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Keller AV, Muller-Cohn CM, Austin TA, Jak AJ, Twamley EW. Neuropsychological functioning, neurobehavioral symptoms, and community reintegration in unstably housed veterans with mental health conditions. Clin Neuropsychol 2023; 37:1728-1744. [PMID: 36772819 PMCID: PMC10415532 DOI: 10.1080/13854046.2023.2176364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 01/30/2023] [Indexed: 02/12/2023]
Abstract
Objective: Returning Veterans often have conditions (e.g. posttraumatic stress disorder [PTSD], depression, and history of traumatic brain injury [TBI]) associated with cognitive dysfunction and problems with work, school, housing, and relationships. Rehabilitative efforts in Veterans aim to promote community reintegration, or successful adjustment in one's home, community, and desired social roles. We examined associations between neuropsychological performance, neurobehavioral symptoms, and community reintegration in Veterans. Method: 89 Iraq/Afghanistan Veterans at risk for homelessness and receiving residential mental healthcare completed a neuropsychological assessment and the Community Reintegration for Service Members-Computer Adaptive Test (CRIS-CAT). Neuropsychological components were derived using Principal Component Analysis. Bivariate Pearson correlations between neuropsychological variables, neurobehavioral symptoms, and CRIS-CAT scales (Extent of Participation, Perceived Limitations, and Satisfaction) were used to determine significant correlates of community reintegration. Regression models were used to examine associations between bivariate-significant neuropsychological components, neurobehavioral symptoms, and CRIS-CAT scales. Results: Bivariate analyses revealed that better community reintegration was associated with better performance in attention/executive functioning and fewer neurobehavioral symptoms. Three regression models examining predictors of variance in Extent of Participation, Perceived Limitations, and Satisfaction in community reintegration were statistically significant overall, with only fewer affective symptoms emerging as significantly and uniquely associated with greater participation and greater satisfaction in community functioning. Conclusions: Veterans with fewer affective symptoms reported greater participation and satisfaction with community functioning. Future longitudinal research examining associations between neurobehavioral symptoms, cognition, and risk factors of poorer community reintegration in unstably housed Veterans is warranted.
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Affiliation(s)
- Amber V. Keller
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology
- Research Service, VA San Diego Healthcare System
| | - Chantal M. Muller-Cohn
- Research Service, VA San Diego Healthcare System
- California School of Professional Psychology, Alliant International University
| | - Tara A. Austin
- The VISN 17 Center of Excellence for Research on Returning War Veterans
| | - Amy J. Jak
- Mental Health Service, VA San Diego Healthcare System
- Department of Psychiatry, University of California San Diego
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System
| | - Elizabeth W. Twamley
- Research Service, VA San Diego Healthcare System
- Department of Psychiatry, University of California San Diego
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System
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Maye JE, Van Patten R, Lykins HC, Vella L, Mahmood Z, Clark JMR, Twamley EW. Memory, fluid reasoning, and functional capacity in adults experiencing homelessness. Clin Neuropsychol 2023; 37:1441-1454. [PMID: 36154911 PMCID: PMC10039959 DOI: 10.1080/13854046.2022.2125906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 09/13/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND OBJECTIVE In individuals experiencing homelessness, determinants of functional capacity (i.e. the ability to perform activities of daily living) are poorly understood. Identifying potentially modifiable correlates of functional capacity, such as cognitive abilities, may inform treatment targets to address independence and housing stability. This study aimed to identify the strongest neuropsychological predictors of variance in functional performance in 100 adults living in a homeless shelter. METHODS Participants completed a brief cognitive screening test, from which four composite scores were derived, as well as tests of processing speed, fluid reasoning, premorbid intellectual function, and performance-based functional capacity. We conducted a hierarchical linear regression to predict variance in functional capacity. RESULTS Beyond the impact of education and premorbid intellectual function, better memory and fluid reasoning predicted better functional performance. CONCLUSIONS Although our cross-sectional design does not permit causal inference, it is possible that interventions targeting memory and fluid reasoning may improve functional ability in individuals experiencing homelessness.
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Affiliation(s)
- Jacqueline E. Maye
- Research Service, VA San Diego Healthcare System
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System
- Department of Psychiatry, University of California San Diego
| | - Ryan Van Patten
- Department of Psychiatry and Human Behavior, Brown University
- VA Providence Healthcare System
| | | | - Lea Vella
- University of California San Francisco Health, Department of Quality and Patient Safety
| | - Zanjbeel Mahmood
- Research Service, VA San Diego Healthcare System
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology
| | - Jillian M. R. Clark
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System
- Mental Health Service, VA San Diego Healthcare System
| | - Elizabeth W. Twamley
- Research Service, VA San Diego Healthcare System
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System
- Department of Psychiatry, University of California San Diego
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Sprong ME, Hollender H, Lee YS, Rawlins Williams LA, Sneed Z, Garakani A, Buono FD. Disparities in program enrollment and employment outcomes for veterans with psychiatric and co-occurring substance use disorders referred or enrolled for VHA vocational rehabilitation. Front Psychiatry 2023; 14:1200450. [PMID: 37520235 PMCID: PMC10382058 DOI: 10.3389/fpsyt.2023.1200450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 06/26/2023] [Indexed: 08/01/2023] Open
Abstract
Introduction The purpose of the study was to investigate factors that influence vocational rehabilitation program enrollment and employment at discharge of veterans with psychiatric and co-occurring alcohol and other substance use disorders enrolled at a veteran health administration (VHA) medical center. Methods A sample of 2,550 veteran patients referred for VHA vocational rehabilitation between 2016 and 2021 were examined for the current study. The current study was classified as quality improvement/assurance, thus resulting in exempt research by the U.S. Department of Veteran Affairs Institutional Review Board. Results Veterans with active alcohol use disorders (AUDs) and co-occurring depression, anxiety, post-traumatic stress disorder, or bipolar disorders were less likely to be enrolled for vocational rehabilitation program services compared to those without these co-occurring diagnoses. Veterans with AUD (active & in-remission status combined into one category) and a diagnosis of anxiety were less likely to be employed at discharge compared to veterans with AUDs and no anxiety diagnosis (anxiety diagnosis - 3.5% vs. no anxiety diagnosis - 5.8%). Discussion VHA vocational rehabilitation can be an effective intervention to assist veterans in reintegrating back into the community. Yet, there appears to be some disparities in the program enrollment and employment at discharge, depending on the nature of the psychiatric diagnosis. Investigating the factors contributing (mediating or moderating) to these discrepancies are needed. Although it appears access is not the issue in being referred for vocational rehabilitation services, other factors are likely contributing to program entry.
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Affiliation(s)
- Matthew E. Sprong
- Edward Hines Jr. VA Medical Center, Hines, IL, United States
- School of Public Management and Policy, University of Illinois Springfield, Springfield, IL, United States
| | - Heaven Hollender
- Department of Health Sciences, Indiana University-Purdue University Indianapolis, Indianapolis, IN, United States
| | - Yu-Sheng Lee
- School of Integrated Sciences, Sustainability, and Public Health, University of Illinois Springfield, Springfield, IL, United States
| | - Lee Ann Rawlins Williams
- Rehabilitation and Human Services, College of Education and Human Development, University of North Dakota, Grand Forks, ND, United States
| | - Zach Sneed
- School of Health Professions, Texas Tech University Health Sciences Center, Lubbock, TX, United States
| | - Amir Garakani
- Department of Psychiatry and Behavioral Health, Greenwich Hospital, Greenwich, CT, United States
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, United States
| | - Frank D. Buono
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, United States
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O'Connor CMC, Poulos RG, Sharma A, Preti C, Reynolds NL, Rowlands AC, Flakelar K, Raguz A, Valpiani P, Faux SG, Boyer M, Close JCT, Gupta L, Poulos CJ. An Australian aged care home for people subject to homelessness: health, wellbeing and cost-benefit. BMC Geriatr 2023; 23:253. [PMID: 37106318 PMCID: PMC10139912 DOI: 10.1186/s12877-023-03920-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 03/22/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Older people subject to homelessness face many challenges including poor health status, geriatric syndromes, and depression, coupled with barriers in accessing health and aged care services. Many are in need of formal aged care at a younger age than the general population, yet, in Australia, specialised aged-care services to support this vulnerable cohort are limited. METHODS This study was an evaluation of a new purpose-built aged care home for people with high care needs and who are homeless or at risk of homelessness. Over the first 12 months post-admission, the study examined: (1) changes in residents' physical, mental, psychological and social health, and (2) the costs incurred by the study cohort, including any cost benefit derived. RESULTS Thirty-five residents enrolled in the study between March 2020 - April 2021. At admission, almost half of residents were within the range for dementia, the majority were frail, at high risk for falls, and had scores indicative of depression. Over time, linear mixed-effect models showed significant improvement in personal wellbeing scores, with clinically significant improvements in overall health related quality of life. Levels of physical functional independence, frailty, and global cognition were stable, but cognitive functional ability declined over time. Comparison of 12 month pre- and post- admission cost utility data for a smaller cohort (n = 13) for whom complete data were available, suggested an average per resident saving of approximately AU$32,000, while the QALY indicators remained stable post-admission. CONCLUSION While this was a small study with no control group, these preliminary positive outcomes add to the growing body of evidence that supports the need for dedicated services to support older people subject to homelessness.
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Affiliation(s)
- Claire M C O'Connor
- Centre for Positive Ageing, HammondCare, Sydney, Australia.
- School of Population Health, University of New South Wales, Sydney, Australia.
- School of Psychology, University of New South Wales, Sydney, Australia.
- Neuroscience Research Australia, Sydney, Australia.
| | - Roslyn G Poulos
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Anurag Sharma
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Costanza Preti
- Centre for Positive Ageing, HammondCare, Sydney, Australia
| | | | | | - Kyall Flakelar
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Angela Raguz
- Centre for Positive Ageing, HammondCare, Sydney, Australia
| | | | - Steven G Faux
- Departments of Rehabilitation Medicine and Pain Medicine, St Vincent's Hospital, Sydney, Australia
| | | | - Jacqueline C T Close
- Neuroscience Research Australia, Sydney, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Leena Gupta
- Sydney Local Health District, Sydney, Australia
| | - Christopher J Poulos
- Centre for Positive Ageing, HammondCare, Sydney, Australia
- School of Population Health, University of New South Wales, Sydney, Australia
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Gicas KM, Mejia-Lancheros C, Nisenbaum R, Wang R, Hwang SW, Stergiopoulos V. Cognitive determinants of community functioning and quality of life in homeless adults with mental illness: 6-year follow-up from the At Home/Chez Soi Study Toronto site. Psychol Med 2023; 53:362-370. [PMID: 33926584 DOI: 10.1017/s0033291721001550] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND High rates of physical and mental health comorbidities are associated with functional impairment among persons who are homeless. Cognitive dysfunction is common, but how it contributes to various functional outcomes in this population has not been well investigated. This study examines how cognition covaries with community functioning and subjective quality of life over a 6-year period while accounting for the effects of risk and protective factors. METHODS Participants were 349 homeless adults (mean age = 39.8) recruited from the Toronto site of the At Home/Chez Soi study, a large Canadian randomized control trial of Housing First. Participants completed up to four clinical evaluations over 6 years. Factor scores were created to index verbal learning and memory (vLM) and processing speed-cognitive flexibility (PSCF). The primary outcomes were community functioning and subjective quality of life. Risk factors included lifetime homelessness, mental health diagnoses, medical comorbidity, and childhood adversity. Linear mixed-effects models were conducted to examine cognition-functional outcome associations over time, with resilience as a moderator. RESULTS Better vLM (b = 0.787, p = 0.010) and PSCF (b = 1.66, p < 0.001) were associated with better community functioning, but not with quality of life. Resilience conferred a protective effect on subjective quality of life (b = 1.45, p = 0.011) but did not moderate outcomes. CONCLUSIONS Our findings suggest a need to consider the unique determinants of community functioning and quality of life among homeless adults. Cognition should be prioritized as a key intervention target within existing service delivery models to optimize long-term functional outcomes.
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Affiliation(s)
- K M Gicas
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - C Mejia-Lancheros
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - R Nisenbaum
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - R Wang
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - S W Hwang
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - V Stergiopoulos
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Novacek DM, Wynn JK, Gabrielian S, Glynn SM, Hellemann G, Horan WP, Kern RS, Lee J, Marder SR, Sugar C, Green MF. Examining racial differences in community integration between black and white homeless veterans. Psychiatry Res 2022; 308:114385. [PMID: 34999292 DOI: 10.1016/j.psychres.2021.114385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/26/2021] [Accepted: 12/31/2021] [Indexed: 10/19/2022]
Abstract
Black Americans are overrepresented in Veteran and non-Veteran homeless populations. Community integration remains a problem for many Veterans after they obtain housing, and Black Veterans may encounter additional difficulties due to systemic racism. However, no prior study has specifically examined whether there are racial differences in community integration; similarly, no study has considered racial differences in psychosocial correlates of community integration in homeless Veterans. Knowledge of these factors could inform the development of culturally congruent rehabilitative interventions for Black Veterans. Semi-structured clinical interviews were administered to Black (N = 99) and White (N = 49) homeless Veterans to examine relations among psychiatric symptoms, motivation, and community integration domains (e.g., social integration, work productivity, and independent living). There were no significant racial differences in independent living or work productivity. Black Veterans had better social integration with family compared to White Veterans. In addition, psychiatric symptoms were more strongly correlated with social integration for Black than White Veterans. The association between motivation and work productivity was also stronger for Black Veterans. Recovery-oriented interventions could harness family connections and better target psychiatric symptoms to improve community integration for Black Veterans. Work productivity may improve from interventions aimed at enhancing motivation for Black Veterans.
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Affiliation(s)
- Derek M Novacek
- Desert Pacific Mental Illness Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, United States.
| | - Jonathan K Wynn
- Desert Pacific Mental Illness Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, United States
| | - Sonya Gabrielian
- Desert Pacific Mental Illness Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, United States
| | - Shirley M Glynn
- Desert Pacific Mental Illness Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, United States
| | - Gerhard Hellemann
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, United States
| | - William P Horan
- Desert Pacific Mental Illness Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, United States; VeraSci Inc., Durham, NC, United States
| | - Robert S Kern
- Desert Pacific Mental Illness Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, United States
| | - Junghee Lee
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Stephen R Marder
- Desert Pacific Mental Illness Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, United States
| | - Catherine Sugar
- Desert Pacific Mental Illness Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, United States; Department of Biostatistics, University of California, Los Angeles, CA, United States
| | - Michael F Green
- Desert Pacific Mental Illness Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, United States
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Green MF, Wynn JK, Gabrielian S, Hellemann G, Horan WP, Kern RS, Lee J, Marder SR, Sugar CA. Motivational and cognitive factors linked to community integration in homeless veterans: study 1 - individuals with psychotic disorders. Psychol Med 2022; 52:169-177. [PMID: 32517838 DOI: 10.1017/s0033291720001889] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Little is known about the determinants of community integration (i.e. recovery) for individuals with a history of homelessness, yet such information is essential to develop targeted interventions. METHODS We recruited homeless Veterans with a history of psychotic disorders and evaluated four domains of correlates of community integration: perception, non-social cognition, social cognition, and motivation. Baseline assessments occurred after participants were engaged in supported housing services but before they received housing, and again after 12 months. Ninety-five homeless Veterans with a history of psychosis were assessed at baseline and 53 returned after 12 months. We examined both cross-sectional and longitudinal relationships with 12-month community integration. RESULTS The strongest longitudinal association was between a baseline motivational measure and social integration at 12 months. We also observed cross-sectional associations at baseline between motivational measures and community integration, including social, work, and independent living. Cross-lagged panel analyses did not suggest causal associations for the motivational measures. Correlations with perception and non-social cognition were weak. One social cognition measure showed a significant longitudinal correlation with independent living at 12 months that was significant for cross-lagged analysis, consistent with a causal relationship and potential treatment target. CONCLUSIONS The relatively selective associations for motivational measures differ from what is typically seen in psychosis, in which all domains are associated with community integration. These findings are presented along with a partner paper (Study 2) to compare findings from this study to an independent sample without a history of psychotic disorders to evaluate the consistency in findings regarding community integration across projects.
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Affiliation(s)
- Michael F Green
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA90024-1759, USA
- Department of Veterans Affairs, Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles, CA, USA
- VA Research and Enhancement Award Program to Enhance Community Integration in Homeless Veterans, Los Angeles, CA, USA
| | - Jonathan K Wynn
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA90024-1759, USA
- Department of Veterans Affairs, Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles, CA, USA
- VA Research and Enhancement Award Program to Enhance Community Integration in Homeless Veterans, Los Angeles, CA, USA
| | - Sonya Gabrielian
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA90024-1759, USA
- Department of Veterans Affairs, Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles, CA, USA
- VA Research and Enhancement Award Program to Enhance Community Integration in Homeless Veterans, Los Angeles, CA, USA
| | - Gerhard Hellemann
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA90024-1759, USA
- Department of Veterans Affairs, Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles, CA, USA
- VA Research and Enhancement Award Program to Enhance Community Integration in Homeless Veterans, Los Angeles, CA, USA
| | - William P Horan
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA90024-1759, USA
- Department of Veterans Affairs, Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles, CA, USA
- VA Research and Enhancement Award Program to Enhance Community Integration in Homeless Veterans, Los Angeles, CA, USA
- VeriSci, Durham, North Carolina, USA
| | - Robert S Kern
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA90024-1759, USA
- Department of Veterans Affairs, Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles, CA, USA
- VA Research and Enhancement Award Program to Enhance Community Integration in Homeless Veterans, Los Angeles, CA, USA
| | - Junghee Lee
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA90024-1759, USA
- Department of Veterans Affairs, Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles, CA, USA
- VA Research and Enhancement Award Program to Enhance Community Integration in Homeless Veterans, Los Angeles, CA, USA
| | - Stephen R Marder
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA90024-1759, USA
- Department of Veterans Affairs, Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles, CA, USA
- VA Research and Enhancement Award Program to Enhance Community Integration in Homeless Veterans, Los Angeles, CA, USA
| | - Catherine A Sugar
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA90024-1759, USA
- Department of Veterans Affairs, Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles, CA, USA
- VA Research and Enhancement Award Program to Enhance Community Integration in Homeless Veterans, Los Angeles, CA, USA
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Wynn JK, Gabrielian S, Hellemann G, Horan WP, Kern RS, Lee J, Marder SR, Sugar CA, Green MF. Motivational and cognitive factors linked to community integration in homeless veterans: Study 2 - clinically diverse sample. Psychol Med 2021; 51:2915-2922. [PMID: 32466807 DOI: 10.1017/s0033291720001609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND In an initial study (Study 1), we found that motivation predicted community integration (i.e. functional recovery) 12 months after receiving housing in formerly homeless Veterans with a psychotic disorder. The current study examined whether the same pattern would be found in a broader, more clinically diverse, homeless Veteran sample without psychosis. METHODS We examined four categories of variables as potential predictors of community integration in non-psychotic Veterans: perception, non-social cognition, social cognition, and motivation at baseline (after participants were engaged in a permanent supported housing program but before receiving housing) and a 12-month follow-up. A total of 82 Veterans had a baseline assessment and 41 returned for testing after 12 months. RESULTS The strongest longitudinal association was between an interview-based measure of motivation (the motivation and pleasure subscale from the Clinical Assessment Interview for Negative Symptoms) at baseline and measures of social integration at 12 months. In addition, cross-lagged panel analyses were consistent with a causal influence of general psychiatric symptoms at baseline driving social integration at 12 months, and reduced expressiveness at baseline driving independent living at 12 months, but there were no significant causal associations with measures of motivation. CONCLUSIONS The findings from this study complement and reinforce those in Veterans with psychosis. Across these two studies, our findings suggest that motivational factors are associated at baseline and at 12 months and are particularly important for understanding and improving community integration in recently-housed Veterans across psychiatric diagnoses.
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Affiliation(s)
- Jonathan K Wynn
- Department of Veterans Affairs, Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles, USA
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, USA
- VA Research and Enhancement Award Program to Enhance Community Integration in Homeless Veterans
| | - Sonya Gabrielian
- Department of Veterans Affairs, Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles, USA
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, USA
- VA Research and Enhancement Award Program to Enhance Community Integration in Homeless Veterans
| | - Gerhard Hellemann
- Department of Veterans Affairs, Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles, USA
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, USA
- VA Research and Enhancement Award Program to Enhance Community Integration in Homeless Veterans
| | - William P Horan
- Department of Veterans Affairs, Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles, USA
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, USA
- VA Research and Enhancement Award Program to Enhance Community Integration in Homeless Veterans
- VeriSci, Durham, North Carolina, USA
| | - Robert S Kern
- Department of Veterans Affairs, Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles, USA
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, USA
- VA Research and Enhancement Award Program to Enhance Community Integration in Homeless Veterans
| | - Junghee Lee
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, USA
- VA Research and Enhancement Award Program to Enhance Community Integration in Homeless Veterans
| | - Stephen R Marder
- Department of Veterans Affairs, Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles, USA
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, USA
- VA Research and Enhancement Award Program to Enhance Community Integration in Homeless Veterans
| | - Catherine A Sugar
- Department of Veterans Affairs, Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles, USA
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, USA
- VA Research and Enhancement Award Program to Enhance Community Integration in Homeless Veterans
- Department of Biostatistics, University of California, Los Angeles, USA
| | - Michael F Green
- Department of Veterans Affairs, Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles, USA
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, USA
- VA Research and Enhancement Award Program to Enhance Community Integration in Homeless Veterans
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9
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Chinchilla M, Gabrielian S, Hellemann G, Glasmeier A, Green M. Determinants of Community Integration Among Formerly Homeless Veterans Who Received Supportive Housing. Front Psychiatry 2019; 10:472. [PMID: 31297070 PMCID: PMC6607471 DOI: 10.3389/fpsyt.2019.00472] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 06/13/2019] [Indexed: 11/24/2022] Open
Abstract
Community integration is recognized as a meaningful goal that is highly relevant to the long-term success of supportive housing programs. Research to date highlights concerns that some individuals in permanent supportive housing remain socially isolated and have limited success in other domains of community integration. However, we know little about what factors impact formerly homeless veterans' ability to achieve community integration. To identify factors associated with community integration among homeless veterans housed through the Department of Veterans Affairs' (VA's) Supportive Housing program (HUD-VASH), we performed secondary database analyses of Veterans (n = 560) housed via HUD-VASH in the VA Greater Los Angeles Healthcare System from 10/1/14-9/30/15. We conducted ordinal and logit regressions to examine associations between baseline HUD-VASH participant characteristics, supportive housing voucher type, health service utilization in the year post-housing, and three types of community integration outcomes (i.e., change in community adjustment, status of housing stability, and change in employment). Data were obtained from HOMES (VA's homeless registry) and Corporate Data Warehouse (CDW) (VA's a national administrative dataset of VA inpatient and outpatient care). Mental health service utilization was negatively associated with community adjustment, housing stability, and employment. Employment at baseline was positively associated with housing stability and employment. Also, substance use disorder visits was positively associated with employment, and combined medical and substance use disorder diagnoses was positively associated with change in community adjustment. We considered 29 variables and found relatively few were associated with community integration. Consistent with previous research, our study highlights the importance of mental health needs, and suggests that utilization of mental health services is an important indicator of improvements in community adjustment, housing stability, and employment.
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Affiliation(s)
- Melissa Chinchilla
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation, & Policy, Los Angeles, CA, United States
| | - Sonya Gabrielian
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation, & Policy, Los Angeles, CA, United States
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Gerhard Hellemann
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Amy Glasmeier
- Department of Urban Studies and Planning Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Michael Green
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
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