title: A mixed methods epidemiological investigation of preventable deaths among U.S. Army soldiers assigned to a rehabilitative warrior transition unit.
abstract: BACKGROUND
  The prevalence of medical risk factors for suicide (e.g., mental disorders, severe disability, social disruption) may be higher among WTs compared to traditional Army units. Likewise, the extent to which traditional factors that protect soldiers from developing serious mental disorders (e.g., social support, unit cohesion, leadership) are present among soldiers assigned to the WTU is unclear.
  
  
  OBJECTIVE
  An epidemiological consultation (EPICON) was conducted in 2010 to assess potential causes for a perceived high rate of suicides and preventable deaths in U.S. Army Warrior Transition Units (WTUs) and to identify potential improvements to the system of care.
  
  
  METHODS
  The EPICON focused on: (1) risk factors for suicide/preventable deaths; (2) chronic pain management; (3) utilization of and access to WTU medical and behavioral health (BH) services; and (4) the impact of the WTU environment on mission focus and warrior disposition. BH history was examined for soldiers who died by suicide or preventable death while assigned to the WTU (index cases) and a representative comparison group of non-index case soldiers. Surveys and focus groups were conducted at four WTUs with Warriors in Transition (WTs) and key support staff.
  
  
  RESULTS
  The use of psychotropic and/or CNS depressant medications, prevalence of BH diagnoses and substance use disorders, polypharmacy, alcohol use, and a high cumulative number of stressors were identified as important risk factors for preventable deaths in the WTC. Areas of potential improvement to the system of care included addressing negative perceptions of the WTU environment, lack of social support, barriers to accessing BH services and issues related to coordination of care.
  
  
  CONCLUSIONS
  There was no one single risk factor found to be associated with an increased likelihood of preventable deaths within the WTU. The unique design and operation of the WTUs as environments focused on treatment and rehabilitation provide both benefits and challenges to recovery and risk mitigation.
authors.affiliation: Behavioral and Social Health Outcomes Program, US Army Institute of Public Health, US Army Public Health Command, Aberdeen Proving Ground, MD, USA.
authors.forename: M S
authors.initials: MS
authors.lastname: Gallaway
authors.affiliation: Behavioral and Social Health Outcomes Program, US Army Institute of Public Health, US Army Public Health Command, Aberdeen Proving Ground, MD, USA.
authors.forename: C
authors.initials: C
authors.lastname: Lagana-Riordan
authors.affiliation: Behavioral and Social Health Outcomes Program, US Army Institute of Public Health, US Army Public Health Command, Aberdeen Proving Ground, MD, USA.
authors.forename: C R
authors.initials: CR
authors.lastname: Dabbs
authors.affiliation: Behavioral and Social Health Outcomes Program, US Army Institute of Public Health, US Army Public Health Command, Aberdeen Proving Ground, MD, USA.
authors.forename: M R
authors.initials: MR
authors.lastname: Bell
authors.affiliation: Behavioral and Social Health Outcomes Program, US Army Institute of Public Health, US Army Public Health Command, Aberdeen Proving Ground, MD, USA.
authors.forename: A A
authors.initials: AA
authors.lastname: Bender
authors.affiliation: Behavioral and Social Health Outcomes Program, US Army Institute of Public Health, US Army Public Health Command, Aberdeen Proving Ground, MD, USA.
authors.forename: D S
authors.initials: DS
authors.lastname: Fink
authors.affiliation: Behavioral and Social Health Outcomes Program, US Army Institute of Public Health, US Army Public Health Command, Aberdeen Proving Ground, MD, USA.
authors.forename: K
authors.initials: K
authors.lastname: Forys-Donahue
authors.affiliation: Behavioral and Social Health Outcomes Program, US Army Institute of Public Health, US Army Public Health Command, Aberdeen Proving Ground, MD, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Pecko
authors.affiliation: Behavioral and Social Health Outcomes Program, US Army Institute of Public Health, US Army Public Health Command, Aberdeen Proving Ground, MD, USA.
authors.forename: S C
authors.initials: SC
authors.lastname: Schmissrauter
authors.affiliation: Behavioral and Social Health Outcomes Program, US Army Institute of Public Health, US Army Public Health Command, Aberdeen Proving Ground, MD, USA.
authors.forename: R
authors.initials: R
authors.lastname: Perales
authors.affiliation: Behavioral and Social Health Outcomes Program, US Army Institute of Public Health, US Army Public Health Command, Aberdeen Proving Ground, MD, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Coombs
authors.affiliation: Behavioral and Social Health Outcomes Program, US Army Institute of Public Health, US Army Public Health Command, Aberdeen Proving Ground, MD, USA.
authors.forename: M R
authors.initials: MR
authors.lastname: Rattigan
authors.affiliation: Behavioral and Social Health Outcomes Program, US Army Institute of Public Health, US Army Public Health Command, Aberdeen Proving Ground, MD, USA.
authors.forename: A M
authors.initials: AM
authors.lastname: Millikan
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D003643:Death; D062787:Drug Overdose / Q000401:mortality; D016021:Epidemiologic Studies; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications; D008875:Middle Aged; D008889:Military Personnel / Q000706:statistics & numerical data*; D012047:Rehabilitation Centers / Q000592:standards*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D013405:Suicide / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D000092864:Suicide Prevention
keywords: Military; behavioral health; polypharmacy; soldiers; suicide