Military Sexual Trauma Linked to Homelessness

Nancy A. Melville

April 25, 2016

Veterans who report experiencing sexual trauma while in the military have more than twice the rate of postdeployment homelessness than their counterparts who have not experienced such trauma, with the risk higher in men, new research shows.

"These results underscore the relevance of the military sexual screen as a marker of clinical and prognostic significance regarding reintegration outcomes and emphasize the importance of trauma-informed care and trauma-specific interventions for veterans with a positive screen for military sexual trauma," the authors, led by Adi V. Gundlapalli, MD, PhD, of the Informatics, Decision Enhancement, and Analytic Sciences Center, the VA Salt Lake City Health Care System, Utah, write.

The study was published online April 20 in JAMA Psychiatry.

Homeless 30 Days Post Deployment

Veterans are known to be overrepresented in the homeless population in the United States. Unlike the general homeless population, screening results are available for most who used the services of the Veterans Health Administration (VHA), regardless of treatment-seeking behaviors, allowing for a closer look at the possible characteristics associated with homelessness.

With some preliminary research linking military sexual trauma with homelessness, the investigators evaluated data on 603,495 US veterans who were deployed in Iraq or Afghanistan, who were separated from the military between the fiscal years 2001 and 2011, and who subsequently used VHA services.

The screening for military sexual trauma consists of the following questions: "While you were in the military:

  • Did you receive uninvited and unwanted sexual attention, such as touching, cornering, pressure for sexual favors, or verbal remarks?

  • Did someone ever use force or threat of force to have sexual contact with you against your will?"

Among the 603,495 screened veterans evaluated in the study, 1076 declined to respond, 583,822 responded negatively, and 18,597 responded positively to the questions concerning military sexual trauma.

The homelessness evaluation cohort consisted of 601,892 veterans in the 30-day cohort, 590,989 in the 1-year cohort, and 262,589 in the 5-year cohort. The mean age of the veterans in the study was 38.9 years; 87.7% were male; about half were white; and 63.5% were enlisted in the Army.

Of those who reported having experienced military sexual trauma, rates of homelessness were 1.6% within 30 days, 4.4% within 1 year, and 9.6% within 5 years, significantly higher than corresponding rates of those who did not experience military sexual trauma (0.7%, 1.8%, and 4.3%, respectively).

After adjusting for co-occurring mental health and substance abuse disorders, military sexual trauma remained independently associated with homelessness, adjusted odds ratios (AORs) of homelessness within 30 days of 1.62 (95% confidence interval [CI], 1.36 - 1.93); at 1 year, 1.49 (95% CI, 1.33 - 1.66); and at 5 years, 1.39 (95% CI, 1.24 - 1.55).

"Positive military sexual trauma screen status was associated with homelessness as early as 30 days after the first VHA encounter and continued to be associated with homelessness through the end of follow-up at 5 years, indicating that military sexual trauma affects both immediate and long-term reintegration outcomes," the authors note.

Fully adjusted models also showed the association between military sexual trauma and postdeployment homelessness to be higher among men than women (11.8% vs 8.9% at 5 years).

The findings are consistent with previous research suggesting that women are more likely to access mental health treatment following a report of military sexual trauma then men, the authors note.

"In addition to the burden of issues regarding masculinity, sexuality, and self-concept among males who have experienced sexual trauma, sex differences in risk for homelessness conferred by military sexual status may relate to differences in treatment-seeking behaviors following a positive screen."

In women and men alike, however, military sexual trauma and other postdeployment mental health disorders can result in a variety of negative effects, including poorer interpersonal relationships, less social support, and greater medical problems and run-ins with the criminal justice system, that could contribute to financial instability, and consequently housing instability, the authors write.

"Given these linkages, positive military sexual trauma status may represent a single data point that serves as an important marker for potential challenges to successful community reintegration, with postdeployment homelessness as an extreme case of poor reintegration," they add.

They note that the study is the first to show that the negative effects of military sexual trauma extend to potential homelessness.

"To our knowledge, this study is the first to evaluate exposure to military sexual trauma, as indicated by a positive screen in VHA data, as an independent risk factor for postdeployment homelessness among a large national sample of US veterans and the first to examine the differential risk for homelessness due to military sexual trauma exposure by sex."

Risk Identification

In an editorial published in conjunction with the study, Natalie Mota, PhD, of the Department of Clinical Health Psychology, at the University of Manitoba, Winnipeg, Canada, said the findings parallel a previous study that Dr Mota and colleagues published showing a strong association between childhood adversity and adult homelessness.

"It may be important for future work to study the association of military sexual trauma with homelessness risk in veterans directly and interactively with sociodemographic characteristics, other trauma exposures (eg, childhood abuse), psychiatric disorders, and other relevant factors," they write.

They add that the new study underscores the need to identify veterans at risk and work to prevent military sexual trauma from occurring in the first place.

"Taken together, results of this study highlight the importance of including military sexual trauma in theoretical models of postdeployment homelessness, of considering sex differences in the risk for homelessness in veterans, of promoting prevention and early intervention efforts for military sexual trauma and associated mental health difficulties, and of facilitating access to secure housing for those veterans in need," they write.

JAMA Psychiatry. Published online April 20, 2016. Abstract, Editorial

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