Abstract

“Evidence has suggested increased risk for homelessness and suicide among veterans, but little is known about the associations between housing instability and psychological distress (including suicidal ideation). We examine frequent mental distress (FMD) and suicidal ideation among a probability-based sample of 1,767 Nebraska veterans who participated in the 2010 Behavioral Risk Factor Surveillance Survey who had and had not experienced housing instability in the past 12 months. Veterans experiencing housing instability had increased odds of FMD and suicidal ideation.”

Implications

For Practice

This study has several practical implications for veterans, veteran advocates, and both VA-affiliated and non-VA affiliated practitioners. Practitioners should be aware of the high rate of suicidal ideation among homeless veterans and monitor any homeless veterans under their care to ensure they are not under mental distress. Contrary to prior research that reports older veterans with a higher prevalence of suicidal ideation, this study reports that younger, female, and unmarried veterans have a higher prevalence of suicidal ideation. While continuing to watch for signs of mental distress among older veterans, practitioners should also watch for signs of mental distress among younger veterans, especially unmarried women veterans. Veterans should be proactive in sharing in mental health concerns with their healthcare provider(s) so that veterans can receive any care they need. Veteran advocates should understand the connection between financial instability, mental distress and suicidal ideation for veterans, keeping in mind that housing instability does not just affect older, male veterans. Community service providers should partner with community health providers to ensure that veterans are receiving any psychiatric support they might need. Providers working with veterans should be aware of housing statuses among veterans and seek ways to secure stable housing for veterans, including through the use of referrals.

For Policy

The VA has implemented a preventative public health initiative to screen all veterans eligible for VA health care for pending risk of homelessness and connected them with community support services. Additionally, the VA is campaigning to increase the focus placed on suicide and homelessness among veteran populations. The VA and community health centers and hospitals might form partnerships to ensure that all the mental health needs of their veterans are being met. Policymakers might investigate ways to ensure that the mental health and housing needs of veterans not being seen by VA are still addressed. Policymakers could increase the implementation of programs targeted at the mental health and housing needs of female and younger veterans, such as creating gender-specific transitional housing. Policy makers might continue to support policies that are aimed at providing housing assistance, reduced housing costs, and financial assistance to reduce housing instability and homelessness, thereby reducing mental distress and suicidal ideation.

For Future Research

This study is the first of its kind to analyze the impact of financial strain on housing instability among veterans. A limitation of this study is that the data is from one state, Nebraska, and has a relatively small sample (N=1,767). Future researchers should utilize a larger sample size, which is nationally representative to allow for generalizability of results. The data in this study is cross-sectional with reference period likely occurring at differing variables such as past 30 days, past 12 months, and lifetime. Future researchers should also consider using a longitudinal dataset, as use of a longitudinal dataset would allow for the examination of causality and temporal relationships among the variables. Further research is needed to understand the impact of other aspects of housing instability, such as frequent moves, employment status, and/or substance abuse. For example, this study paired suicidal ideation and mental distress with homelessness and housing instability but suicidal ideation and mental distress could occur as a result of substance abuse and/ or employment status. Finally, while there has been research about DoD and VA efforts to prevent homelessness and psychological distress among veterans, additional research into independent efforts devoted to suicide prevention and homelessness may discover innovative partnerships that enhance safety and improve the quality of life for at-risk veterans.