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. 2024 Mar;39(4):587-595.
doi: 10.1007/s11606-023-08337-7. Epub 2023 Oct 26.

Temporary Financial Assistance for Housing Expenditures and Mortality and Suicide Outcomes Among US Veterans

Richard E Nelson  1   2   3 , Ann Elizabeth Montgomery  4   5   6 , Ying Suo  7   8 , Atim Effiong  7   8 , Warren Pettey  7   8 , Lillian Gelberg  4   9   10   11 , Stefan G Kertesz  4   6   12 , Jack Tsai  4   13 , Thomas Byrne  4   14   15
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Temporary Financial Assistance for Housing Expenditures and Mortality and Suicide Outcomes Among US Veterans

Richard E Nelson et al. J Gen Intern Med. 2024 Mar.

Abstract

Introduction: It is unclear whether interventions designed to increase housing stability can also lead to improved health outcomes such as reduced risk of death and suicide morbidity. The objective of this study was to estimate the potential impact of temporary financial assistance (TFA) for housing-related expenses from the US Department of Veterans Affairs (VA) on health outcomes including all-cause mortality, suicide attempt, and suicidal ideation.

Methods: We conducted a retrospective national cohort study of Veterans who entered the VA Supportive Services for Veteran Families (SSVF) program between 10/2015 and 9/2018. We assessed the association between TFA and health outcomes using a multivariable Cox proportional hazards regression approach with inverse probability of treatment weighting. We conducted these analyses on our overall cohort as well as separately for those in the rapid re-housing (RRH) and homelessness prevention (HP) components of SSVF. Outcomes were all-cause mortality, suicide attempt, and suicidal ideation at 365 and 730 days following enrollment in SSVF.

Results: Our analysis cohort consisted of 41,969 unique Veterans with a mean (SD) duration of 87.6 (57.4) days in the SSVF program. At 365 days following SSVF enrollment, TFA was associated with a decrease in the risk of all-cause mortality (HR: 0.696, p < 0.001) and suicidal ideation (HR: 0.788, p < 0.001). We found similar results at 730 days (HR: 0.811, p = 0.007 for all-cause mortality and HR: 0.881, p = 0.037 for suicidal ideation). These results were driven primarily by individuals enrolled in the RRH component of SSVF. We found no association between TFA and suicide attempts.

Conclusion: We find that providing housing-related financial assistance to individuals facing housing instability is associated with improvements in important health outcomes such as all-cause mortality and suicidal ideation. If causal, these results suggest that programs to provide housing assistance have positive spillover effects into other important aspects of individuals' lives.

Keywords: VA; financial assistance; homelessness; mortality; suicide.

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Conflict of interest statement

All authors declare that they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
Kaplan–Meier curves depicting the proportion of individuals in our cohort who have not had an event (mortality, suicide attempt, suicidal ideation) at a given time up to 730 days from the index date—rapid re-housing only.
Fig. 2
Fig. 2
Kaplan–Meier curves depicting the proportion of individuals in our cohort who have not had an event (mortality, suicide attempt, suicidal ideation) at a given time up to 730 days from the index date—homelessness prevention only.
See this image and copyright information in PMC

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