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RESEARCH WEEKLY: The Life Circumstances of U.S Veterans with Schizophrenia
By Morré Taylor
(October 12, 2022) The prevalence of mental illness, including schizophrenia, is particularly high among U.S veterans compared to the rest of the U.S population. Veterans with schizophrenia are especially vulnerable to many of the negative outcomes associated with having a serious mental illness, such as incarceration, homelessness, hospitalization, unemployment and premature mortality. A recent study from BMC Psychiatry explored the healthcare-related life outcomes of U.S veterans with and without schizophrenia to provide insight on the clinical characteristics of veterans and the potential financial implications of having schizophrenia within this population.
Study details
Data for this study were sourced from the U.S Veterans Health Administration— the largest integrated healthcare system in the U.S that provides health services to approximately 9 million veterans. Data capturing information from inpatient, outpatient and emergency department visits as well as demographic and mortality information from January 1, 2013 to September 30, 2019 was used to create two groups of veterans to be studied: one group with diagnosed schizophrenia and another without— with 102,207 participants in each group.
The researchers of this study also conducted an analysis of two subgroups: veterans aged 18-35 with schizophrenia and veterans aged 18-35 without schizophrenia— with 11,699 participants in each group. The purpose of comparing these cohorts of young veterans was to test the hypothesis that the burden of schizophrenia might be even more prominent in younger individuals as they may be at an increased risk for poor treatment adherence and disease relapse.
Results
Veterans with schizophrenia had higher rates of substance use disorder (42%) compared to veterans without schizophrenia (25%) and were more likely to have experienced all other observed mental health-related comorbidities, such as posttraumatic stress disorder (PTSD), anxiety and suicidal ideation, according to the results. A similar trend was found among the young veteran subgroups: substance use disorder was experienced by 49% of young veterans with schizophrenia but only 24% of young veterans without schizophrenia. Additionally, 31% of young veterans with schizophrenia experienced PTSD and 11% experienced suicidal ideation, whereas PTSD was experienced by only 19% of their counterparts without schizophrenia and suicidal ideation was experienced by 0.3%.
For all non-healthcare-related outcomes, including unemployment, homelessness and incarceration, the frequency of those events was higher for veterans with schizophrenia compared to those without and were slightly higher when looking specifically at young veterans (aged 18-35) compared to veterans of all ages.
The most significant findings uncovered by the researchers were with regards to unemployment and homelessness: veterans with schizophrenia were 5.4x more likely to be unemployed and 4.5x more likely to be homeless than veterans without schizophrenia. However, veterans who were Black or had a history of substance abuse had the greatest risk of unemployment, regardless of schizophrenia status. Lastly, the researchers found that 83% of veterans with schizophrenia who died did so prematurely, mostly due to cardiovascular disease, cancer or chronic lower respiratory disease. Comparatively, 62% of deceased veterans without schizophrenia died prematurely.
The researchers suggest that these outcomes might have significant financial burdens, especially since the high rates of incarceration and homelessness are likely to increase demand for costly resources such as housing and rehabilitation services. Additionally, the prevalence of health-related comorbidities among the studied population is likely to result in expensive healthcare costs for medications, hospitalizations and emergency department visits.
Policy implications
The findings of this study reveal that veterans with schizophrenia exhibit greater frequency of mental health comorbidities and have higher rates of unemployment, homelessness, incarceration and premature death compared to veterans without schizophrenia. Additionally, this study confirms the belief that younger veterans with schizophrenia are at an increased risk for negative mental health and life circumstances, emphasizing the need for early interventions that are aimed at preventing relapse, reducing hospitalization and managing comorbidities.
Although the study does not evaluate the cost associated with these outcomes, the authors are able to infer potential financial burdens of schizophrenia, especially as it relates to the high rate of homelessness among veterans with schizophrenia and the cost of sheltering an unhoused individual. As such, there is an economic incentive to support programs that target these adverse outcomes related to schizophrenia. Lastly, this study highlights the interplay between social determinants of health, such as housing and employment, and health disparities— further demonstrating the importance of targeted and multifaceted interventions for groups that experience health disparities.
References
Lin, D., Kim, H., & Wada, K., et al. (2022, July). 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 22(1).
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