title: Non-routine Discharge From Military Service: Mental Illness, Substance Use Disorders, and Suicidality.
abstract: BACKGROUND
  Mental illness and substance use disorders among newly returned military service members pose challenges to successful reintegration into civilian life and, in extreme cases, may lead to outcomes such as incarceration, homelessness, and suicide. One potential early indicator for these difficulties is non-routine discharge from military service.
  
  
  METHODS
  Using data from the Veterans Health Administration (VHA) for 443,360 active duty service Veterans who deployed to Afghanistan and Iraq and subsequently utilized VHA services between Fiscal Years 2004 and 2013, this study examined risk for receiving a VHA-documented diagnosis of mental illness, substance use disorders, and suicidality as a function of discharge type, controlling for demographic and military service covariates. Analyses were conducted in 2016.
  
  
  RESULTS
  In total, 126,314 Veterans (28.5%) had a non-routine military service discharge. Compared with routinely discharged Veterans, odds for nearly all diagnostic outcomes were significantly greater among Veterans discharged for disqualification or misconduct, including personality disorders (AOR=9.21 and 3.29, respectively); bipolar/psychotic disorders (AOR=3.98 and 3.40); alcohol/substance use disorders (AOR=1.55 and 4.42); and suicidal ideation and behaviors (AOR=2.81 and 2.77). Disability-discharged Veterans had significantly higher odds for diagnoses of anxiety disorders (AOR=1.97) and bipolar/psychotic disorders (AOR=3.93).
  
  
  CONCLUSIONS
  Non-routine service discharge strongly predicts VHA-diagnosed mental illness, substance use disorders, and suicidality, with particularly elevated risk among Veterans discharged for disqualification or misconduct. Results emphasize the importance of discharge type as an early marker of adverse post-discharge outcomes, and suggest a need for targeted prevention and intervention efforts to improve reintegration outcomes among this vulnerable subpopulation.
authors.affiliation: Informatics, Decision Enhancement, and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, Utah; Department of Psychology, Utah State University, Logan, Utah.
authors.forename: Emily
authors.initials: E
authors.lastname: Brignone
authors.affiliation: Informatics, Decision Enhancement, and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, Utah; Department of Psychology, Utah State University, Logan, Utah; National Center for Homelessness Among Veterans, VA Medical Center, Philadelphia, Pennsylvania.
authors.forename: Jamison D
authors.initials: JD
authors.lastname: Fargo
authors.affiliation: Informatics, Decision Enhancement, and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, Utah; Department of Psychology, Utah State University, Logan, Utah.
authors.forename: Rebecca K
authors.initials: RK
authors.lastname: Blais
authors.affiliation: Informatics, Decision Enhancement, and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, Utah; Departments of Internal Medicine and Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, Utah.
authors.forename: Marjorie E
authors.initials: ME
authors.lastname: Carter
authors.affiliation: Informatics, Decision Enhancement, and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, Utah; Departments of Internal Medicine and Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, Utah.
authors.forename: Matthew H
authors.initials: MH
authors.lastname: Samore
authors.affiliation: Informatics, Decision Enhancement, and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, Utah; National Center for Homelessness Among Veterans, VA Medical Center, Philadelphia, Pennsylvania;; Departments of Internal Medicine and Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, Utah. Electronic address: adi.gundlapalli@hsc.utah.edu.
authors.forename: Adi V
authors.initials: AV
authors.lastname: Gundlapalli
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D000437:Alcoholism / Q000453:epidemiology; D015331:Cohort Studies; D016208:Databases, Factual; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D015994:Incidence; D054542:Iraq War, 2003-2011; D008016:Life Change Events; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology*; D008605:Mental Health Services / Q000458:organization & administration; D008875:Middle Aged; D008889:Military Personnel / Q000523:psychology*; D020380:Needs Assessment; D012189:Retrospective Studies; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000453:epidemiology*; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology*; D059020:Suicidal Ideation; D013405:Suicide / Q000706:statistics & numerical data*; D013997:Time Factors; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology