Homelessness Among Male Veterans and the Role of Military Sexual Assault and Posttraumatic Stress Disorder

Background and Purpose: In the U.S., male veterans are over-represented among the homeless. Research shows that military sexual trauma (experiencing sexual harassment or sexual assault) is associated with posttraumatic stress disorder (PTSD) among male veterans. However, the current literature does not evaluate (a) MSA separate from sexual harassment or (b) how homeless experiences in combination with MSA are associated with PTSD. The purpose of this study is to examine housing instability, MSA as a cumulative trauma, and associations with PTSD among male veterans.

Methods: Data and samples: Two non-clinical, community samples of veterans from Chicago (N = 1,294) and San Francisco (N = 686) were used. Male participants (n = 1,665) were selected for inclusion (69.4%; n = 1,155) if they identified types of housing stability or instability during the past three months.

Measures: Homeless experiences were measured by asking participants to indicate the type of places they slept during the past three months (i.e. friend’s home, shelter, outside). Housing items were defined using the Housing and Urban Development definitions of housed, at-risk of homelessness, and literal homelessness. Participants’ responses indicated fluctuations in housing experiences, thereby creating four sub-groups: (a) housing stability included being housed, (b) minimal housing instability included being both housed and at-risk, (c) some housing instability included being housed, at-risk, and literal homelessness, and (d) major housing instability included both at-risk and literal homelessness. Participants were placed in only one sub-group. MSA was evaluated with five items with an endorsement on any one item dichotomized as “yes” for MSA. PTSD was measured by the PCL-5 with a score of 33 or above indicating probable PTSD.

Analyses: All analyses were completed in SAS 9.4. Descriptive statistics were used to identify demographic and military-related variable differences between housing stability and instability. A multivariate logistic regression, that included statistically significant co-variates, was used to understand the relationship of housing instability with probable PTSD and the interaction of housing instability and MSA in regard to probable PTSD. The significant interaction of housing instability and MSA was then used to determine predicted odds of probable PTSD.

Results: Chi-square analyses showed significant differences for housing instability compared to housing stability. Among male veterans, multivariate logistic regression analysis showed those who experienced some housing instability (OR = 3.27, 95% CI [2.00, 5.36]; p < .01) and those who experienced major housing instability (OR = 4.54, 95% CI [2.62, 7.86]; p < .001) were more likely to have probable PTSD compared to the housing stability sub-group. Men who experienced some housing instability and MSA had 6.75 the predicted odds of probable PTSD, while those who experienced major housing instability and MSA had 10.28 the predicted odds of probable PTSD.

Conclusions and Implications: Housing instability is associated with clinical levels of PTSD, and the experience of MSA moderates PTSD among male homeless veterans. These findings demonstrate the cumulative effect of housing instability and MSA, as well as highlight the need to assess for MSA among male homeless veterans and provide trauma informed care within homeless services.