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AJPH First Look, published online ahead of print Mar 19, 2009
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May 2009, Vol 99, No. 5 | American Journal of Public Health 871-877
© 2009 American Public Health Association
DOI: 10.2105/AJPH.2008.149989

RESEARCH AND PRACTICE

Clinical and Demographic Factors Associated With Homelessness and Incarceration Among VA Patients With Bipolar Disorder

Laurel A. Copeland, PhD, Alexander L. Miller, MD, Deborah E. Welsh, MS, John F. McCarthy, PhD, John E. Zeber, PhD and Amy M. Kilbourne, PhD

Laurel A. Copeland and John E. Zeber are with the Department of Veterans Affairs, San Antonio, TX. Laurel A. Copeland, Alexander L. Miller, and John E. Zeber are with the Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio. Deborah E. Welsh, John F. McCarthy, and Amy M. Kilbourne are with the Department of Veterans Affairs, Ann Arbor, MI. Amy M. Kilbourne is also with the Department of Psychiatry, University of Michigan, Ann Arbor.

Correspondence: Requests for reprints should be sent to Laurel A. Copeland, PhD, South Texas Veterans Health Care System, 7400 Merton Minter Blvd. (Verdict 11c6), San Antonio, TX 78229-4404 (e-mail: copelandl{at}uthscsa.edu).

Objectives. We assessed the association between homelessness and incarceration in Veterans Affairs patients with bipolar disorder.

Methods. We used logistic regression to model each participant's risk of incarceration or homelessness after we controlled for known risk factors.

Results. Of 435 participants, 12% reported recent homelessness (within the past month), and 55% reported lifetime homelessness. Recent and lifetime incarceration rates were 2% and 55%, respectively. In multivariate models, current medication adherence (based on a 5-point scale) was independently associated with a lower risk of lifetime homelessness (odds ratio [OR] = 0.80 per point, range 0–4; 95% confidence interval [CI] = 0.66, 0.96), and lifetime incarceration increased the risk of lifetime homelessness (OR = 4.4; 95% CI = 2.8, 6.9). Recent homelessness was associated with recent incarceration (OR = 26.4; 95% CI = 5.2, 133.4). Lifetime incarceration was associated with current substance use (OR = 2.6; 95% CI = 2.7, 6.7) after control for lifetime homelessness (OR = 4.2; 95% CI = 2.7, 6.7).

Conclusions. Recent and lifetime incarceration and homelessness were strongly associated with each other. Potentially avoidable or treatable correlates included current medication nonadherence and substance use. Programs that better coordinate psychiatric and drug treatment with housing programs may reduce the cycle of incarceration, homelessness, and treatment disruption within this vulnerable patient population.






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