Chronic Stress, Inflammation, and Resilience: Predictors of Social Integration in Recently Housed Black and White Veterans

Despite the VA’s considerable success in reducing the number of homeless Veterans through permanent supportive housing, a fundamental problem remains. Permanent housing is necessary, but not sufficient, for successful social integration. Many Veterans remain isolated and without adequate social support after being housed. Black Veterans disproportionately experience homelessness yet remain understudied in psychological science. A better understanding of racial differences in risk and protective factors of social integration in recently housed Black and White Veterans could inform the development of novel rehabilitative interventions. This Career Development Award (CDA-2) proposes to utilize an innovative, multimodal approach to examine the contributions of stress, inflammation, and resilience to social integration in recently housed Black and White Veterans. Homelessness is extremely stressful and Black Veterans may experience additional stressors due to systemic inequities that could impede social integration. Furthermore, psychosocial stress is associated with an inflammatory response in the body. Inflammation could, in turn, exacerbate problems with social integration given the increasing evidence of its effect on social behavior. However, previous work finds better social integration in homeless Black Veterans compared to White Veterans, suggesting the presence of protective factors that mitigate the effects of stressors on social integration in Black Veterans. Resilience is a modifiable trait that might help buffer the negative consequences of stress and inflammation on social integration. The extent to which these factors differentially impact social integration in recently housed Black and White Veterans is relatively unknown. The overall goal of this longitudinal study is to examine racial differences in the effects of stress, inflammation, and resilience on social integration in recently housed Black and White Veterans. First, we will examine the cross-sectional and longitudinal associations of stress, inflammation, and resilience with social integration. Second, we will examine whether race moderates these associations. As an exploratory aim, we will examine an integrative longitudinal model of social integration, including the risk and protective factors listed above and psychiatric symptoms, in recently housed Black and White Veterans. Findings from this study have the potential to advance our understanding of risk and protective mechanisms of social integration in recently housed Black and White Veterans and inform innovative rehabilitative treatments that mitigate the effects of stress and inflammation to improve social integration. This CDA will provide the applicant, Derek M. Novacek, PhD, with the training in the areas of: (1) social integration and Veteran homelessness; (2) stress and inflammation, including multiple methods to assess inflammatory markers; and (3) racial health disparities in Veterans. The applicant’s career goal is to become a VA research psychologist, working to improve social integration in homeless Veterans and develop culturally congruent interventions. The training outlined in this CDA application will lay the groundwork for the applicant to develop an independent research program within the VA focused on determinants of social integration in homeless Veterans. The VA RR&D Center on Enhancing Community Integration for Homeless Veterans (THRIVe), VISN 22 Mental Illness Research, Education, and Clinical Center (MIRECC) at the VA Greater Los Angeles Healthcare System (GLA), and the University of California, Los Angeles (UCLA) provide an excellent environment and infrastructure to complete the proposed study. The primary mentor will be Michael F. Green, PhD, the Director of THRIVe, Director of the VISN 22 MIRECC Treatment Unit, and an established researcher in Veteran homelessness. The applicant will also receive specialized training from an expert in research with vulnerable Veterans (Lillian Gelberg, MD, MPH), a leading researcher in inflammation (Steven W. Cole, PhD), and a renowned scholar in racial health disparities in Veterans (Donna L. Washington, MD, MPH). The applicant will also receive statistical consultation from biostatistician, Catherine A. Sugar, Ph.D.