O5.3. MOTIVATIONAL FACTORS PREDICT COMMUNITY INTEGRATION IN RECENTLY-HOUSED VETERANS WITH PSYCHOSIS: A 12-MONTH LONGITUDINAL STUDY

Homelessness in Veterans is a major public health problem. Even with efforts to reduce Veteran homelessness, Veterans continue to experience challenges with community integration (e.g., social functioning, independent living, work/school activities) after they receive housing. Homeless Veterans with a psychotic disorder are a unique population with complex challenges and limited reintegration into the community. However, the specific determinants contributing to poor community integration have not been explored. Previous research with non-homeless psychotic individuals indicate motivation (e.g., negative symptoms and defeatist beliefs) and ability (e.g., social and non-social cognition) as two main predictors of community integration. We used this framework as a starting point to examine predictors of community integration in recently-homeless Veterans over a one-year period. Participants included 95 homeless Veterans from the Veterans Affairs (VA) Greater Los Angeles Healthcare System with a DSM-IV psychotic disorder (schizophrenia, schizoaffective, bipolar disorder or major depression with psychotic features, psychotic disorder not otherwise specified). Participants were enrolled in the Housing and Urban Development – VA Supportive Housing program which provides permanent housing in the community with case management and were tested at baseline (before receiving housing) and 12 months later. For motivation, we used the Clinical Assessment Interview for Negative Symptoms (CAINS) motivation and pleasure (MAP) subscale and Defeatist Attitudes from the Dysfunctional Attitudes Scale. For ability, we examined non-social cognition with the MATRICS Consensus Cognitive Battery and social cognition with the Empathic Accuracy Task, the Ekman Facial Identification Task, and The Awareness of Social Inference Task. We assessed community integration with a normed composite derived from three measures: Role Functioning Scale (using the family and social network ratings), Lubben Social Network Scale, and the Social Disconnectedness Scale. We examined predictors of community integration at baseline and baseline prediction of community integration after 12 months using correlational analyses. Data were available for 95 participants at baseline and 51 at 12 months. The CAINS-MAP at baseline correlated strongly with community integration at baseline (r = -0.69, p < 0.001) and at 12 months (r = -0.62, p < 0.001), with lower motivation being associated with worse community integration. MAP at baseline correlated with community integration at 12 months even after controlling for baseline community integration with partial correlation (r = -0.29, p = 0.04). Defeatist attitudes correlated with community integration at baseline (r = -0.27, p < 0.01), but did not predict community integration at 12 months. The ability factors of social and non-social cognition were not associated with community integration either at baseline or predicting integration at 12-months. Our results revealed that motivation, but not ability, predicted community integration at baseline, as well as 12 months later, in homeless Veterans with psychosis. These findings have treatment implications for this unique population: interventions targeting motivational challenges (e.g., motivational interviewing) may be important to improving community integration after homeless individuals are housed.