Non-Routine Discharge From Military Linked To Mental Health and Substance Abuse Interview with:
Emily Brignone, BS

Informatics, Decision Enhancement, and Analytic Sciences Center
VA Salt Lake City Health Care System, Salt Lake City, Department of Psychology
Utah State University, Logan, Utah What is the background for this study?

Response: Nearly 30% of active duty Veterans of post-9/11 conflicts in Iraq and Afghanistan are discharged from military service for reasons other than expired term of service or retirement. These non-routine discharges can occur for a variety of reasons, including disability, failure to meet or maintain qualifications, early release, or misconduct. Veterans discharged under non-routine conditions are at greater risk for several concerning outcomes during the reintegration period, including unemployment, incarceration, homelessness, and suicide.

A better understanding of the context of the transition from military service to civilian life, including discharge type, may provide opportunities for mitigating risk for these negative outcomes. One potential indicator for the conditions surrounding this transition is the administrative code that the Department of Defense assigns to active duty military service members at the time of their separation from service. These codes describe the circumstances related to discharge, and can serve as clinically significant early markers for post-deployment mental illness, substance use disorders, and suicidality, and thereby subsequent adverse reintegration outcomes. What are the main findings?

Response: In the present study, we explore the association between discharge type and post-deployment diagnoses of mental illness, substance use, disorders, and suicidality during the first year of VA service usage using administrative data from the VA and the Department of Defense for a national sample of 443,360 Veterans.

In statistical models adjusted for the effects of demographic and military service characteristics, Veterans who were discharged from service for reasons related to disability, disqualification, or misconduct demonstrated risks for VHA-documented diagnoses related to mental illness, substance use disorders, and suicidality that were much higher than those who were discharged under routine conditions or with an early release discharge. Compared to routinely-discharged Veterans, odds for nearly all diagnostic outcomes were significantly greater among Veterans discharged for disqualification or misconduct, including up to 9 times higher for personality disorders, up to 4 times higher for bipolar/psychotic and alcohol/substance use disorders, and nearly 3 times higher for suicidal ideation and behaviors.

Disability-discharged Veterans had 2 times higher odds for diagnoses of anxiety disorders, and 4 times higher odds for bipolar/psychotic disorders. What should readers take away from your report?

Response: These results indicate a striking divide between Veterans with relatively low-risk discharge types (i.e., routine and early release) and those with high-risk discharge types (i.e., disability, disqualified, and misconduct) with regard to mental health in the early post-deployment period. These mental health risks may inform important points of intervention in the pathway toward serious negative reintegration outcomes. Thus, discharge type is an important factor to consider in post-deployment care, potentially including targeted case management and greater provider sensitivity to mental health issues among Veterans with risky discharge types. What recommendations do you have for future research as a result of this study?

Response: Future research can expand on the role of the discharge type by exploring factors that may precipitate non-routine discharge, potentially informing in-service preventive and rehabilitative efforts. In addition, because many of the vulnerabilities common among Veterans with high-risk discharge types are associated with worse health status and increased healthcare needs, future research should explore the relative frequency, types, patterns, and costs of health service utilization of these Veterans. Examination of these characteristics may provide important information regarding unmet treatment needs, problematic patterns of care, and opportunities to provide integrated care, ultimately informing strategies to mitigate adverse outcomes among this vulnerable Veteran subpopulation. Thank you for your contribution to the community.


Non-routine Discharge From Military Service: Mental Illness, Substance Use Disorders, and Suicidality
Brignone, Emily et al.
American Journal of Preventive Medicine , Volume 0 , Issue 0 ,

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on January 20, 2017 by Marie Benz MD FAAD