Unemployment, Homelessness, and Other Societal Outcomes Among US Veterans With Schizophrenia Relapse: A Retrospective Cohort Study.

Objective

To evaluate societal outcomes including unemployment and homelessness among US veterans with schizophrenia with a history of relapse.

Methods

A retrospective cohort study was conducted using US Veterans Health Administration (VHA) data from January 1, 2013, to September 30, 2019. Veterans with ≥ 2 diagnoses of schizophrenia, schizotypal disorder, and/or schizoaffective disorders (ICD-9-CM 295.xx, ICD-10-CM F20.x, F21, or F25.x) during the study period on different days were identified. The index date was the earliest observed diagnosis. Two cohorts were created and propensity score matched: (1) the relapse cohort of veterans with ≥ 1 prior relapse, defined as hospitalization or emergency department visit associated with a schizophrenia diagnosis during the 12-month preindex period, and (2) the nonrelapse cohort of veterans with no evidence of relapse during the preindex period. The frequencies of unemployment, divorce, homelessness, incarceration, and premature death were compared between matched cohorts using standardized mean difference (SMD ≥ 0.1 indicating imbalance).

Results

Each cohort included 16,862 veterans (92.0% male, 57.0% White, median age of 58-59 years). In the relapse cohort, 67.4% and 42.0% of veterans had a history of substance use disorder and non-schizophrenia mental health disorder, respectively, compared to 43.5% and 23.8% in the matched nonrelapse cohort (both SMD > 0.1). The relapse cohort had a higher frequency of unemployment (75.4% vs 71.4%), divorce (35.6% vs 33.7%), homelessness (38.9% vs 23.7%), incarceration (0.6% vs 0.4%), and premature death (23.3% vs 16.9%) compared to the nonrelapse cohort (all SMD > 0.1).

Conclusions

Schizophrenia relapse is associated with increased adverse societal outcomes in the VHA population.