Homelessness following disability-related discharges from active duty military service in Afghanistan and Iraq
Homelessness following disability-related discharges from active duty military service in Afghanistan and Iraq
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DOI：
10.1016/j.dhjo.2017.03.003
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发表时间：
2017-10-01
影响因子：
4.5
通讯作者：
Gundlapalli, Adi V.
中科院分区：
文献类型：
--
作者：
Fargo, Jamison D.;Brignone, Emily;Gundlapalli, Adi V.
背景资料：美国退伍军人中与兵役相关的残疾、医疗保健福利、心理健康障碍和部署后无家可归之间的关系的许多动态尚未得到很好的理解。目标：确定退伍军人与残疾有关的退伍军人是否有更高的无家可归的风险，退伍军人健康管理局（VHA）的服务连接残疾福利是否减轻了这种风险，以及是否与出院类型，服务相关的残疾，或它们之间的相互作用的风险变化作为一个功能的心理健康disorders.Methods：回顾性队列研究的364,997退伍军人与残疾相关或常规放电和初始VHA遇到2005年和2013年之间。Logistic回归和生存分析被用来估计无家可归的风险作为一个功能的放电状态，精神健康障碍，并收到VHA disability benefits.Results：残疾出院退伍军人有较高的无家可归率相比，常规放电（15.1对9.1每1000人年的风险）。在第一次遇到VHA时，心理健康障碍与残疾退伍军人中无家可归的风险差异较大，相对于那些有常规放电。在VHA服务使用的第一年，更高水平的残疾福利是防止无家可归的退伍军人，但不是残疾退伍军人。5年，残疾放电是无家可归的危险因素（AOR = 1.30）。结论：在长期，残疾放电是无家可归的独立危险因素。虽然VHA残疾福利有助于减轻退伍军人在重返社会初期无家可归的风险，但它们可能无法为残疾退伍军人提供足够的保护。(C)2017爱思唯尔公司All rights reserved.
Background: Many dynamics in the relationship among military service-related disabilities, health care benefits, mental health disorders, and post-deployment homelessness among US Veterans are not well understood.Objectives: Determine whether Veterans with a disability-related discharge from military service are at higher risk for homelessness, whether Veterans Health Administration (VHA) service-connected disability benefits mitigates that risk, and whether risks associated with discharge type, service-connected disability, or the interaction between them vary as a function of mental health disorders.Methods: Retrospective cohort study of 364,997 Veterans with a disability-related or routine discharge and initial VHA encounter between 2005 and 2013. Logistic regression and survival analyses were used to estimate homelessness risk as a function of discharge status, mental health disorders, and receipt of VHA disability benefits.Results: Disability-discharged Veterans had higher rates of homelessness compared to routine discharges (15.1 verses 9.1 per 1000 person-years at risk). At the time of the first VHA encounter, mental health disorders were associated with differentially greater risk for homelessness among Veterans with a disability discharge relative to those with a routine discharge. During the first year of VHA service usage, higher levels of disability benefits were protective against homelessness among routinely-discharged Veterans, but not among disability-discharged Veterans. By 5-years, disability discharge was a risk factor for homelessness (AOR = 1.30).Conclusions: In the long-term, disability discharge is an independent risk factor for homelessness. While VHA disability benefits help mitigate homelessness risk among routinely-discharged Veterans during the early reintegration period, they may not offer sufficient protection for disability-discharged Veterans. (C) 2017 Elsevier Inc. All rights reserved.