Abstract
BACKGROUND: The work of addressing veteran homelessness has largely been focused on veterans who are already homeless. OBJECTIVES: This study aimed to identify factors that can be targeted upstream before military personnel leave the military to prevent veteran homelessness during the critical transition from active duty to civilian life. DESIGN: Data were analyzed from a 2001 to 2014 longitudinal cohort study of 418 624 post-9/11 veterans who entered Veterans Affairs (VA) healthcare after leaving the military. METHODS: Department of Defense (DoD) data on clinical diagnoses, demographics, and military history were linked to VA data on homelessness and neighborhood of residence. RESULTS: Homelessness in the 2 years after military discharge was associated with residing in a socioeconomically disadvantaged neighborhood after discharge as well as with younger age; Black race; and diagnoses of substance use disorder (SUD), serious mental illness (SMI), and personality disorder. Veterans with co-occurring SUD, SMI, and personality disorder had 5 times higher incidence of homelessness than veterans with none of these diagnoses, with rates most elevated among veterans residing in disadvantaged neighborhoods. LIMITATIONS AND CONCLUSION: Several limitations include potential for missed cases of homelessness due to the use of medical records and lack of generalizability as note all veterans utilize VA services. Nevertheless, this large-sample, longitudinal sampling frame revealed critical environment-level and individual-level risk factors predicting homelessness after military separation that can be addressed proactively by policy and programs aimed at improving community reintegration of veterans transitioning to civilian life.