Suicide Among Persons Experiencing Homelessness

Characterizing Violent Fatalities Among People Experiencing Homelessness Using the National Violent Death Reporting System, 2010 to 2021

Homelessness continues to be a serious public health problem in the United States. People experiencing homelessness (PEH) face stark health inequities, including high mortality rates and increased risk of violence victimization. Little is known about the risk factors around PEH dying violently. The objective of this study is to comprehensively describe these fatalities to inform future research and prevention efforts for this population. This retrospective study utilized data from the National Violent Death Reporting System from 2010 to 2021 to characterize and compare fatalities among PEH versus people who were not experiencing homelessness (PNEH). This study identified 7,231 PEH and 423,363 PNEH victims. Among PEH, the most common manners of death were suicide (44.9%) and homicide (31.0%), most were male (83.0%), and White, non-Hispanic (59.3%). Compared to PNEH, a significantly greater proportion of PEH had an alcohol problem (26.9% vs. 15.2%; p < .001) or other substance use problem (48.8% vs. 19.6%; p < .001). Among decedents who had a current mental health problem (PEH: 33.6% vs. PNEH: 36.7%), a smaller percentage of PEH were currently receiving treatment (PEH: 13.9% vs. PNEH: 20.7%; p<.001). Among those who died by suicide, more PEH had a recent eviction/loss of home that contributed to the death, compared to PNEH (21.0% vs. 2.8%; p < .001). Among individuals who died by homicide, PEH were significantly more likely to be killed by a random act of violence (PEH: 5.1% vs. PNEH: 2.6%; p < .001). These findings highlight unique characteristics of violent deaths among PEH, including circumstances involving mental health and substance use problems, and identify key intervention points for suicide prevention among this population. Future research to help prevent violence-related deaths among PEH would benefit by improved data collection methods to reduce missing data and linkages with other data sources.

Role of homelessness and psychiatric disorders in suicide deaths among veterans: A four-way decomposition analysis

Homelessness and suicide are top priorities in the U.S. Department of Veterans Affairs (VA). This study examined the various pathways involving homelessness, substance use, and mental health disorders in relation to suicide deaths among veterans in the VA healthcare system. A retrospective cohort study was conducted among 6,128,921 veterans-399,125 homeless and 5,729,796 non-homeless-followed-up between 2017 and 2021 using VA/Department of Defense linked databases. Multivariable Cox regression was applied for homelessness and psychiatric disorders as predictor of suicide deaths, sequentially controlling for demographic, clinical, substance use, and mental health characteristics. Four-way decomposition analysis was used to calculate proportions of suicide deaths mediated and/or moderated by homelessness, substance use, and mental health disorders. The relationship between homelessness and suicide-specific mortality risk was reduced from 40 % greater risk in unadjusted to 9 % greater risk in fully-adjusted models. Nearly 26 % of the total effect of homelessness on suicide-specific mortality risk was mediated by substance use disorders, whereas 49 % was mediated and 36 % was moderated by mental health disorders. In conclusion, excess suicide-specific mortality risk in homeless veterans is partly explained by substance use and mental health disorders, highlighting the importance of wrap-around health and social services for homeless veterans in mitigating suicide risk.

Prevalence of youth experiencing homelessness and its association with suicidal thoughts and behaviors: Findings from a population-based study

Although various studies have examined factors associated with suicidal behaviors among youth, few studies have investigated the association between youth experiencing homelessness (YEH) and suicidal thoughts and behaviors (STBs) using a large nationally representative sample. The objectives of this study were to investigate prevalence of YEH and its association with STBs. Data for this study came from the 2021 Youth Risk Behavior Survey. An analytic sample of 17,033 youth aged 14-18 (51.7 % male) was analyzed using binary logistic regression. Of the 17,033 youth examined, 3 % experienced homelessness during the past 30 days, 21.3 % experienced suicidal ideation, 17.3 % made a suicide plan, and 10.9 % attempted suicide during the past 12 months. Controlling for demographic characteristics and feeling sad or hopeless, YEH was associated with 2.48 times higher odds of experiencing suicidal ideation (AOR=2.48, p<.001), 2.46 times higher odds of making a suicide plan (AOR=2.46, p<.001), and 4.38 times higher odds of making a suicide attempt (AOR=4.38, p<.001). The findings of this study highlight the importance of identifying youth who are at risk of experiencing homelessness to ensure early interventions are put in place to prevent suicidal behaviors.