More PTSD among homeless vets

The good news: Fewer veterans of the wars in Iraq and Afghanistan are homeless than their counterparts of previous eras — about 1.97 percent in their cadre, compared with 2.63 percent in the older groups, according to the Department of Veterans Affairs (VA). The bad news: Two-thirds of homeless Iraq and Afghanistan veterans in one major sample had post-traumatic stress disorder (PTSD) — a much higher rate than in earlier cohorts of homeless veterans, who have PTSD rates between 8 percent and 13 percent, according to a study in press in the journal Administration and Policy in Mental Health and Mental Health Services Research.

The high rates of PTSD make sense because all Iraq and Afghanistan veterans were deployed and many saw combat, while many of their counterparts of previous eras weren't deployed, says the study's lead author, psychologist Jack Tsai, PhD, of Yale University. The higher rates "may also reflect a greater awareness and more careful assessment of PTSD in VA," he adds.

Tsai and his team analyzed data at one point in time on 994 Iraq and Afghanistan vets who entered the Housing and Urban Development–Veterans Affairs Supportive Housing program from 2008 to 2011, and compared them with previous reports on homeless veterans. All of the Iraq and Afghanistan veterans in the study were homeless or at risk of being homeless. (HUD estimates there were approximately 12,700 homeless veterans of the Iraq and Afghanistan wars in 2010.)

In addition to combat-related PTSD, 7.7 percent of male homeless Iraq and Afghanistan veterans and nearly a quarter of female homeless veterans from these wars reported having PTSD that was related to previous traumas, which other studies show can include childhood abuse, assaults and rape. Furthermore, 15 percent of men and 34.1 percent of women in this sample who reported combat-related PTSD also reported PTSD that wasn't related to combat.

"A lot of studies show that homeless people often experience PTSD after becoming homeless, and that many veterans experienced trauma even before entering the military," says Tsai.

On the positive side, homeless veterans of Iraq and Afghanistan had lower rates of psychotic disorders and substance abuse than previous cohorts of homeless veterans, possibly because of increased VA efforts to provide early mental health interventions and the military's zero-tolerance policy on substance abuse, adopted in 1982, says Tsai. 

Despite their high need for help, many Iraq and Afghanistan veterans were not receiving any VA disability payments, likely because they had served so recently and were just learning about the VA's offerings, Tsai adds.

The findings suggest several ways for VA, providers and policymakers to help these young homeless veterans, says Tsai. These include making sure that supportive-housing case managers work closely with PTSD clinicians to provide needed treatment; distinguishing between combat-related and non-combat-related PTSD and providing treatment accordingly; and following up on homeless veterans after they find housing.

VA might also want to consider using technology to reach younger homeless veterans, adds Tsai, who is conducting a study of technology use among the homeless Iraq and Afghanistan veterans.  

"A lot of younger homeless veterans are much more savvy about technology than older cohorts of homeless veterans," says Tsai. "VA could use this fact to develop new ways of reaching them."

For instance, smart phones and computers could be used to help these veterans receive disability compensation, hook into in-person treatment or receive online treatment, he says.

Tori DeAngelis is a writer in Syracuse, N.Y.