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Motivational and cognitive factors linked to community integration in homeless veterans: Study 2 – clinically diverse sample

Published online by Cambridge University Press:  29 May 2020

Jonathan K. Wynn Open the ORCID record for Jonathan K. Wynn [Opens in a new window] ,
Sonya Gabrielian ,
Gerhard Hellemann ,
William P. Horan ,
Robert S. Kern ,
Junghee Lee ,
Stephen R. Marder ,
Catherine A. Sugar  and
Michael F. Green
Jonathan K. Wynn
Affiliation:
Department of Veterans Affairs, Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles, USA Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, USA VA Research and Enhancement Award Program to Enhance Community Integration in Homeless Veterans
Sonya Gabrielian
Affiliation:
Department of Veterans Affairs, Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles, USA Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, USA VA Research and Enhancement Award Program to Enhance Community Integration in Homeless Veterans
Gerhard Hellemann
Affiliation:
Department of Veterans Affairs, Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles, USA Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, USA VA Research and Enhancement Award Program to Enhance Community Integration in Homeless Veterans
William P. Horan
Affiliation:
Department of Veterans Affairs, Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles, USA Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, USA VA Research and Enhancement Award Program to Enhance Community Integration in Homeless Veterans VeriSci, Durham, North Carolina, USA
Robert S. Kern
Affiliation:
Department of Veterans Affairs, Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles, USA Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, USA VA Research and Enhancement Award Program to Enhance Community Integration in Homeless Veterans
Junghee Lee
Affiliation:
Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, USA VA Research and Enhancement Award Program to Enhance Community Integration in Homeless Veterans
Stephen R. Marder
Affiliation:
Department of Veterans Affairs, Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles, USA Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, USA VA Research and Enhancement Award Program to Enhance Community Integration in Homeless Veterans
Catherine A. Sugar
Affiliation:
Department of Veterans Affairs, Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles, USA Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, USA VA Research and Enhancement Award Program to Enhance Community Integration in Homeless Veterans Department of Biostatistics, University of California, Los Angeles, USA
Michael F. Green*
Affiliation:
Department of Veterans Affairs, Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles, USA Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, USA VA Research and Enhancement Award Program to Enhance Community Integration in Homeless Veterans
*
Author for correspondence: Michael F. Green, E-mail: mgreen@ucla.edu
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Abstract

Background

In an initial study (Study 1), we found that motivation predicted community integration (i.e. functional recovery) 12 months after receiving housing in formerly homeless Veterans with a psychotic disorder. The current study examined whether the same pattern would be found in a broader, more clinically diverse, homeless Veteran sample without psychosis.

Methods

We examined four categories of variables as potential predictors of community integration in non-psychotic Veterans: perception, non-social cognition, social cognition, and motivation at baseline (after participants were engaged in a permanent supported housing program but before receiving housing) and a 12-month follow-up. A total of 82 Veterans had a baseline assessment and 41 returned for testing after 12 months.

Results

The strongest longitudinal association was between an interview-based measure of motivation (the motivation and pleasure subscale from the Clinical Assessment Interview for Negative Symptoms) at baseline and measures of social integration at 12 months. In addition, cross-lagged panel analyses were consistent with a causal influence of general psychiatric symptoms at baseline driving social integration at 12 months, and reduced expressiveness at baseline driving independent living at 12 months, but there were no significant causal associations with measures of motivation.

Conclusions

The findings from this study complement and reinforce those in Veterans with psychosis. Across these two studies, our findings suggest that motivational factors are associated at baseline and at 12 months and are particularly important for understanding and improving community integration in recently-housed Veterans across psychiatric diagnoses.

Keywords

homelessVeteranscommunity integrationmotivationlongitudinal
Type
Original Article
Information
Psychological Medicine , Volume 51 , Issue 16 , December 2021 , pp. 2915 - 2922
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Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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