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Keeping Silent: Women Veterans, Intimate Partner Violence and Homelessness

Victims of intimate partner violence (IPV) often suffer in silence. For women veterans, research has shown it increases their risk of homelessness. Photo by Marjan_Apostolovic.

In the universe of “things we’d like to know” about women veterans and how they experience periods of unstable housing and homelessness, one of the most compelling is the often-opaque relationship between Intimate Partner Violence (IPV) — previously known as Domestic Violence (DV) — and homelessness. There are far more questions than answers, and to date very little research has explored this relationship.

Intimate Partner Violence (IPV) as defined by the Centers for Disease Control (CDC).

In 2015, when I first started surveying women veterans across the country about their experiences of homelessness after military service, a surprising number of women veterans reported “staying in an unsafe relationship,” such as one characterized by intimate partner violence, during periods of housing instability. The first survey had 400 respondents, but the second one, begun two years later, has had many more respondents — over 2,500 to date. And yet the choice of “staying in an unsafe relationship” was chosen by both sets of respondents as the second most popular choice, from a slate of more than a dozen choices. Only couch-surfing was more popular; sleeping in their vehicles comes in a distant third. So clearly, there’s an important relationship of some kind between IPV and homelessness in women veterans — but just what is that relationship, and how much do we know about it?

Recently, a three-day workshop taught by a superstar professor of grounded theory, Kathy Charmaz, Ph.D., gave me the opportunity to take a look at some of the comments women veterans had made in my previous survey about homelessness, specific to the experience of IPV. Here are just a few:

“I’ve had to stay in an unstable relationship just to have a roof over my head. This relationship has affected school, work and other personal aspects of my life in a negative way.”
“I live with someone who doesn’t let me feel safe. I can’t afford a real home on my own because I’m disabled.”
“I was in an abusive marriage and I stayed for 20 years.”
“I was married to an abusive husband, but since I had no place to go (otherwise) I stayed with him. I had one daughter who was an infant at the time. My husband is and was a (servicemember).”

Intimate partner violence (IPV) increases the risk for homelessness in women veterans. Photo by spukkato.

Recently, more attention has been paid to this topic by researchers, especially about past-year incidence of IPV. (My research does not address past-year incidence, but retrospectively looks at whether staying in an unsafe relationship is a choice made by the percentage of women veterans who experience homelessness after leaving the military.)

In a study published in the January issue of the American Journal of Preventive Medicine by VA researcher Ann Elizabeth Montgomery, Ph.D., et al. on “Recent Intimate Partner Violence and Housing Instability among Women Veterans,” the authors suggest that intimate partner violence is both a significant pathway to homelessness among women veterans and that it occurs more often among women who have served in the military than those who have not.

Taking a look at 8,427 women veterans who had responded to clinical screenings about past-year incidence of IPV at 13 VA healthcare facilities across the country, they found that, overall, female veteran patients who screened positive for past-year IPV had up to four times the odds of experiencing housing instability, as documented in their medical records. Even controlling for age and race, screening positive for IPV seemed to have increased a woman veteran’s odds of experiencing housing instability by almost a factor of three. Several factors seemed to increase the odds: Identifying as black or African-American, having screened positive previously for military sexual trauma (MST), having a mental health diagnosis and/or having a substance used disorder. Additional risk factors seemed to include being middle-aged and/or being unmarried. According to the researchers, women veterans who were receiving compensation for a service-connected disability and those who reported being married are significantly less likely to have also had an indicator of housing instability. (Both of these potentially protective factors may address the income/means issue for women veterans, since those in stronger financial positions at least on paper have more options for leaving a situation where they feel victimized, if they are able.)

A previous study of 6,287 women veterans conducted by Rachel Kimerling, Ph.D., et al. and published in 2015 reported similar numbers to the Montgomery et al. study. Kimerling and her co-authors found that nearly 20 percent of women veterans who were also Veterans Healthcare Administration (VHA) patients reported experiencing IPV within the past year. They also observed that women veterans are at increased risk of IPV over the course of their lifetimes (33 percent) compared to their civilian female counterparts (23.8 percent). More mystifying was the relationship between military service and IPV: Did military service generally increase the risk of IPV in women veterans, or did specific military experiences, such as recent deployments or MST confer specific risk for IPV following military service? (More research is needed.)

Chicken or the egg

Similar to the question about how military service interacts with IPV in terms of raising the risk, there are questions that feel very “chicken or the egg” about the relationship between IPV and homelessness, or more broadly, between IPV, MST and homelessness in women veterans. (Research by Emily Brignone, Ph.D., et al., published in JAMA Psychiatry in 2016 has already shown an independent relationship between MST and homelessness in both male and female veterans at various intervals studied.)

Specifically:

  • Does homelessness predispose women veterans to more experiences of IPV?
  • Or does IPV predispose them to more experiences of homelessness?
  • Or is there some other relationship?
  • Or is it bidirectional, where each experience influences the other?

There is a very limited amount of research into the topic to help discern this.

In a research brief published in January 2018, “Examining the Role of Intimate Partner Violence in Housing Instability and Homelessness among Women Veterans,” Melissa Dichter, Ph.D. and her colleagues (including Dr. Montgomery) found that lack of stable housing may also increase women veterans’ vulnerability to further IPV (for example, if a woman is reliant on an abusive partner for housing). They also acknowledged that IPV can lead directly to housing instability when, for example, a woman veteran flees an abusive partner without a safe and stable living alternative, if she is unsafe in her housing due to threats of violence, and/or if an abusive partner destroys her housing as part of their abuse.

Although the study used the same population of 8,427 women veterans from the Montgomery et al. study, additional interviews were conducted with 20 of the respondents, where women veterans could provide more detail about their experiences. In the full group, nearly one in four (24.2 percent) who screened positive for past-year IPV experienced housing instability, compared to only one in 10 (10.1%) who screened negative.

Some impacts of Intimate Partner Violence (IPV), adapted from a screen capture from a VA Roundtable discussion on IPV and veteran homelessness, January, 2018.

Their research proposed three main themes about IPV and housing instability:

  • IPV interacts with housing instability both directly and indirectly;
  • Experiencing IPV impacts a woman veteran’s definition of housing safety and security. (This is important because women veterans and those who they interact with, including healthcare providers, may not “see” them as at risk for homelessness if they are partnered and/or housed; so it successfully introduces the idea that you can be housed and yet be unsafe.)
  • IPV can be a barrier to accessing housing services and other support systems, because of the risks associated with IPV experience, including the fluid nature of the threat(s) and the need for safety planning to take place sometimes in secret.

In my survey of approximately 2,500 U.S. women veterans about their experiences of homelessness after military service, almost one in five (16.7%) shared that they had stayed in a relationship characterized by intimate partner violence during a period of unstable housing (including but not limited to homelessness). Of this subgroup of women veterans who reported staying in an unsafe relationship, almost two-thirds (65.6%) had experienced military sexual trauma (MST) previously.

Looking at my data in a different way, of those women veterans who disclosed that a healthcare practitioner had told them they had experienced MST, and who also experienced unstable housing or homelessness, almost four in 10 (39.3%) reported staying in an unsafe relationship during housing instability. (A caveat is this subgroup does not represent the entire group of women veterans who experienced MST, not all of whom also experienced unstable housing or homelessness.)

With this as a background, I wanted to introduce what I’ve found in my survey of more than 2,500 women veterans from every era, including those who do not access VA services. A bit about my respondents:

  • Their average age was 46 in 2017.
  • Almost three-quarters (73.2%) were white, 13.5% were black, and 7.6% were Hispanic (not mutually exclusive with white or black).
  • More than one quarter (26.7%) had bachelor’s degrees, and almost one in five (19.6%) had master’s degrees.
  • The largest group had served in the Army (39.3%), followed by the Air Force (14.9%), the Navy (14.1%), higher than expected numbers from the Marine Corps (12.3%), with National Guard (7.5%) and Coast Guard (1.5%) accounting for the rest of responses. (Respondents who served in more than one branch, fewer than 10 percent of those surveyed, were tallied as part of each branch they mentioned.)
  • Three in 10 (30%) served during OIF/OEF, and
  • One-third (33.3%) reported serving during combat.
Women veterans are more likely than their civilian counterparts to experience intimate partner violence (IPV) over their lifetimes, according to recent research from VA. Women veterans are also the fastest-growing demographic of homeless veterans, according to VA. The relationship between IPV and homelessness in women veterans is opaque: Some women veterans may become homeless as a result of IPV, while others may experience IPV as a result of homelessness. In either case, more research is needed. Photo by DanielBendjy

Some of my findings

With the disclaimer that I haven’t finished analyzing all the results of my survey, here are some findings so far with respect to IPV and homelessness. Of the more than 1,500 women veterans who experienced homelessness or unstable housing and reported their branch — without respect to experiencing IPV or not — the percentages were fairly similar across the branches, meaning, not much difference by branch. For experiencing unstable housing/homelessness overall, National Guard was highest (29.4%), followed by Coast Guard (23.7%), and then Marines (22.5%), Air Force (20.2%), Army (20%), and Navy (19.6%).

Of the more than 400 women veterans who reported that they had stayed in an unsafe relationship and also reported their

  • Branch: 44.7% had served in the Army, 18% in the Air Force, 16.6% in the Marines, 16.11% in the Navy, 2.4% in the National Guard, and 2.2% in the Coast Guard.
  • Race/ethnicity: 66.9% were white, 11.8% were black, 7.4% were Hispanic, and 13.9% were other.
  • Current marital status: 38.9% were were currently separated, divorced or widowed, 38.1% were currently married or in a civil union, and 22.9% were single.

Other findings:

  • Of the approximately 350 women veterans who had stayed in an unsafe relationship and also reported what era of service they served during — and these eras can overlap, so they’re not mutually exclusive — the highest percentage was post-9/11 veterans (38.3%), followed by those who served during peacetime (35.5%), Gulf War-era (19.8%) and Vietnam (6.4%).
  • Combat exposure did not seem to make a big difference. Of those who reported staying in an unsafe relationship, about the same reported not having been exposed to combat (16%) as those who had (18%).
  • OEF/OIF service: Of those who reported staying in an unsafe relationship, one-third (32.6%) had served during OEF/OIF, while two-thirds (67.4%) had not.

Regarding VA eligibility and participation

In prior eras, women veterans may have been affirmatively told they were “not veterans” and/or that they were “not eligible” for VA services. This has created a gap in who knew that they were eligible and consequently enrolled, and is at least in part to blame for lower numbers of women veterans participating in VA healthcare than might have been expected. (Those numbers are growing, however, and including many older women veterans who now realize they are eligible). Because of this, I asked women veterans in my survey whether they had been told at the time they left the military that they were eligible for VA healthcare services, and also whether they had enrolled in services. (Those enrolled still may choose to get their healthcare elsewhere, but administratively they are now considered enrolled.)

As a point of information, in my survey, approximately six in 10 (59.7%) were told that they were eligible, and four in 10 were not told (40.3%). Separately, more than three-quarters of my respondents (75.9%) were enrolled in VA healthcare, while one-quarter (24.1%) were not. These figures are important because VA research is often limited to just those who are enrolled and participating in services and it’s important to also be able to include those who are for whatever reason, including wrong information, non-participants.

Of the subgroup of approximately 400 women veterans who had experienced housing instability and furthermore stayed in an unsafe relationship, characterized by IPV, during their time of unstable housing or homelessness — and answered questions about VA eligibility and enrollment — slightly more than half (53.3%) said they were not told they were eligible for VA services, versus 46.7% who were told. Similarly, of this same group who reported staying in an unsafe relationship, most (87.7%) were enrolled in VA services, while 12.3% were not.

Service-connected disability

In my study, of the women who reported IPV during periods of unstable housing and homelessness, almost three-quarters (72.9%) are today receiving compensation for a service-connected disability. (No relationship between IPV and service-connected disability is implied, but as mentioned earlier it might provide more options regarding leaving an unsafe relationship.) When I asked about what rating they had received, almost 300 women veterans in the subgroup of those who had stayed in an unsafe relationship provided their current ratings:

Another important consideration that deserves more exploration is what relationship, if any, there is to women veterans’ experience of military sexual trauma? Military sexual trauma is time-limited terminology, referring to experiences that occurred during military service, but intimate partner violence can happen before, during, or after military service. The question to ask would be is intimate partner violence happening more or less among women veterans who report experiencing military sexual trauma? And there are arguments that could be made either way about whether it would be likely to increase or decrease the risk. Again, more research needs to be conducted on this, because there is very little to date to analyze.

One of the implicit challenges with teasing out the relationship among military sexual trauma, intimate partner violence and homelessness among women veterans is that MST is not just under-reported but likely to be under-reported by quite a bit. (You can read RAND material to learn more about under-reporting of MST.) A recent report by Blais et al. mentioned various reasons why. In their study, nearly 1/4 of the female veterans in the self-selected sample indicated that they did not disclose their MST status when screened. (Non-disclosure was highest among those who reported that their assailant was a fellow unit member.)

For more information:

Although IPV is not a “women veterans-only” issue, there is gender-specific information for women veterans on VA’s site, here.

You can learn more about what Military Sexual Trauma (MST) is here.

The so-called “Wheel of Power and Control” can be a very eye-opening introduction to the causes and conditions of intimate partner violence for all people, irrespective of gender or veteran status. It’s linked below.