Laurel A. Copeland ^1*, Alexander L. Miller ², Deborah E. Welsh ³, John F. McCarthy ³, John E. Zeber ⁴, Amy M. Kilbourne ³

¹ Department of Veterans Affairs - HSRD
² University of Texas Health Science Center at San Antonio
³ Veterans Affairs - HSRD
⁴ Veterans Affairs HSRD

^* To whom correspondence should be addressed. E-mail: copelandl{at}uthscsa.edu.

	Abstract

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.

Key Words: Health Care Facilities/Services, Health Policy, Homelessness, Mental Health