A total 47.1% of veterans endorsed any barrier to care, with 38.7% endorsing instrumental barriers to care, 28.8% perceived stigma, and 22.0% negative beliefs about mental health care. Lower purpose in life, grit, and received social support were most consistently associated with these barriers to care. CONCLUSIONS: Nearly half of US veterans with psychiatric need and no history of mental health treatment report barriers to care. Modifiable characteristics such as a low purpose in life, grit, and received support were associated with endorsement of these barriers. Results may help inform resource allocation, as well as prevention, psychoeducation, and treatment efforts to help reduce barriers and promote engagement with mental health services in this population.
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Despite increasing recognition that positive psychological changes or posttraumatic growth (PTG) may develop after highly stressful or traumatic events, contemporary population-based data on the epidemiology of PTG in high-risk samples such as U.S. military veterans are lacking. Additionally, in light of emerging evidence suggesting an 8-factor model of posttraumatic stress disorder (PTSD) symptoms, an up-to-date characterization of how these symptom clusters relate to PTG can help inform efforts to help promote PTG. Data were analyzed from the 2019-2020 National Health and Resilience in Veterans Study (NHRVS), which surveyed a nationally representative sample of 3,847 trauma-exposed U.S. veterans. Participants completed assessments of potentially traumatic events, PTSD symptoms, and PTG, as well as a broad range of sociodemographic, military, trauma, health, personality, and psychosocial characteristics. Results revealed that 63.2% of trauma-exposed veterans and 86.4% of veterans who screened positive for PTSD endorsed moderate-or-greater PTG; these prevalences are higher than those reported in an independent U.S. veteran sample in 2011 (50.1% and 72.0%, respectively). An inverted U-shaped association was observed between PTSD symptom severity and PTG levels, with scores of 31 to 51 on the PTSD Checklist for DSM-5 associated with the highest likelihood of PTG. Intrinsic religiosity and internally- and externally-generated intrusive symptoms of PTSD were identified as the strongest correlates of PTG. Results suggest that prevention and treatment efforts to mitigate severe PTSD symptoms, and help promote intrinsic religiosity, and more deliberate and organized rumination about traumatic experiences may help foster PTG in veterans.
Subject(s)
Posttraumatic Growth, Psychological , Resilience, Psychological , Stress Disorders, Post-Traumatic , Veterans , Humans , Veterans/psychology , Stress Disorders, Post-Traumatic/psychology , Surveys and QuestionnairesABSTRACT
Among veterans, availability of social support and histories of military sexual trauma (MST) and/or adverse childhood experiences (ACEs) are particularly salient correlates of homelessness. Using path analyses, we investigated whether social support (i.e., interpersonal social support and community integration) would at least partially account for the relationships of MST and ACEs with any lifetime homelessness in a large, nationally representative sample of veterans (N = 4069, 9.8% female). Interpersonal social support and community integration partially explained the relationship between ACEs and any lifetime homelessness. However, they did not mediate the relationship between MST and any lifetime homelessness. Female veterans also reported higher trauma rates and lower perceived social support than male counterparts during correlational analyses. These results reinforce existing literature on the importance of research and interventions tailored to veterans with low social support and integration. Results have potential to inform interventions and policy for veterans experiencing and/or at risk for homelessness.
Subject(s)
Adverse Childhood Experiences , Ill-Housed Persons , Veterans , Male , Humans , Female , Military Sexual Trauma , Social SupportABSTRACT
There are great and growing behavioral needs in the United States. The Department of Health and Human Services (HHS) already invests in many lines of research and services to address those needs. But there are opportunities for other federal agencies to provide investments as well. All federal agencies are now required to develop evidence-building plans, called Learning Agendas, per the Evidence-Based Policy Making Act. This commentary reviews the content of 2022-2026 Learning Agendas for priorities related to behavioral health across all U.S. federal agencies besides HHS. Across 4 other federal agencies and 2 cross-government plans, there are Learning Agenda priorities related to behavioral health. These priorities cover examining ways to expand access to mental health and substance use disorder treatment to veterans, Medicaid beneficiaries, and lesbian, gay, bisexual, transgender, and intersex individuals; and improving the social and emotional well-being of school children, veterans with disabilities, and veterans with military sexual trauma. Some important developing areas were not mentioned in any of the Learning Agendas, which are worth considering. These areas include new digital technologies and artificial intelligence for behavioral health, psychotropic agents, and the strong link between physical and mental health. To meet the behavioral health needs of the country, there are opportunities for inter-agency collaboration at the federal level to build evidence and incorporate new, important developments in behavioral health.
Subject(s)
Psychiatry , Veterans , Female , Child , United States , Humans , Artificial Intelligence , Policy Making , MedicaidABSTRACT
BACKGROUND: Older veterans involved in the criminal legal system (CLS) may have patterns of multimorbidity that place them at risk for poor health outcomes. OBJECTIVES: To estimate the prevalence of medical multimorbidity (≥2 chronic medical diseases), substance use disorders (SUDs), and mental illness among CLS-involved veterans aged 50 and older. RESEARCH DESIGN: Using Veterans Health Administration health records, we estimated the prevalence of mental illness, SUD, medical multimorbidity, and the co-occurrence of these conditions among veterans by CLS involvement as indicated by Veterans Justice Programs encounters. Multivariable logistic regression models assessed the association between CLS involvement, the odds for each condition, and the co-occurrence of conditions. SUBJECTS: Veterans aged 50 and older who received services at Veterans Health Administration facilities in 2019 (n=4,669,447). METHODS: Mental illness, SUD, medical multimorbidity. RESULTS: An estimated 0.5% (n=24,973) of veterans aged 50 and older had CLS involvement. For individual conditions, veterans with CLS involvement had a lower prevalence of medical multimorbidity compared with veterans without but had a higher prevalence of all mental illnesses and SUDs. After adjusting for demographic factors, CLS involvement remained associated with concurrent mental illness and SUD (adjusted odds ratio [aOR] 5.52, 95% CI=5.35-5.69), SUD and medical multimorbidity (aOR=2.09, 95% CI=2.04-2.15), mental illness and medical multimorbidity (aOR=1.04, 95% CI=1.01-1.06), and having all 3 simultaneously (aOR=2.42, 95% CI=2.35-2.49). CONCLUSIONS: Older veterans involved in the CLS are at high risk for co-occurring mental illness, SUDs, and medical multimorbidity, all of which require appropriate care and treatment. Integrated care rather than disease-specific care is imperative for this population.
Subject(s)
Criminals , Mental Disorders , Substance-Related Disorders , Veterans , Humans , Middle Aged , Aged , Multimorbidity , Mental Disorders/epidemiology , Substance-Related Disorders/epidemiology , Substance-Related Disorders/therapy , Chronic DiseaseABSTRACT
In 2011, the U.S. Department of Veterans Health (VA) implemented a homeless-tailored primary care medical home model called the Homeless Patient Aligned Care Teams (HPACTs). The impact of HPACTs on health and healthcare outcomes of veterans experiencing homelessness has not been adequately synthesized. This narrative review summarized peer-reviewed studies published in databases Ovid MEDLINE, Ovid EMBASE, and APA PsycInfo from 1946 to February 2022. Only original research studies that reported outcomes of the HPACT model were included in the review. Of 575 studies that were initially identified and screened, 26 studies met inclusion criteria and were included in this review. Included studies were categorized into studies that described the following: (1) early HPACT pilot implementation; (2) HPACT's association with service quality and utilization; and (3) specialized HPACT programs. Together, studies in this review suggest HPACT is associated with reductions in emergency department utilization and improvements in primary care utilization, engagement, and positive patient experiences; however, the methodological rigor of the included studies was low, and thus, these findings should only be considered preliminary. There is a need for randomized controlled trials assessing the impact of the PACT model on key outcomes of interest, as well as to determine whether the model is a viable way to manage healthcare for persons experiencing homelessness outside of the VA system.
Subject(s)
Ill-Housed Persons , Veterans , United States , Humans , United States Department of Veterans Affairs , Patient-Centered Care , Patient Care TeamABSTRACT
BACKGROUND: Homelessness is a major public health problem among U.S. military veterans. However, contemporary, population-based data on the prevalence, correlates, and mental health burden of homelessness among veterans are lacking. METHODS: Data were analyzed from the 2019-2020 National Health and Resilience in Veterans Study, a nationally representative survey of veterans (n = 4069). Analyses examined the prevalence and correlates of homelessness, as well as the independent associations between homelessness and current probable psychiatric conditions, suicidality, and functioning. RESULTS: The lifetime prevalence of homelessness was 10.2% (95% confidence interval 9.3-11.2). More than 8-of-10 veterans reported experiencing their first episode of homelessness following military service, with a mean of 10.6 years post-discharge until onset (s.d. = 12.6). Adverse childhood experiences (ACEs), cumulative trauma burden, current household income, younger age, and drug use disorder emerged as the strongest correlates of homelessness (49% of total explained variance). Veterans with a history of homelessness had elevated odds of lifetime suicide attempt, attempting suicide two or more times, and past-year suicide ideation [odd ratios (ORs) 1.3-3.1]. They also had higher rates of current probable posttraumatic stress disorder, major depressive, generalized anxiety, and drug use disorders (ORs 1.7-2.4); and scored lower on measures of mental, physical, cognitive, psychosocial functioning (d = 0.11-0.15). CONCLUSIONS: One in ten U.S. veterans has experienced homelessness, and these veterans represent a subpopulation at substantially heightened risk for poor mental health and suicide. ACEs were the strongest factor associated with homelessness, thus underscoring the importance of targeting early childhood adversities and their mental health consequences in prevention efforts for homelessness in this population.
Subject(s)
Depressive Disorder, Major , Ill-Housed Persons , Stress Disorders, Post-Traumatic , Substance-Related Disorders , Veterans , Child, Preschool , Humans , Veterans/psychology , Mental Health , Prevalence , Depressive Disorder, Major/epidemiology , Aftercare , Patient Discharge , Stress Disorders, Post-Traumatic/epidemiology , Suicidal Ideation , Substance-Related Disorders/epidemiologyABSTRACT
OBJECTIVE: To determine the current prevalence of perceived purpose in life (PIL) and its association with screening positive for mental disorders and suicidality in a nationally representative sample of predominantly older U.S. veterans. METHODS: Data were analyzed from the 2019-2020 National Health and Resilience in Veterans Study (N = 4,069; Mage = 62.2). Veterans were classified into three groups based on perceived PIL level (i.e., low, average, and high). Self-report assessments were administered to screen for mental disorders and suicidality. RESULTS: Most veterans endorsed average PIL (71.7%), while 16.0% endorsed low PIL and 12.4% endorsed high PIL. A "dose-response" association was observed between PIL and outcomes. High PIL was associated with 42%-94% reduced odds of screening positive for major depressive, generalized anxiety, posttraumatic stress, and substance use disorders, as well as suicide attempts, ideation, and future intent. CONCLUSION: Higher PIL is associated with lower odds of mental disorders and suicidality in U.S. veterans, underscoring the potential importance of interventions to bolster PIL in this population.