Schizophrenia Linked to Higher Risk of Homelessness, Unemployment for US Veterans

The likelihood of adverse societal outcomes, such as homelessness, unemployment, and incarceration, was greater among veterans with vs without schizophrenia. Researchers published their findings in BMC Psychiatry.

“While the substantial burden of schizophrenia has been well-documented in the general US population, to the best of our knowledge, there is no literature describing societal outcomes within the US Veterans Health Administration (VHA) population, among whom the prevalence of mental health disorders, including schizophrenia, is high relative to the general population,” investigators said.

Using the VHA database, researchers conducted a retrospective cohort study with data spanning January 2013 to September 2019. To meet inclusion criteria, veterans must have received at least 2 diagnoses of ICD-9295.xx, ICD-10 F20.x, F21, and/or F25.x during the study period. Veterans with schizophrenia were propensity score matched to those without schizophrenia.

There were 102,207 veterans in each cohort. Participants were predominantly male (91%) and White (61%) and were an average age of 59 years. More veterans with schizophrenia had substance use disorder (42% vs 25%) and mental health-related comorbidities (30% vs 15%) than those without schizophrenia.

Veterans with schizophrenia were more likely to experience the following:

• unemployment (69% vs 41%; SMD: 0.81);
• divorce (35% vs 28%; SMD: 0.67);
• homelessness (28% vs 7%; SMD: 0.57);
• incarceration (0.4% vs 0.1%; SMD: 0.47); and
• premature death (14% vs 12%; SMD < 0.1).

Researchers used logistic regression models to estimate the risks of unemployment and homelessness, which were found to be 5.4 and 4.5 times greater among the veteran population who had schizophrenia, compared to the other cohort.

Black race and a history of substance use disorder were additional predictors for unemployment, while younger age (18-34 years) and a history of mental health-related comorbidities predicted homelessness.

“Given their elevated risk for unemployment and homelessness, veterans with schizophrenia should be a focus of targeted, multifactorial interventions to reduce disease burden,” researchers concluded.

Reference:
Lin D, Kim H, Wada K, et al. Unemployment, homelessness, and other societal outcomes in patients with schizophrenia: a real-world retrospective cohort study of the United States Veterans Health Administration database: Societal burden of schizophrenia among US veterans. BMC Psychiatry. 2022;22(1):458. doi:10.1186/s12888-022-04022-x