Mental Health Risk Among Veterans with Non-Routine Separation from Military Service

Introduction: Nearly 30% of active duty Veterans leave military service under non-routine conditions (i.e., separation due to conditions other than expired term of service, including disability or misconduct). Veterans with non-routine separations are at elevated risk for several poor reintegration outcomes, including unemployment, incarceration, and homelessness. An understanding of the relationship between type of military separation and outcomes such as mental health and substance use during the early stages of reintegration is important for understanding and addressing problematic post-deployment trajectories among Veterans with non-routine separations from military service.

Methods: Administrative data from the Veterans Health Administration (VHA) was utilized in a retrospective cohort design. Data were included for Active Duty U.S. Veterans who participated in deployments related to operations Iraqi Freedom, Enduring Freedom, and New Dawn, and subsequently utilized Veterans Health Administration (VHA) services over a 10-year period (N=443,360). Administrative codes characterizing type of separation from military service were classified into categories, including normal, disability, early release, disqualified, misconduct, and other/unknown. Using a series of logistic regression analyses, mental health and substance use diagnoses were modeled as outcomes as a function of separation category, controlling for demographic and military service covariates.

Results: Compared to Veterans with routine separations, Veterans who separated due to disability had significantly higher odds for anxiety and mood disorders (adjusted odds ratios [AOR] = 1.90 and 2.54), as well as psychotic disorders (AOR=4.52). Veterans with early release separations had similar diagnostic outcomes to Veterans with routine separations. Veterans who separated due to disqualification or misconduct had significantly higher odds of every diagnostic outcome, including 3.5 times higher odds for bipolar disorder (AOR = 3.53 and 3.59), 4 times higher odds for suicidal behavior and ideation (AOR range = 2.96-4.44), up to 8 times higher odds for personality and psychotic disorders (AOR range = 4.13-8.76), and up to 6 times higher odds for alcohol and substance use disorders (AOR range = 1.47-6.85).

Conclusions: Non-routine separation from military service is a strong predictor of several mental health and substance use diagnoses, with particularly high risk among Veteran who separate due to disqualification or misconduct. Results emphasize the importance of separation type as a marker of post-deployment outcomes, and suggest a need for targeted prevention and intervention efforts to improve reintegration outcomes among this vulnerable subpopulation of Veterans.