Multimorbidity of mental health and substance use disorders among housed and homeless U.S. veterans

Abstract Housing can be an important social determinant of mental health, which is why it is important to understand how mental health disorders (MHDs) and substance use disorders (SUDs) cluster and vary by housing instability. This study examined rates of comorbid MHDs and SUDs among three groups o...

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Main Authors: Jack Tsai, Dorota Szymkowiak, Hind Beydoun
Format: Article
Language:English
Published: Nature Portfolio 2025-04-01
Series:Scientific Reports
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Online Access:https://doi.org/10.1038/s41598-025-99394-x
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author Jack Tsai
Dorota Szymkowiak
Hind Beydoun
author_facet Jack Tsai
Dorota Szymkowiak
Hind Beydoun
author_sort Jack Tsai
collection DOAJ
description Abstract Housing can be an important social determinant of mental health, which is why it is important to understand how mental health disorders (MHDs) and substance use disorders (SUDs) cluster and vary by housing instability. This study examined rates of comorbid MHDs and SUDs among three groups of U.S. veterans: those experiencing homelessness, those in supported housing, and those independently housed. Administrative data on a national cohort of 5,402,062 veterans (including 181,131 homeless veterans and 29,166 veterans in supported housing) enrolled in the U.S. Department of Veterans Affairs (VA) healthcare system from 2021 to 2023 were analyzed. Among homeless veterans, 28.3% had a SUD diagnosis, 62.9% a MHD diagnosis, and 24.7% comorbid MHD/SUD. Among veterans in supported housing, 38.2% had a SUD diagnosis, 67.3% a MHD diagnosis, and 32.0% comorbid MHD/SUD diagnoses. Among independently housed veterans, 7.9% had a SUD diagnosis, 41.6% a MHD diagnosis, and 5.8% comorbid MHD/SUD diagnoses. Homeless veterans with comorbid MHD/SUD used significantly more outpatient, inpatient, and emergency department care than veterans in supported housing; in turn, supported housing veterans with comorbid MHD/SUD used significantly more outpatient, inpatient, and emergency department care than independently housed veterans. Among homeless veterans with comorbid MHD/SUD diagnoses, those with addiction to central nervous system (CNS) stimulants used more outpatient, inpatient, and emergency department care than those with addiction to CNS depressants. In conclusion, the psychiatric epidemiology and comorbidity of veterans varies by housing situation, and there is continued need for psychiatric treatment among homeless veterans who enter supported housing.
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spelling doaj-art-5eb006aaa6bd4166965c0bdec1e8a7cb2025-08-20T02:10:49ZengNature PortfolioScientific Reports2045-23222025-04-011511910.1038/s41598-025-99394-xMultimorbidity of mental health and substance use disorders among housed and homeless U.S. veteransJack Tsai0Dorota Szymkowiak1Hind Beydoun2United States Department of Veterans Affairs, Homeless Programs OfficeUnited States Department of Veterans Affairs, Homeless Programs OfficeUnited States Department of Veterans Affairs, Homeless Programs OfficeAbstract Housing can be an important social determinant of mental health, which is why it is important to understand how mental health disorders (MHDs) and substance use disorders (SUDs) cluster and vary by housing instability. This study examined rates of comorbid MHDs and SUDs among three groups of U.S. veterans: those experiencing homelessness, those in supported housing, and those independently housed. Administrative data on a national cohort of 5,402,062 veterans (including 181,131 homeless veterans and 29,166 veterans in supported housing) enrolled in the U.S. Department of Veterans Affairs (VA) healthcare system from 2021 to 2023 were analyzed. Among homeless veterans, 28.3% had a SUD diagnosis, 62.9% a MHD diagnosis, and 24.7% comorbid MHD/SUD. Among veterans in supported housing, 38.2% had a SUD diagnosis, 67.3% a MHD diagnosis, and 32.0% comorbid MHD/SUD diagnoses. Among independently housed veterans, 7.9% had a SUD diagnosis, 41.6% a MHD diagnosis, and 5.8% comorbid MHD/SUD diagnoses. Homeless veterans with comorbid MHD/SUD used significantly more outpatient, inpatient, and emergency department care than veterans in supported housing; in turn, supported housing veterans with comorbid MHD/SUD used significantly more outpatient, inpatient, and emergency department care than independently housed veterans. Among homeless veterans with comorbid MHD/SUD diagnoses, those with addiction to central nervous system (CNS) stimulants used more outpatient, inpatient, and emergency department care than those with addiction to CNS depressants. In conclusion, the psychiatric epidemiology and comorbidity of veterans varies by housing situation, and there is continued need for psychiatric treatment among homeless veterans who enter supported housing.https://doi.org/10.1038/s41598-025-99394-xEpidemiologyMental disordersSubstance use disordersHomeless persons
spellingShingle Jack Tsai
Dorota Szymkowiak
Hind Beydoun
Multimorbidity of mental health and substance use disorders among housed and homeless U.S. veterans
Scientific Reports
Epidemiology
Mental disorders
Substance use disorders
Homeless persons
title Multimorbidity of mental health and substance use disorders among housed and homeless U.S. veterans
title_full Multimorbidity of mental health and substance use disorders among housed and homeless U.S. veterans
title_fullStr Multimorbidity of mental health and substance use disorders among housed and homeless U.S. veterans
title_full_unstemmed Multimorbidity of mental health and substance use disorders among housed and homeless U.S. veterans
title_short Multimorbidity of mental health and substance use disorders among housed and homeless U.S. veterans
title_sort multimorbidity of mental health and substance use disorders among housed and homeless u s veterans
topic Epidemiology
Mental disorders
Substance use disorders
Homeless persons
url https://doi.org/10.1038/s41598-025-99394-x
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AT dorotaszymkowiak multimorbidityofmentalhealthandsubstanceusedisordersamonghousedandhomelessusveterans
AT hindbeydoun multimorbidityofmentalhealthandsubstanceusedisordersamonghousedandhomelessusveterans