Brief
duration of the current episode of hornelessness, current residence, dates ofmilitary service, and clinical diagnosis. Diagnoses are determined in clinical evaluations by a mental health worker. We used this data base to determine the proportion of women seen in the program. Chi square tests were used to examine sociodemographic and clinical differences between female and male homeless veterans.
Reports
Mental Illness Among Homeless Female Veterans Catherine Robert
Leda,
M.S.N.,
Rosenheck,
Peggy
Gallup,
M.P.H.
M.D.
Ph.D.
For more than a decade, public concern about the plight of homeless mentally ill persons has grown (1), and particular attention has been drawn to the apparently increasing number of homeless women (2). Community surveys have shown that psychiatric illness is more prevalent among women, who make up 1 5 to 25 percent ofadult homeless persons (3), than among men, although substance abuse has been found to be more prevalent among men (4,5). Specific concern has also been cxpressed about the unexpectedly large proportion ofveterans among homeless men, with estimates ranging from 32 to 47 percent (6). Although women have always been a small part ofthis country’s military, the proportion of women in the armed forces and among veterans has increased substantially in recent years (7,8). In view of the large proportion of vet-
The
authors
Northeast Center Medical Avenue,
are affiliated
the
Program Evaluation (182), Veterans Affairs Center, 950 Campbell West Haven, Connec-
ticut 065 16. director, Dr. tor, and Dr.
Ms. Leda is project Rosenheck is direcGallup is a research
analyst. sociate
Dr. Rosenheck clinical professor
chiatry
at Yale University Connecticut. This
Haven,
with
is also asof psyin New paper is
based on one presented at the annual meeting of the American Psychiatric Association held May 11-16, 1991, in New Orleans.
1026
enans in the homeless population and the growing proportion of women among veterans, an examination of the number and health status of homeless female veterans is timely. This study examined sociodemographic and psychiatric diagnostic data from 19,3 1 3 veterans seen in the Department of Veterans Affairs Homeless Chronically Mentally Ill (HCMI) Veterans Program from 1988 to 1991. The purpose of the study was to determine the proporlion of women among homeless veterans, to compare the prevalences of psychiatric disorders and substance abuse problems among homeless female and male veterans, and to compare diagnostic distributions among homeless female veterans and nonvetenans.
Methods Implemented in May 1987, the HCMI veterans program operates at 45 VA medical centers across the country and, to date, has provided help to thousands of seriously ill veterans. The goals of the program are to establish contact with homeless veterans with psychiatric pnoblems, including substance abuse, and to facilitate their access to a broad range of VA and non-VA services. The program offers community outreach, psychiatric and medical assessment and treatment, time-limited placement in residential treatment facilities contracted by the VA, and ongoing case management (9). As part of a national monitoring effort, information is collected on every veteran receiving treatment in the program. Mental health workers, primarily social workers and nurses, complete a standardized intake fbem that records age, gender, ethnicity, marital status, employment status,
October
1992
Vol.
43
No.
10
Results Proportion ofwomen. Ofthe 19,313 veterans seen in the HCMI veterans program from March 1988 to January 1991 a total of 3 10 (1 .6 pencent) were women, a proportion that fell within the expected estimate of women in the program. The expected proportion of women was determined using data on both the propontion ofwomen in the general veteran population (8) and the proportion of women typically found among homeless adults (3). Based on national survey data on the proportion of women in various age cohorts in the general veteran population, the cxpected proportion of women in the program was 3.6 percent. However, because homeless surveys indicate that women are between .3 and .5 times as likely as men to be homeless, a final estimate was calculated to be between 1.08 and 1.8 percent. Since the actual proportion of 1.6 percent fell within this range, it does not appear that women are disproportionately represented in the HCMI veterans program. Comparisons with male veterans. As shown in Table 1 compared with homeless male veterans, female veterans were younger and less likely to be employed. Although homeless female veterans were somewhat more likely to be married than males, only a small proportion of veterans in either group were marned. No statistical differences were found in ethnicity or income. Compared with male veterans, significantly more homeless female veterans reported being homeless for less than one month, and a smaller proportion were homeless for two years or more. Compared with the male group, a significantly larger proportion of ,
,
Hospital
and
Community
Psychiatry
Table 1 Characteristics Chronically
of women (N=310) and Mentally Ill Veterans Program
Characteristic Sociodemographic Underage35 Married
Nonwhite Employed Past month’s
men
(N=
from
1988
19,003)
in the Homeless in percentages
seen
to 1991,
Women
Men
X2t
41 8 49
25 4 46
34.9*** 11.4*** 1.0
18
27
10.5**
34 49 17
33 54 14
.3 2.2 1.9
35 34 11 7 11
25 34 13 9 17
12.8*** 1.7 .7 1.4 6.8**
2
1
35 43
64 33 72
17
12
10 35 1 53 18
7 23 10 41 27
income
None $1to499 $500 or more Homelessness (months) Lessthanone
Onetofive
Sixtoll 12to23 Morethan23 Unknown
1.1
Diagnosis Alcohol use disorder Drug use disorder Any substance use disorder Schizophrenia
Other psychotic Mooddisorder
disorder stress
Posttraumatic
Any major
24
mental
disorder illness1
Dualdiagnosis
9.8** 125.0*** 5.4* 4.6* 25.0*** 25.7*** 15.2*** 10.6**
p
duration of the current episode of hornelessness, current residence, dates ofmilitary service, and clinical diagnosis. Diagnoses are determined in clinical evaluations by a mental health worker. We used this data base to determine the proportion of women seen in the program. Chi square tests were used to examine sociodemographic and clinical differences between female and male homeless veterans.
Reports
Mental Illness Among Homeless Female Veterans Catherine Robert
Leda,
M.S.N.,
Rosenheck,
Peggy
Gallup,
M.P.H.
M.D.
Ph.D.
For more than a decade, public concern about the plight of homeless mentally ill persons has grown (1), and particular attention has been drawn to the apparently increasing number of homeless women (2). Community surveys have shown that psychiatric illness is more prevalent among women, who make up 1 5 to 25 percent ofadult homeless persons (3), than among men, although substance abuse has been found to be more prevalent among men (4,5). Specific concern has also been cxpressed about the unexpectedly large proportion ofveterans among homeless men, with estimates ranging from 32 to 47 percent (6). Although women have always been a small part ofthis country’s military, the proportion of women in the armed forces and among veterans has increased substantially in recent years (7,8). In view of the large proportion of vet-
The
authors
Northeast Center Medical Avenue,
are affiliated
the
Program Evaluation (182), Veterans Affairs Center, 950 Campbell West Haven, Connec-
ticut 065 16. director, Dr. tor, and Dr.
Ms. Leda is project Rosenheck is direcGallup is a research
analyst. sociate
Dr. Rosenheck clinical professor
chiatry
at Yale University Connecticut. This
Haven,
with
is also asof psyin New paper is
based on one presented at the annual meeting of the American Psychiatric Association held May 11-16, 1991, in New Orleans.
1026
enans in the homeless population and the growing proportion of women among veterans, an examination of the number and health status of homeless female veterans is timely. This study examined sociodemographic and psychiatric diagnostic data from 19,3 1 3 veterans seen in the Department of Veterans Affairs Homeless Chronically Mentally Ill (HCMI) Veterans Program from 1988 to 1991. The purpose of the study was to determine the proporlion of women among homeless veterans, to compare the prevalences of psychiatric disorders and substance abuse problems among homeless female and male veterans, and to compare diagnostic distributions among homeless female veterans and nonvetenans.
Methods Implemented in May 1987, the HCMI veterans program operates at 45 VA medical centers across the country and, to date, has provided help to thousands of seriously ill veterans. The goals of the program are to establish contact with homeless veterans with psychiatric pnoblems, including substance abuse, and to facilitate their access to a broad range of VA and non-VA services. The program offers community outreach, psychiatric and medical assessment and treatment, time-limited placement in residential treatment facilities contracted by the VA, and ongoing case management (9). As part of a national monitoring effort, information is collected on every veteran receiving treatment in the program. Mental health workers, primarily social workers and nurses, complete a standardized intake fbem that records age, gender, ethnicity, marital status, employment status,
October
1992
Vol.
43
No.
10
Results Proportion ofwomen. Ofthe 19,313 veterans seen in the HCMI veterans program from March 1988 to January 1991 a total of 3 10 (1 .6 pencent) were women, a proportion that fell within the expected estimate of women in the program. The expected proportion of women was determined using data on both the propontion ofwomen in the general veteran population (8) and the proportion of women typically found among homeless adults (3). Based on national survey data on the proportion of women in various age cohorts in the general veteran population, the cxpected proportion of women in the program was 3.6 percent. However, because homeless surveys indicate that women are between .3 and .5 times as likely as men to be homeless, a final estimate was calculated to be between 1.08 and 1.8 percent. Since the actual proportion of 1.6 percent fell within this range, it does not appear that women are disproportionately represented in the HCMI veterans program. Comparisons with male veterans. As shown in Table 1 compared with homeless male veterans, female veterans were younger and less likely to be employed. Although homeless female veterans were somewhat more likely to be married than males, only a small proportion of veterans in either group were marned. No statistical differences were found in ethnicity or income. Compared with male veterans, significantly more homeless female veterans reported being homeless for less than one month, and a smaller proportion were homeless for two years or more. Compared with the male group, a significantly larger proportion of ,
,
Hospital
and
Community
Psychiatry
Table 1 Characteristics Chronically
of women (N=310) and Mentally Ill Veterans Program
Characteristic Sociodemographic Underage35 Married
Nonwhite Employed Past month’s
men
(N=
from
1988
19,003)
in the Homeless in percentages
seen
to 1991,
Women
Men
X2t
41 8 49
25 4 46
34.9*** 11.4*** 1.0
18
27
10.5**
34 49 17
33 54 14
.3 2.2 1.9
35 34 11 7 11
25 34 13 9 17
12.8*** 1.7 .7 1.4 6.8**
2
1
35 43
64 33 72
17
12
10 35 1 53 18
7 23 10 41 27
income
None $1to499 $500 or more Homelessness (months) Lessthanone
Onetofive
Sixtoll 12to23 Morethan23 Unknown
1.1
Diagnosis Alcohol use disorder Drug use disorder Any substance use disorder Schizophrenia
Other psychotic Mooddisorder
disorder stress
Posttraumatic
Any major
24
mental
disorder illness1
Dualdiagnosis
9.8** 125.0*** 5.4* 4.6* 25.0*** 25.7*** 15.2*** 10.6**
p
