Examining the Role of Intimate Partner Violence in Housing Instability Among Women Veterans

Background and Purpose: Women veterans face disproportionate risks of housing instability, including actual homelessness, compared with both women non-veterans and male veterans. Experiences of intimate partner violence (IPV) can lead to housing instability (HI) through direct and indirect pathways. The objective of this study was to understand the relationship between IPV and HI among women veterans who received Veterans Administration (VA) healthcare services, including characteristics associated with increased risk of HI and the ways in which experiences of IPV and concerns about safety contribute to HI and housing-related service access among women veterans.

Methods: This study employed mixed-methods, including: (1) quantitative examination of medical records data for women veteran patients who were screened for experience of past-year IPV (n = 8,427), and (2) in-depth qualitative interviews with women veteran patients who screened positive for housing instability (n = 20). In medical records data, patients’ experiences of housing instability was assessed through several indicators: ICD-9/10 codes indicating homelessness or inadequate housing, clinic stop codes indicating use of VHA homeless programs, and response to VA’s universal screen for housing instability. A series of logistic regressions, controlling for age and race, estimated the relationship between past-year IPV and HI; a mulvariable logistic regression assessed sociodemographic and clinical correlates of HI among veterans who experienced past-year IPV. In-depth qualitative interviews were conducted with women veterans who had screened positive for HI (current or risk of imminent homelessness). Transcripts of recorded interviews were coded and analyzed using thematic template analysis.

Results: Women veterans who screened positive for past-year IPV (8.4%) were nearly three times as likely as those who screened negative for past-year IPV to have an indicator of HI documented in the medical record; among those who had experienced past-year IPV, the odds of HI were greater among veterans who identified as black/African American, were not receiving compensation for a service-connected disability, were unmarried, had experienced sexual assault or harassment during military service, and had a severe mental illness or substance use disorder diagnosis. Themes emerging from the qualitative interviews fell into three broad domains: (1) direct and indirect impacts of IPV on housing instability, (2) impacts of IPV on definitions of safe and secure housing, and (3) experiences of IPV as a barrier to seeing and receiving services. Participants highlighted ways in which considerations around personal safety shape their access to acceptable housing options. Analysis of narratives further revealed particular service needs related to experiences of IPV, including need for confidentiality in communications with service providers as well as the need to examine definitions of homelessness and risk in the context of interpersonal violence and safety.

Conclusions and Implications: Study findings add to the literature on the intersection of violence and housing instability among women veterans. Concerns about personal safety, in particular, safety from interpersonal violence, are paramount to women veterans who have experienced such violence when seeking secure and stable housing. Programs that seek to prevent and end homelessness among women veterans must attend to such concerns and client safety needs.