WHITE RIVER JUNCTION, VT — In addition to their substantial healthcare burdens, veterans with schizophrenia face a much higher risk of adverse societal outcomes, according to a new report.
Researchers from the White River Junction, VT, VAMC working with industry colleagues wrote that schizophrenia Impacts on the individual, healthcare system and society “may be particularly striking within the veteran population due to the presence of physical and mental health [comorbidities]. Disease burden is also influenced by a complex interplay between social determinants of health and health disparities.”
The study, published in BMC Psychiatry, sought to compare nonhealthcare societal outcomes between veterans with and without schizophrenia in the VHA.1
To do that, the study team conducted a retrospective cohort study using the VHA database from January 2013 to September 2019, identifying veterans with schizophrenia based on two or more diagnoses of ICD-9295.xx, ICD-10 F20.x, F21 and/or F25.x during the study period. The index date was defined as the earliest observed schizophrenia diagnosis.
The researcher’s propensity score-matched 102,207 veterans with mental illness to a similar number of those without the serious mental illness schizophrenia. The study team looked at frequency of unemployment, divorce, incarceration, premature death and homelessness, comparing it between the matched cohorts.
Results indicated that, among veterans with schizophrenia, 42% had a substance use disorder, and 30% had mental health-related comorbidities, compared with 25 and 15%, respectively, of veterans without schizophrenia. The study found that veterans with schizophrenia were more likely than veterans without schizophrenia to experience:
- Unemployment (69% vs. 41%; SMD: 0.81),
- Divorce (35% vs. 28%; SMD: 0.67),
- Homelessness (28% vs. 7%; SMD: 0.57),
- Incarceration (0.4% vs. 0.1%; SMD: 0.47), and
- Premature death (14% vs. 12%; SMD < 0.1)
After further adjustments, the researchers calculated that the risk of unemployment and of homelessness were 5.4 and 4.5 times higher among veterans with versus without schizophrenia. They reported that other predictors of unemployment included Black race and history of substance use disorder. For homelessness, additional predictors were younger age (18-34 years) and history of mental health-related comorbidities.
“A greater likelihood of adverse societal outcomes was observed among veterans with versus without schizophrenia,” the authors wrote. “Given their elevated risk for unemployment and homelessness, veterans with schizophrenia should be a focus of targeted, multifactorial interventions to reduce disease burden.”
- Lin D, Kim H, Wada K, Aboumrad M, Powell E, Zwain G, Benson C, Near AM. Unemployment, homelessness, and other societal outcomes in patients with schizophrenia: a real-world retrospective cohort study of the United States Veterans Health Administration database : Societal burden of schizophrenia among US veterans. BMC Psychiatry. 2022 Jul 8;22(1):458. doi: 10.1186/s12888-022-04022-x. PMID: 35804314; PMCID: PMC9264584.
