Abstract
Perceptions of health status among 331 homeless veterans and homeless nonveterans were examined. Homeless veterans were significantly less apt to perceive their health as fair/poor (8%) compared to non-veteran homeless men (19%). Homeless veterans were also more likely to report having a regular source of care (57% versus 36%). Logistic regression analysis indicated the adjusted odds of fair/poor health were more than two times greater for persons reporting depressive symptomatology than for those without this history; veterans continue to remain less likely to report fair/poor health than nonveterans. High rates of substance abuse were observed for the entire sample. Such differences in perceived health result in important health access issues.
CURRENT ESTIMATES INDICATE that veterans comprise almost 40% of the homeless population and that more than 250,000 may be homeless on any given night. 1 Poverty, postmilitary mental illness, and social isolation are among the complex pattern of risk factors that predispose veterans to homelessness. Additional factors include childhood physical and/or sexual abuse and lack of support from family and friends. 2,3 Up to 70% of homeless veterans have long-standing alcohol dependence, 4 and 45% suffer from mental illness, primarily depression. 5 Homeless veterans also have high rates of posttraumatic stress disorder (PTSD), 3 comorbid psychiatric conditions, 6 and severely impaired occupational and social functioning. 3,7 A number of homeless veterans face disabilities due to serious mental illnesses. 8
As a group, post-Vietnam era veterans are more than 3 times as likely to be homeless as their nonveteran counterparts. 2 This cohort of veterans, aged 20-34, has also been found to disproportionately experience pervasive addiction problems. Moreover, rates of antisocial behavior are 5 to 6 times higher in this subgroup than in the general population. 3
Compared to other homeless adults, homeless veterans tend to be older, better educated, and are more likely to have been or currently be married. 4 They also have access to an array of health care resources through the Veterans Administration (VA). However, homeless veterans' perceptions of their health status and whether these perceptions differ from those of nonveteran homeless individuals, when other potentially important predictors of general health are considered, have not received adequate attention.
In this study, the perception of health status was compared among homeless veterans and homeless nonveterans residing in the skid row area of Los Angeles. In addition, the relationship was examined between situational, personal, cognitive, and behavioral factors and the perceptions of health among homeless adults. This information was used to control for those variables that might confound any relationship between veteran and health status. Such information can help guide the design of intervention programs to improve the health of veterans and assist them in exiting their homeless state.