U.S. military service members who are discharged from service for misconduct are at high risk for mental health and substance use disorders, homelessness, mortality, and incarceration. The purpose of this dissertation was to investigate the pre- and post-discharge experiences and characteristics of this highly vulnerable population in order to inform improved prevention and intervention strategies.
Administrative data from the Department of Defense and Veterans Health Administration for veterans of recent conflicts were used to conduct 3 related retrospective cohort studies. These included (1) an evaluation of the demographic and military service characteristics and service-connected disabilities associated with discharge for misconduct; (2) an examination of post-discharge health status and healthcare utilization among misconduct-discharged veterans; and (3) the development of predictive models for homelessness and mortality among misconduct-discharged veterans.
Several demographic and military service characteristics were associated with increased risk for misconduct discharge, as were exposure to sexual trauma, and post-discharge designation of service-connected disabilities related to mental illness. Misconduct-discharged veterans were found to have significant and complex healthcare needs, and used clinical services at approximately double the rate of routinely discharged veterans. Several risk factors for homelessness and mortality among this population were identified. Risk stratification models showed good predictive accuracy for homelessness, and fair predictive accuracy for mortality.
Targeted counter-attrition strategies and an increased focus on health-related determinants of misconduct, including rehabilitative approaches to behavioral problems, may help to reduce misconduct-related attrition. Efforts to transition post-discharge care from specialty settings to integrated primary care settings may be successful in mitigating adverse outcomes. Risk stratification techniques can facilitate the efficient targeting of resources.
| Identifer | oai:union.ndltd.org:UTAHS/oai:digitalcommons.usu.edu:etd-7048 |
| Date | 01 May 2017 |
| Creators | Brignone, Emily |
| Publisher | DigitalCommons@USU |
| Source Sets | Utah State University |
| Detected Language | English |
| Type | text |
| Format | application/pdf |
| Source | All Graduate Theses and Dissertations |
| Rights | Copyright for this work is held by the author. Transmission or reproduction of materials protected by copyright beyond that allowed by fair use requires the written permission of the copyright owners. Works not in the public domain cannot be commercially exploited without permission of the copyright owner. Responsibility for any use rests exclusively with the user. For more information contact digitalcommons@usu.edu. |
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