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SAN DIEGO -- Previous homelessness appears to be an independent risk factor for suicide attempts among U.S. veterans, a new study found.

In the analysis of over 3,000 veterans, the link between lifetime homelessness and suicide attempts remained after adjusting for demographics and mental health (adjusted OR 3.75), reported Jack Tsai, PhD, of VA New England Mental Illness Research Education and Clinical Center in West Haven, Connecticut.

Homelessness and suicide in veterans "shouldn't be seen in isolation," Tsai told MedPage Today. "They go hand in hand."

The study, presented here at the American Public Health Association meeting, suggests that "addressing homelessness among veterans, and people in general," could also curb suicide rates, he added.

Tsai, a clinical psychologist who studies suicide in U.S. veterans, said he's concerned that the VA may lose sight of the role of homelessness as the system shifts its attention away from this issue toward suicide prevention.

The study examined findings from the 2015 National Epidemiological Survey of Alcohol and Related Conditions-III, which conducted in-person interviews. The researchers -- Tsai and a colleague -- focused on responses from 3,101 veterans (including 225 who reported any lifetime homelessness) and 33,024 non-veterans (including 1,455 who reported any lifetime homelessness).

In weighted analyses, a quarter of veterans with a history of homelessness reported lifetime suicide attempts compared with 3% of those who said they hadn't been homeless (OR 11.10). As noted, the association remained after adjustment for various factors.

Numbers among non-veterans were similar, at 23% and 5%, respectively (OR 6.35), with lifetime homelessness also an independent risk factor for suicide attempts in this group, but to a lesser extent (adjusted OR 1.83).

"It seems like homelessness is an independent risk factor for suicide," Tsai said. "It's not just that they share risk factors."

Unclear from the data were whether homelessness preceded suicide attempts and whether providing housing to the homeless would reduce suicide attempts, Tsai noted.

Why might homelessness and suicide attempts be connected? "Some of the major risk factors for homelessness are mental illness, substance abuse, and poverty," he said. "We know those are also major risk factors for suicide."

Noted limitations to the research included a reliance on self-reports. Tsai said he has not compared suicide death rates among homeless and non-homeless veterans.

Clinical neuropsychologist John Schinka, PhD, of the University of South Florida and the VA's National Center for Homelessness Among Veterans, said in an interview that the study findings reflect the results of other research into homelessness and suicide in vets.

According to him, other research has suggested the risk of suicidal behavior is highest just before veterans become homeless. "Hopelessness is a key factor in suicide and it may play a part in suicidal behavior in homeless veterans," he said.

Social psychologist Dennis Culhane, PhD, of the University of Pennsylvania, told MedPage Today that the VA system should address this problem by expanding its approach to homelessness at VA clinics.

Now, he said, all patients are screened for homelessness risk. If a patient is at risk, he said, the clinics should aim to reduce their sense of hopelessness by emphasizing how homelessness is typically temporary. "It's not a death sentence, it's not catastrophic, and people recover," he said.

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