{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T04:29:49Z","timestamp":1773289789117,"version":"3.50.1"},"reference-count":35,"publisher":"BMJ","issue":"4","funder":[{"name":"U.S. Department of Veterans Affairs, Health Services Research and Development","award":["IIR-13-334"],"award-info":[{"award-number":["IIR-13-334"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Epidemiol Community Health"],"accepted":{"date-parts":[[2020,10,24]]},"published-print":{"date-parts":[[2021,4]]},"abstract":"<jats:sec id=\"s1\">\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>People without stable housing\u2014and Veterans specifically\u2014are at increased risk of suicide. This study assessed whether unstably housed Veterans\u2019 participation in homeless services is associated with reduced risk of all-cause and suicide mortality.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"s2\">\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This retrospective cohort study used a sample of 169\u00a0221 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\u2019 utilisation of homeless services and all-cause and suicide mortality, adjusting for sociodemographics and severity of medical comorbidities.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"s3\">\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>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\u20130.98). An increasing number of homeless services used was associated with significantly reduced hazards of both all-cause (aHR=0.93, 95% CI=0.91\u20130.95) and suicide mortality (aHR=0.81, 95% CI=0.73\u20130.89).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"s4\">\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>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\u2014and ensuring \u2018upstream\u2019 interventions\u2014within 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.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/jech-2020-214664","type":"journal-article","created":{"date-parts":[[2020,11,18]],"date-time":"2020-11-18T17:35:12Z","timestamp":1605720912000},"page":"380-386","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Intervention to address homelessness and all-cause and suicide mortality among unstably housed US Veterans, 2012\u20132016"],"prefix":"10.1136","volume":"75","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4420-3526","authenticated-orcid":false,"given":"Ann Elizabeth","family":"Montgomery","sequence":"first","affiliation":[{"name":"National Center on Homelessness among Veterans, US Department of Veterans Affairs, Birmingham, Alabama, USA"},{"name":"Health Behavior, The University of Alabama at Birmingham School of Public Health, Birmingham, Alabama, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melissa","family":"Dichter","sequence":"additional","affiliation":[{"name":"Center for Health Equity Research and Promotion, U.S. Department of Veterans Affairs, Philadelphia, Pennsylvania, USA"},{"name":"School of Social Work, Temple University, Philadelphia, Pennsylvania, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Byrne","sequence":"additional","affiliation":[{"name":"School of Social Work, Boston University, Boston, Massachusetts, USA"},{"name":"Center for Healthcare Organization and Implementation Research, US Department of Veterans Affairs, Bedford, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Blosnich","sequence":"additional","affiliation":[{"name":"Center for Health Equity Research and Promotion, U.S. Department of Veterans Affairs, Philadelphia, Pennsylvania, USA"},{"name":"University of Southern California Suzanne Dworak-Peck School of Social Work, Los Angeles, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,11,18]]},"reference":[{"key":"2025100306283352000_75.4.380.1","first-page":"66","article-title":"Homeless: a high risk group for the public health","volume":"4","author":"Babatsikou","year":"2010","journal-title":"Health Sci J"},{"key":"2025100306283352000_75.4.380.2","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1007\/BF03405026","article-title":"Is homelessness hazardous to your health?","volume":"93","author":"Hwang","year":"2002","journal-title":"Can J Pub Health"},{"key":"2025100306283352000_75.4.380.3","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1001\/jamainternmed.2013.1604","article-title":"Mortality among homeless adults in Boston: shifts in causes of death over a 15-year period","volume":"173","author":"Baggett","year":"2013","journal-title":"JAMA Int Med"},{"key":"2025100306283352000_75.4.380.4","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2014.302248"},{"key":"2025100306283352000_75.4.380.5","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2009.180109"},{"key":"2025100306283352000_75.4.380.6","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1037\/a0018479","article-title":"Personal, medical, and healthcare utilization among homeless Veterans served by metropolitan and nonmetropolitan Veteran facilities","volume":"7","author":"Gordon","year":"2010","journal-title":"Psychol Ser"},{"key":"2025100306283352000_75.4.380.7","doi-asserted-by":"crossref","first-page":"829","DOI":"10.1007\/s11126-019-09667-8","article-title":"Suicidal ideation and attempt among homeless people: a systematic review and meta-analysis","volume":"90","author":"Ayano","year":"2019","journal-title":"Psych Q"},{"key":"2025100306283352000_75.4.380.8","doi-asserted-by":"crossref","first-page":"1049","DOI":"10.1176\/appi.ps.201800415","article-title":"Suicidality and the onset of homelessness: evidence for a temporal association from VHA treatment records","volume":"70","author":"Culhane","year":"2019","journal-title":"Psych Ser"},{"key":"2025100306283352000_75.4.380.9","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1111\/sltb.12369","article-title":"Suicidal self\u2010directed violence among homeless US Veterans: a systematic review","volume":"48","author":"Hoffberg","year":"2018","journal-title":"Suicide Life-Threatening Behav"},{"key":"2025100306283352000_75.4.380.10","unstructured":"National Institute of Mental Health . 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