Study Compares Characteristics and Outcomes between Homeless Male and Female Veterans

BACKGROUND:
Women are the fastest growing segment of the Veteran population, and an alarming proportion are becoming homeless. Over the last two decades, VA has dramatically increased funding for a variety of homeless services. VA's main supported housing program is the Housing and Urban Development-Veterans Affairs Supportive Housing (HUD-VASH) program. This study examined a recent national sample of homeless Veterans in the HUD-VASH program to report differences between homeless male and female Veterans on individual characteristics at referral, as well as housing and clinical outcomes over a one-year period after program admission. Using VA data, investigators identified 43,853 homeless Veterans (4,686 women and 39,167 men) referred to the HUD-VASH program from January 2008 to April 2011. Not all Veterans referred were admitted to HUD-VASH, and there was considerable attrition over time. Over a one-year period, study outcome analyses were conducted on 29,203 Veterans admitted to the program. Measures included: demographics, recent housing history, medical conditions (i.e., oral/dental, hypertension, liver disease, diabetes, and traumatic brain injury), and psychiatric diagnoses (i.e., substance use disorder, PTSD, and psychotic disorder).

FINDINGS:

• Among Veterans who stayed in the program, adjusting for socio-demographic characteristics, there were no gender differences in housing outcomes over time, except females tended to stay more nights in someone else's place, while males stayed more nights in transitional housing.
• There were several unique characteristics of homeless female Veterans at referral as compared to homeless male Veterans. Homeless female Veterans were younger, more likely to have recently served in the military, had shorter homeless histories, were less likely to have been incarcerated, and were less likely to have alcohol and drug use disorders.
• Despite being less likely to report combat exposure, female Veterans were more likely to have PTSD than male Veterans. Homeless female Veterans also were much more likely to have dependent children with them, and to plan to live with family members in supported housing.
• For all Veterans, it took an average of over 40 days to be admitted to HUD-VASH after referral, an average of over 40 days to obtain a voucher after being admitted, and then an average of more than 50 days to sign a lease after obtaining a voucher. There were no significant gender differences in process times, except that female Veterans were admitted an average of 10 days sooner after program referral than male Veterans.

LIMITATIONS:

• This study was based on administrative data, and medical and psychiatric diagnoses relied on the clinical judgment of referring clinicians so their validity cannot be confirmed.

AUTHOR/FUNDING INFORMATION:
Dr. Tsai was supported by an HSR&D Career Development Award. Drs. Tsai and Rosenheck are part of VA's New England Mental Illness Research, Education, and Clinical Center and Drs. Tsai, Rosenheck, and Mr. Kane are affiliated with the National Center on Homelessness among Veterans.

Tsai J, Rosenheck R, and Kane V. Homeless Female U.S. Veterans in a National Supported Housing Program: Comparison of Individual Characteristics and Outcomes with Male Veterans. Psychological Services April 14, 2014;e-pub ahead of print.