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Intervention to address homelessness and all-cause and suicide mortality among unstably housed US Veterans, 2012–2016
  1. Ann Elizabeth Montgomery1,2,
  2. Melissa Dichter3,4,
  3. Thomas Byrne5,6,
  4. John Blosnich3,7
  1. 1 National Center on Homelessness among Veterans, US Department of Veterans Affairs, Birmingham, Alabama, USA
  2. 2 Health Behavior, The University of Alabama at Birmingham School of Public Health, Birmingham, Alabama, USA
  3. 3 Center for Health Equity Research and Promotion, U.S. Department of Veterans Affairs, Philadelphia, Pennsylvania, USA
  4. 4 School of Social Work, Temple University, Philadelphia, Pennsylvania, USA
  5. 5 School of Social Work, Boston University, Boston, Massachusetts, USA
  6. 6 Center for Healthcare Organization and Implementation Research, US Department of Veterans Affairs, Bedford, Massachusetts, USA
  7. 7 University of Southern California Suzanne Dworak-Peck School of Social Work, Los Angeles, California, USA
  1. Correspondence to Ann Elizabeth Montgomery, RPHB 227M, 1720 2nd Avenue South, Birmingham, AL 35294-0022, USA; aemontgo{at}; ann.montgomery2{at}


Background People without stable housing—and Veterans specifically—are at increased risk of suicide. This study assessed whether unstably housed Veterans’ participation in homeless services is associated with reduced risk of all-cause and suicide mortality.

Methods This retrospective cohort study used a sample of 169 221 Veterans across the US who self-reported housing instability between 1 October 2012 and 30 September 2016. Multivariable Cox regression models assessed the association between Veterans’ utilisation of homeless services and all-cause and suicide mortality, adjusting for sociodemographics and severity of medical comorbidities.

Results More than one-half of unstably housed Veterans accessed homeless services during the observation period; utilisation of any homeless services was associated with a 6% reduction in hazards for all-cause mortality (adjusted HR[aHR]=0.94, 95% CI[CI]=0.90–0.98). An increasing number of homeless services used was associated with significantly reduced hazards of both all-cause (aHR=0.93, 95% CI=0.91–0.95) and suicide mortality (aHR=0.81, 95% CI=0.73–0.89).

Conclusions The use of homeless services among Veterans reporting housing instability was significantly associated with reduced hazards of all-cause and suicide mortality. Addressing suicide prevention and homelessness together—and ensuring ‘upstream’ interventions—within the context of the VHA healthcare system holds promise for preventing suicide deaths among Veterans. Mental health treatment is critical for suicide prevention, but future research should investigate if social service programmes, by addressing unmet human needs, may also reduce suicide.

  • Homelessness
  • housing
  • health services

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  • Twitter Thomas Byrne @TomHByrne.

  • Contributors AE Montgomery led the study. JR Blosnich conducted analyses and contributed to writing. TH Byrne and ME Dichter contributed to writing and conceptualizing the study.

  • Funding This study was funded by the U.S. Department of Veterans Affairs (VA), National Center on Homelessness among Veterans and Health Services Research and Development (HSR&D) (IIR-13-334). Analyses conducted by JRB on study data were partially supported by a VA HSR&D Career Development Award (CDA-14-408) and a research award from the National Center on Homelessness among Veterans.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.