Differential risk for homelessness among US male and female veterans with a positive screen for military sexual trauma

Importance: Military sexual trauma (MST) is associated with adverse physical and mental health outcomes following military separation. Recent research suggests that MSTmay be a determinant in several factors associated with postdeployment homelessness. Objective: To evaluate MST as an independent risk factor for homelessness and to determine whether risk varies by sex. Design, Setting and Participants: A retrospective cohort study of US veterans who used Veterans Health Administration (VHA) services between fiscal years 2004 and 2013 was conducted using administrative data from the Department of Defense and VHA. Included in the study were 601 892 US veterans deployed in Iraq or Afghanistan who separated from the military between fiscal years 2001 and 2011 and subsequently used VHA services. Exposure: Positive response to screen forMST administered in VHA facilities. Main Outcomes and Measures: Administrative evidence of homelessness within 30 days, 1 year, and 5 years following the first VHA encounter after last deployment. Results The mean (SD) age of the 601 892 participants was 38.9 (9.4) years, 527 874 (87.7%) were male, 310 854 (51.6%) were white, and 382 361 (63.5%) were enlisted in the Army. Among veterans with a positive screen forMST, rates of homelessness were 1.6% within 30 days, 4.4%within 1 year, and 9.6%within 5 years, more than double the rates of veterans with a negativeMST screen (0.7%, 1.8%, and 4.3%, respectively). A positive screen forMST was significantly and independently associated with postdeployment homelessness. In regression models adjusted for demographic and military service characteristics, odds of experiencing homelessness were higher among those who screened positive for MST compared with those who screened negative (30-day: adjusted odds ratio [AOR], 1.89; 95% CI, 1.58-2.24; 1-year: AOR, 2.27; 95%CI, 2.04-2.53; and 5-year: AOR, 2.63; 95%CI, 2.36-2.93). Military sexual trauma screen status remained independently associated with homelessness after adjusting for co-occurring mental health and substance abuse diagnoses in follow-up regression models (30-day: AOR, 1.62; 95%CI, 1.36-1.93; 1-year: AOR, 1.49; 95%CI, 1.33-1.66; and 5-year: AOR, 1.39; 95%CI, 1.24-1.55). In the fully adjusted models, the interaction between MST status and sex was significant in the 30-day and 1-year cohorts (30-day: AOR, 1.54; 95%CI, 1.18-2.02; and 1-year: AOR, 1.46; 95%CI, 1.23-1.74), denoting higher risk for homelessness among males with a positive screen forMST. Conclusions And Relevance: A positive screen forMST was independently associated with postdeployment homelessness, with male veterans at greater risk than female veterans. These results underscore the importance of the MST screen as a clinically important marker of reintegration outcomes among veterans. These findings demonstrate significant long-term negative effects and inform our understanding of the public health implications of sexual abuse and harassment.