Examining Veterans’ Health Behaviors After Homelessness: A Brief Review Review
Main Article Content
Keywords
permanent supportive housing, health, outcomes
Abstract
Introduction: Veterans with a history of homelessness are at greater risk of developing chronic medical and mental health conditions than veterans who have never been homeless. Further, these veterans have a higher risk of suicide. Interventions aimed at improving housing stability may reduce adverse health outcomes. Eligible veterans can transition into permanent supportive housing (PSH), which provides housing support and case management services for individuals who are chronically homeless. However, after moving into PSH, veterans may not engage in health behaviors, which may lead to poor health management and reduced life expectancy.
Methods: This brief review was not systematic, but rather a targeted thematic review with the primary aim of analyzing themes related to the effects of living in PSH on veterans’ health behaviors. A secondary aim was to review the literature and government reports about suicidality among veterans with a history of homelessness for broader implications. Ten articles were included in the analysis, representing 87,263 veterans.
Results: The impact of homelessness on veterans' health is substantial. Veterans who have experienced homelessness are diagnosed with more chronic health conditions and have significantly higher rates of mental health challenges compared to veterans with no history of homelessness. Although access to health care and mental health support improved after moving into PSH, the long-term health outcomes are still uncertain.
Conclusions: PSH is a protective factor that positively impacts the health behaviors of formerly homeless veterans. Barriers within PSH include securing affordable housing units, access to transportation, and frequent turnover among case managers. To improve veterans' health behaviors and quality of life following homelessness, providers and staff who support veterans living in PSH should provide opportunities for social engagement, establish primary care providers, and foster positive relationships.
References
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7. Dunne EM, Burrell LE, 2nd, Diggins AD, Whitehead NE, Latimer WW. Increased risk for substance use and health-related problems among homeless veterans. The American Journal on Addiction. Oct 2015;24(7):676-80. doi:10.1111/ajad.12289
8. Brignone E, Gundlapalli AV, Blais RK, et al. Differential risk for homelessness among us male and female veterans with a positive screen for military sexual trauma. JAMA Psychiatry. 2016;73(6):582. doi:10.1001/jamapsychiatry.2016.0101
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20. Mcginnis JM, Williams-Russo P, Knickman JR. The case for more active policy attention to health promotion. Health Affairs. 2002;21(2):78-93.
21. Gabrielian S, Yuan AH, Andersen RM, Gelberg L. Diagnoses treated in ambulatory care among homeless-experienced veterans: Does supported housing matter? Journal of Primary Care & Community Health. Oct 2016;7(4):281-7. doi:10.1177/2150131916656009
22. Cusack M, Montgomery AE. Barriers and facilitators to housing access and maintenance in hud-vash: Participant and staff perspectives. Social Work in Health Care. Jul 2018;57(6):422-439. doi:10.1080/00981389.2018.1441213
23. Harris T, Winetrobe H, Rhoades H, Castro CA, Wenzel S. Moving beyond housing: Service implications for veterans entering permanent supportive housing. Clinical Social Work Journal. 2018;46(2):130-144. doi:10.1007/s10615-018-0648-7
24. Chinchilla M, Gabrielian S, Hellemann G, Glasmeier A, Green M. Determinants of community integration among formerly homeless veterans who received supportive housing. Frontiers in Psychiatry. 2019;10doi:10.3389/fpsyt.2019.00472
25. Tsai J, Byrne TH. National utilization patterns of veterans affairs homelessness programs in the era of housing first. Psychiatric Services. 2019;70(4):309-315. doi:10.1176/appi.ps.201800393
26. Tsai J, Gelberg L, Rosenheck RA. Changes in physical health after supported housing: Results from the collaborative initiative to end chronic homelessness. J Gen Intern Med. Sep 2019;34(9):1703-1708. doi:10.1007/s11606-019-05070-y
27. Montgomery AE, Szymkowiak D, Cusack MC, et al. Veterans' assignment to single-site versus scattered-site permanent supportive housing. Am J Orthopsychiatry. 2020;90(1):37-47. doi:10.1037/ort0000380
28. Wong MS, Gabrielian S, Lynch KE, et al. Healthcare service utilization for formerly homeless veterans in permanent supportive housing: Do neighborhoods matter? Psychol Serv. Aug 2022;19(3):471-479. doi:10.1037/ser0000561
29. Varley AL, Hoge A, Riggs KR, et al. What do Veterans with homeless experience want us to know that we are not asking? A qualitative content analysis of comments from a national survey of healthcare experience. Health Soc Care Community. Nov 2022;30(6):e5027-e5037. doi:10.1111/hsc.13918
30. Belon AP, Nieuwendyk LM, Vallianatos H, Nykiforuk CI. How community environment shapes physical activity: Perceptions revealed through the PhotoVoice method. Social Science & Medicine. 2014;116:10-21. doi:10.1016/j.socscimed.2014.06.027
31. U.S. Department of Health and Human Services. Social determinants of health. U.S. Department of Health and Human Services. https://odphp.health.gov/healthypeople/priority-areas/social-determinants-health
32. Kerman N, Sylvestre J. Surviving versus living life: Capabilities and service use among adults with mental health problems and histories of homelessness. Health & Social Care in the Community. 2020;28(2):414-422. doi:10.1111/hsc.12873
33. Fine DR, Joyce A, Chang Y, et al. Health care utilization among homeless-experienced adults who were seen by a mobile addiction health clinic in Boston, Massachusetts: A quasi-experimental study. Substance Use & Misuse. 2023;58(9):1115-1120. doi:10.1080/10826084.2023.2212279
34. U.S. Department of Veterans Affairs. Health care for homeless veterans: FAQs. U.S. Department of Veterans Affairs. https://www.va.gov/HOMELESS/HCHV_FAQS.asp
35. U.S. Department of Veterans Affairs. Homeless patient aligned care team (HPACT). 2023, October. https://www.va.gov/HOMELESS/docs/HPACT_Fact_Sheet_FY24-25_508c.pdf
36. U.S. Department of Veterans Affairs. VA launches mobile medical units to increase access to health care for homeless veterans. U.S. Department of Veterans Affairs. https://news.va.gov/press-room/va-launches-mobile-medical-units-to-increase-access-to-health-care-for-homeless-veterans/
37. Byrne T, Tsai J. An analysis of returns to homelessness among veterans exiting VA homeless programs to permanent housing. 2023, June. https://www.va.gov/homeless/docs/An-Analysis-of-Returns-to-Homelessness-among-Veterans-Exiting-A-Homeless-Programs-to-Permanent-Housing_508c.pdf
38. Hoffberg AS, Spitzer E, Mackelprang JL, Farro SA, Brenner LA. Suicidal self-directed violence among homeless US veterans: A systematic review. Suicide and Life Threatening Behavior. Aug 2018;48(4):481-498. doi:10.1111/sltb.12369
39. U.S. Department of Veterans Affairs. 2023 national veteran suicide prevention annual report. 2023, November. https://www.mentalhealth.va.gov/docs/data-sheets/2023/2023-National-Veteran-Suicide-Prevention-Annual-Report-FINAL-508.pdf
40. Armoon B, Griffiths MD, Mohammadi R, Ahounbar E. Suicidal behaviors and risk taking among homeless individuals: A systematic review and meta-analysis. Community Mental Health Journal. Oct 2023;59(7):1283-1299. doi:10.1007/s10597-023-01111-3
41. Holliday R, Liu S, Brenner LA, et al. Preventing suicide among homeless veterans: A consensus statement by the Veterans Affairs suicide prevention among veterans experiencing homelessness workgroup. Medical Care. 2021;59(4)(2):S103-S105. doi:10.1097/MLR.0000000000001399
42. Bahraini N, Brenner LA, Barry C, et al. Assessment of rates of suicide risk screening and prevalence of positive screening results among US veterans after implementation of the Veterans Affairs Suicide Risk Identification Strategy. JAMA Network Open. 2020;3(10):e2022531. doi:10.1001/jamanetworkopen.2020.22531
43. U.S. Dept of Veterans Affairs, U.S. Dept of Defense. VA/DoD Clinical Practice Guideline for Assessment and Management of Patients at Risk for Suicide. 2024. https://www.healthquality.va.gov/guidelines/MH/srb/VADoD-CPG-Suicide-Risk-Full-CPG-2024_Final_508.pdf
44. Kline AC, Panza KE, Nichter B, et al. Mental health care use among U.S. military veterans: Results from the 2019-2020 national health and resilience in veterans study. Psychiatr Serv. Jun 2022;73(6):628-635. doi:10.1176/appi.ps.202100112
45. Karel MJ, Wray LO, Adler G, et al. Mental health needs of aging veterans: Recent evidence and clinical recommendations. Clinical Gerontologist. Mar-Apr 2022;45(2):252-271. doi:10.1080/07317115.2020.1716910
46. Rasmussen KA, King DA, Gould MS, et al. Concerns of older veteran callers to the veterans crisis line. Suicide and Life Threatening Behavior. Aug 2017;47(4):387-397. doi:10.1111/sltb.12313
47. U.S. Dept of Housing and Urban Development. Evaluating public housing agency challenges with the HUD Veterans Affairs supportive housing program. 2021, November 30. https://www.oversight.gov/sites/default/files/oig-reports/HUD/2022-LA-0801.pdf
48. Diaz M. VA Homeless Programs: The growing crisis of aging veterans. U.S. Dept of Veterans Affairs. https://www.va.gov/HOMELESS/featuredarticles/aging-homeless-veterans.asp
49. Bensken WP, Krieger NI, Berg KA, Einstadter D, Dalton JE, Perzynski AT. Health status and chronic disease burden of the homeless population: An analysis of two decades of multi-institutional electronic medical records. Journal of Health Care for the Poor and Underserved. 2021;32(3):1619-1634.
50. Trejos Saucedo RR, Salazar Marchan CY, Linkowski L, Hall S, Menezes L. Homelessness in urban communities in the US: A scoping review utilizing the Socio-Ecological Model. Florida Public Health Review. 2022;19(3)
51. Subedi K, Ghimire S. Comorbidity profiles of patients experiencing homelessness: A latent class analysis. PLOS ONE. 2022;17(5):e0268841. doi:10.1371/journal.pone.0268841
52. Nichter B, Tsai J, Pietrzak RH. Prevalence, correlates, and mental health burden associated with homelessness in U.S. military veterans. Psychol Med. Jul 2023;53(9):3952-3962. doi:10.1017/S0033291722000617
53. Wisco BE, Marx BP, Holowka DW, et al. Traumatic brain injury, PTSD, and current suicidal ideation among Iraq and Afghanistan U.S. veterans. Journal of Traumatic Stress. Apr 2014;27(2):244-8. doi:10.1002/jts.21900
54. Meffert BN, Morabito DM, Sawicki DA, et al. US veterans who do and do not utilize Veterans Affairs health care services. The Primary Care Companion For CNS Disorders. 2019;21(1)doi:10.4088/pcc.18m02350
2. Fargo J, Metraux S, Byrne T, Munley E, Montgomery AE, Jones H. Prevalence and risk of homelessness among US veterans. Preventing Chronic Disease. 2012;9:110112. doi:10.5888/pcd9.110112
3. Gundlapalli A, Jones AL, Redd A, et al. Characteristics of the highest users of emergency services in veterans affairs hospitals: Homeless and non-homeless. Studies in Health Technology & Informatics. 2017;238:24-27. doi:10.3233/978-1-61499-781-8-24
4. Tsai J, Rosenheck RA. Risk factors for homelessness among US veterans. Epidemiologic Reviews. 2015;37(1):177-195. doi:10.1093/epirev/mxu004
5. U.S. Dept of Housing and Urban Development, Office of Community Planning and Development. The 2024 Annual Homelessness Assessment Report (AHAR) to Congress: Part 1: Point-in-Time Estimates of Homelessness. 2024, December. https://www.huduser.gov/portal/sites/default/files/pdf/2024-AHAR-Part-1.pdf
6. Metraux S, Clegg LX, Daigh JD, Culhane DP, Kane V. Risk factors for becoming homeless among a cohort of veterans who served in the era of the Iraq and Afghanistan conflicts. Am J Public Health. Dec 2013;103 Suppl 2(Suppl 2):S255-61. doi:10.2105/AJPH.2013.301432
7. Dunne EM, Burrell LE, 2nd, Diggins AD, Whitehead NE, Latimer WW. Increased risk for substance use and health-related problems among homeless veterans. The American Journal on Addiction. Oct 2015;24(7):676-80. doi:10.1111/ajad.12289
8. Brignone E, Gundlapalli AV, Blais RK, et al. Differential risk for homelessness among us male and female veterans with a positive screen for military sexual trauma. JAMA Psychiatry. 2016;73(6):582. doi:10.1001/jamapsychiatry.2016.0101
9. Factors associated with homelessness among US veterans: A systematic review (Office of Research and Development, Department of Veterans Affairs) (2023).
10. U.S. Dept of Veterans Affairs. Homelessness. Office of Research and Development. https://www.research.va.gov/topics/homelessness.cfm
11. U.S. Dept of Veterans Affairs. VA homeless programs. https://www.va.gov/HOMELESS/faqs.asp#accordion-at-risk
12. U.S. Dept of Veterans Affairs. Occupational therapy services in homeless programs: An innovative practice in VHA homeless program operations. https://www.efaidnbmnnnibpcajpcglclefindmkaj/https://www.va.gov/HOMELESS/docs/White-Paper-Occupational-Therapy-in-Homeless-Services-FINAL.pdf
13. U.S. Dept of Veterans Affairs. Veterans Health Administration (VHA) Homeless Programs Office (HPO). Office of Public Affairs Media Relations. https://www.va.gov/HOMELESS/docs/HPO-General-Fact-Sheet-FY-2020-4-5-2021.pdf
14. U.S. Dept of Veterans Affairs. Occupational therapy (OT). https://www.rehab.va.gov/pmrs/Occupational_Therapy.asp#:~:text=VHA%20is%20the%20single%20largest,and%20certified%20occupational%20therapy%20assistants
15. Winer M, Dunlap S, St. Pierre C, McInnes DK, Schutt R. Housing and social connection: Older formerly homeless veterans living in subsidized housing and receiving supportive services. Clinical Gerontologist. 2021;44(4):460-469. doi:10.1080/07317115.2021.1879336
16. National Alliance to End Homelessness statement on declines in veteran homelessness. 2022, November 4. https://endhomelessness.org/wp-content/uploads/2022/11/2022-Veteran-Statement-Final-110422.pdf
17. U.S. Dept of Veterans Affairs. The State of Veteran Homelessness 2024. 2024. https://www.va.gov/HOMELESS/docs/The-State-of-Veteran-Homelessness-2024.pdf
18. Short SE, Mollborn S. Social determinants and health behaviors: Conceptual frames and empirical advances. Current Opinion in Psychology. 2015;5:78-84. doi:10.1016/j.copsyc.2015.05.002
19. Fazel S, Geddes JR, Kushel M. The health of homeless people in high-income countries: Descriptive epidemiology, health consequences, and clinical and policy recommendations. The Lancet. 2014;384(9953):1529-1540. doi:10.1016/s0140-6736(14)61132-6
20. Mcginnis JM, Williams-Russo P, Knickman JR. The case for more active policy attention to health promotion. Health Affairs. 2002;21(2):78-93.
21. Gabrielian S, Yuan AH, Andersen RM, Gelberg L. Diagnoses treated in ambulatory care among homeless-experienced veterans: Does supported housing matter? Journal of Primary Care & Community Health. Oct 2016;7(4):281-7. doi:10.1177/2150131916656009
22. Cusack M, Montgomery AE. Barriers and facilitators to housing access and maintenance in hud-vash: Participant and staff perspectives. Social Work in Health Care. Jul 2018;57(6):422-439. doi:10.1080/00981389.2018.1441213
23. Harris T, Winetrobe H, Rhoades H, Castro CA, Wenzel S. Moving beyond housing: Service implications for veterans entering permanent supportive housing. Clinical Social Work Journal. 2018;46(2):130-144. doi:10.1007/s10615-018-0648-7
24. Chinchilla M, Gabrielian S, Hellemann G, Glasmeier A, Green M. Determinants of community integration among formerly homeless veterans who received supportive housing. Frontiers in Psychiatry. 2019;10doi:10.3389/fpsyt.2019.00472
25. Tsai J, Byrne TH. National utilization patterns of veterans affairs homelessness programs in the era of housing first. Psychiatric Services. 2019;70(4):309-315. doi:10.1176/appi.ps.201800393
26. Tsai J, Gelberg L, Rosenheck RA. Changes in physical health after supported housing: Results from the collaborative initiative to end chronic homelessness. J Gen Intern Med. Sep 2019;34(9):1703-1708. doi:10.1007/s11606-019-05070-y
27. Montgomery AE, Szymkowiak D, Cusack MC, et al. Veterans' assignment to single-site versus scattered-site permanent supportive housing. Am J Orthopsychiatry. 2020;90(1):37-47. doi:10.1037/ort0000380
28. Wong MS, Gabrielian S, Lynch KE, et al. Healthcare service utilization for formerly homeless veterans in permanent supportive housing: Do neighborhoods matter? Psychol Serv. Aug 2022;19(3):471-479. doi:10.1037/ser0000561
29. Varley AL, Hoge A, Riggs KR, et al. What do Veterans with homeless experience want us to know that we are not asking? A qualitative content analysis of comments from a national survey of healthcare experience. Health Soc Care Community. Nov 2022;30(6):e5027-e5037. doi:10.1111/hsc.13918
30. Belon AP, Nieuwendyk LM, Vallianatos H, Nykiforuk CI. How community environment shapes physical activity: Perceptions revealed through the PhotoVoice method. Social Science & Medicine. 2014;116:10-21. doi:10.1016/j.socscimed.2014.06.027
31. U.S. Department of Health and Human Services. Social determinants of health. U.S. Department of Health and Human Services. https://odphp.health.gov/healthypeople/priority-areas/social-determinants-health
32. Kerman N, Sylvestre J. Surviving versus living life: Capabilities and service use among adults with mental health problems and histories of homelessness. Health & Social Care in the Community. 2020;28(2):414-422. doi:10.1111/hsc.12873
33. Fine DR, Joyce A, Chang Y, et al. Health care utilization among homeless-experienced adults who were seen by a mobile addiction health clinic in Boston, Massachusetts: A quasi-experimental study. Substance Use & Misuse. 2023;58(9):1115-1120. doi:10.1080/10826084.2023.2212279
34. U.S. Department of Veterans Affairs. Health care for homeless veterans: FAQs. U.S. Department of Veterans Affairs. https://www.va.gov/HOMELESS/HCHV_FAQS.asp
35. U.S. Department of Veterans Affairs. Homeless patient aligned care team (HPACT). 2023, October. https://www.va.gov/HOMELESS/docs/HPACT_Fact_Sheet_FY24-25_508c.pdf
36. U.S. Department of Veterans Affairs. VA launches mobile medical units to increase access to health care for homeless veterans. U.S. Department of Veterans Affairs. https://news.va.gov/press-room/va-launches-mobile-medical-units-to-increase-access-to-health-care-for-homeless-veterans/
37. Byrne T, Tsai J. An analysis of returns to homelessness among veterans exiting VA homeless programs to permanent housing. 2023, June. https://www.va.gov/homeless/docs/An-Analysis-of-Returns-to-Homelessness-among-Veterans-Exiting-A-Homeless-Programs-to-Permanent-Housing_508c.pdf
38. Hoffberg AS, Spitzer E, Mackelprang JL, Farro SA, Brenner LA. Suicidal self-directed violence among homeless US veterans: A systematic review. Suicide and Life Threatening Behavior. Aug 2018;48(4):481-498. doi:10.1111/sltb.12369
39. U.S. Department of Veterans Affairs. 2023 national veteran suicide prevention annual report. 2023, November. https://www.mentalhealth.va.gov/docs/data-sheets/2023/2023-National-Veteran-Suicide-Prevention-Annual-Report-FINAL-508.pdf
40. Armoon B, Griffiths MD, Mohammadi R, Ahounbar E. Suicidal behaviors and risk taking among homeless individuals: A systematic review and meta-analysis. Community Mental Health Journal. Oct 2023;59(7):1283-1299. doi:10.1007/s10597-023-01111-3
41. Holliday R, Liu S, Brenner LA, et al. Preventing suicide among homeless veterans: A consensus statement by the Veterans Affairs suicide prevention among veterans experiencing homelessness workgroup. Medical Care. 2021;59(4)(2):S103-S105. doi:10.1097/MLR.0000000000001399
42. Bahraini N, Brenner LA, Barry C, et al. Assessment of rates of suicide risk screening and prevalence of positive screening results among US veterans after implementation of the Veterans Affairs Suicide Risk Identification Strategy. JAMA Network Open. 2020;3(10):e2022531. doi:10.1001/jamanetworkopen.2020.22531
43. U.S. Dept of Veterans Affairs, U.S. Dept of Defense. VA/DoD Clinical Practice Guideline for Assessment and Management of Patients at Risk for Suicide. 2024. https://www.healthquality.va.gov/guidelines/MH/srb/VADoD-CPG-Suicide-Risk-Full-CPG-2024_Final_508.pdf
44. Kline AC, Panza KE, Nichter B, et al. Mental health care use among U.S. military veterans: Results from the 2019-2020 national health and resilience in veterans study. Psychiatr Serv. Jun 2022;73(6):628-635. doi:10.1176/appi.ps.202100112
45. Karel MJ, Wray LO, Adler G, et al. Mental health needs of aging veterans: Recent evidence and clinical recommendations. Clinical Gerontologist. Mar-Apr 2022;45(2):252-271. doi:10.1080/07317115.2020.1716910
46. Rasmussen KA, King DA, Gould MS, et al. Concerns of older veteran callers to the veterans crisis line. Suicide and Life Threatening Behavior. Aug 2017;47(4):387-397. doi:10.1111/sltb.12313
47. U.S. Dept of Housing and Urban Development. Evaluating public housing agency challenges with the HUD Veterans Affairs supportive housing program. 2021, November 30. https://www.oversight.gov/sites/default/files/oig-reports/HUD/2022-LA-0801.pdf
48. Diaz M. VA Homeless Programs: The growing crisis of aging veterans. U.S. Dept of Veterans Affairs. https://www.va.gov/HOMELESS/featuredarticles/aging-homeless-veterans.asp
49. Bensken WP, Krieger NI, Berg KA, Einstadter D, Dalton JE, Perzynski AT. Health status and chronic disease burden of the homeless population: An analysis of two decades of multi-institutional electronic medical records. Journal of Health Care for the Poor and Underserved. 2021;32(3):1619-1634.
50. Trejos Saucedo RR, Salazar Marchan CY, Linkowski L, Hall S, Menezes L. Homelessness in urban communities in the US: A scoping review utilizing the Socio-Ecological Model. Florida Public Health Review. 2022;19(3)
51. Subedi K, Ghimire S. Comorbidity profiles of patients experiencing homelessness: A latent class analysis. PLOS ONE. 2022;17(5):e0268841. doi:10.1371/journal.pone.0268841
52. Nichter B, Tsai J, Pietrzak RH. Prevalence, correlates, and mental health burden associated with homelessness in U.S. military veterans. Psychol Med. Jul 2023;53(9):3952-3962. doi:10.1017/S0033291722000617
53. Wisco BE, Marx BP, Holowka DW, et al. Traumatic brain injury, PTSD, and current suicidal ideation among Iraq and Afghanistan U.S. veterans. Journal of Traumatic Stress. Apr 2014;27(2):244-8. doi:10.1002/jts.21900
54. Meffert BN, Morabito DM, Sawicki DA, et al. US veterans who do and do not utilize Veterans Affairs health care services. The Primary Care Companion For CNS Disorders. 2019;21(1)doi:10.4088/pcc.18m02350
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Examining Veterans’ Health Behaviors After Homelessness: A Brief Review: Review. (2025). Research in Psychology and Behavior, 5(1). https://doi.org/10.53520/rdpb2025.107153
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Copyright, 2025 by the authors. This work is licensed under the Creative Commons Attribution 4.0 International License.