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Delayed Homelessness After Military Discharge: Examination of a Sleeper Effect

  • Jack Tsai
    Correspondence
    Address correspondence to: Jack Tsai, PhD, UTHealth School of Public Health SARC, 7411 John Smith Drive, Suite 1100, San Antonio TX 78229.
    Affiliations
    U.S. Department of Veterans Affairs, National Center on Homelessness Among Veterans, Tampa, Florida

    School of Public Health, University of Texas Health Science Center at Houston, San Antonio Campus, San Antonio, Texas

    Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
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  • Dorota Szymkowiak
    Affiliations
    U.S. Department of Veterans Affairs, National Center on Homelessness Among Veterans, Tampa, Florida
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  • Robert H. Pietrzak
    Affiliations
    Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut

    U.S. Department of Veterans Affairs, Clinical Neurosciences Division, National Center for Posttraumatic Stress Disorder, West Haven, Connecticut
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      Introduction

      Addressing veteran homelessness is a major federal priority, but there has been little research on the period between military discharge and homelessness. There are public concerns about new waves of homelessness among recent veterans and questions about a possible sleeper effect, that is, a delayed risk that becomes stronger with time.

      Methods

      Data from 2 national samples were analyzed: Department of Veterans Affairs administrative records of a population-based sample of 275,775 homeless Department of Veterans Affairs service users in 2000–2019 and a nationally representative community survey of 115 veterans with a history of homelessness conducted in 2018.

      Results

      In the Department of Veterans Affairs sample, the average time between discharge and homelessness was 5.5 (SD=4.2) years. In the community veteran sample, the average time between discharge and homelessness was 9.9 (SD=10.5) years. Service in Iraq and Afghanistan was significantly associated with shorter duration between discharge and homelessness. Service in Vietnam, younger age at military discharge, more chronic medical conditions, depression, and alcohol use problems were associated with longer interval between discharge and homelessness. Among homeless service users who were discharged from 2000 to 2003, the rate of homelessness doubled between 10 and 15 years after discharge. Similarly, among those discharged from 2009 to 2013, the rate of homelessness more than doubled between 2 and 5 years after discharge.

      Conclusions

      There appears to be a sleeper effect in veteran homelessness after military discharge. The primary and secondary preventions focused on chronic health conditions, and social adjustment may be needed to address homelessness among recent veterans.
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