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Introduction: In this study we examined the association of homelessness and emergency department (ED) use, considering social, medical, and mental health factors associated with both homelessness and ED use. We hypothesized that social disadvantage alone could account for most of the association between ED use and homelessness.Methods: We used nationally representative data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III). Emergency department use within the prior year was categorized into no use (27,674; 76.61%); moderate use (1–4 visits: 7,972; 22.1%); and high use (5 or more visits: 475; 1.32%). We used bivariate analyses followed by multivariable-adjusted logistic regression analyses to identify demographic, social, medical, and mental health characteristics associated with ED use.Results: Among 36,121 respondents, unadjusted logistic regression showed prior-year homelessness was strongly associated with moderate and high prior-year ED use (odds ratio[OR] 2.31 and 7.34, respectively, P < 0.001). After adjusting for sociodemographic factors, the associations of homelessness with moderate/high ED use diminished (adjusted OR [AOR] 1.27 and 1.62, respectively, both P < 0.05). Adjusting for medical/mental health variables, alone, similarly diminished the association between homelessness and moderate/high ED use (AOR 1.26, P < .05 and 2.07, P < 0.001, respectively). In a final stepwise model including social and healthvariables, homelessness was no longer significantly associated with moderate or high ED usein the prior year.Conclusion: After adjustment for social disadvantage and health problems, we found no statistically significant association between homelessness and ED use. The implications of our findings suggest that ED service delivery must address both health issues and social factors.

BACKGROUND:: Suicidal self-directed violence among Veterans experiencing homelessness remains a significant public health concern. To prevent suicide in this population, concerted clinical and research efforts remain necessary. OBJECTIVE:: This paper serves as a consensus statement by the recently-formed Department of Veterans Affairs (VA) Suicide Prevention among Veterans Experiencing Homelessness Workgroup. We provide a brief overview of current initiatives to prevent suicide among Veterans experiencing homelessness. We also discuss methods of studying this complex subset of the Veteran population, as well as future research endeavors necessary to inform gaps in understanding. CONCLUSIONS:: Veterans experiencing homelessness are a complex subset of the Veteran population whose risk for suicide may be exacerbated by a number of factors (e.g., multimorbidity, rurality). While the VA has implemented a number of initiatives to prevent suicide among Veterans experiencing homelessness (e.g., universal screening for suicidal ideation and recent suicide attempts, Suicide Prevention Gatekeeper Training), there is a continued need to understand how best to tailor these initiatives to Veterans experiencing homelessness. Moreover, because Veterans experiencing homelessness often access a number of services within the community (e.g., community-based clinics, homeless shelters), collaboration between the VA and community is necessary.

BACKGROUND: The permanent supported housing model is known to improve housing outcomes, but there has been sparse research on the effects of supported housing on physical health. Various organizations including the National Academy of Sciences have called for research in this area. OBJECTIVE: This observational multi-site outcome study examined changes in physical health among chronically homeless adults participating in a comprehensive supported housing program and the associations between changes in physical health, housing status, and trust in primary care providers. DESIGN: Data are presented from an observational outcome study analyzed with mixed linear modeling and regression analyses. PARTICIPANTS: A total of 756 chronically homeless adults across 11 sites were assessed every 3 months for 1 year. INTERVENTIONS: The Collaborative Initiative to End Chronic Homelessness provided adults who were chronically homeless with permanent housing and supportive primary healthcare and mental health services. MAIN MEASURES: Days housed, physical health-related quality of life (HRQOL) measured by the Short Form-12 health survey, number of medical conditions, number of treated medical conditions, and number of preventive medical procedures received. KEY RESULTS: Participants showed reduced number of medical problems and receipt of more preventive procedures over time, but there was no statistically significant change in physical HRQOL. Changes in housing were not significantly associated with changes in any physical health outcomes. Over time, participants trust in primary care providers was positively associated with increased numbers of reported medical problems and preventive procedures received but not with physical HRQOL. CONCLUSIONS: Entry into supported housing with linked primary care services was not associated with improvements in physical HRQOL. Improvement in other medical outcome measures was not specifically associated with improved housing status.