How Do Legal Problems Relate to Discharge Status in Post-9/11 Era Military Veterans?

Background: Little is known about over 125,000 veterans who received non-honorable military discharges since 2001, even though these veterans face substantial barriers to obtaining services and are at higher risk than their honorably discharged peers for negative mental and behavioral health outcomes including suicide. While in-service legal problems like DUI and domestic violence arrests are associated with non-honorable discharge status, emerging evidence suggests that these behaviors may reflect undiagnosed mental health challenges, like PTSD, among non-honorably discharged veterans. The present study sought to develop a nuanced model of associations between discharge status, pre-service and in-service legal problems, combat experiences, and PTSD, in order to contribute to improved outcomes in this vulnerable population.

Methods: A total of 847 veterans living the in the San Francisco Bay and greater Chicago area participated in the study. The sample comprised honorably discharged (n=731) and non-honorably discharged veterans (n=116). Two sequential multivariable logistic regression models were specified to test associations between legal problems, combat experiences, PTSD symptoms, and discharge status. In model 1, pre-service legal problems and demographic characteristics were entered simultaneously into the model. In model 2, demographic characteristics were retained and in-service legal problems as well as combat experience and PTSD symptoms were entered into the model.

Results: In model 1 examining associations between pre-service predictors and discharge status, pre-service DUI (OR= 7.88, 95% CI: 2.27, 22.83), arrest (OR= 2.56, 95% CI: 1.12, 5.85), and DV (OR= 9.74, 95% CI: 3.80, 25.02) were significantly associated with non-honorable discharge. In model 2 examining associations between in-service predictors and discharge status, in-service DUI (OR= 5.36, 95% CI: 2.13, 13.44), and DV (OR= 5.72, 95% CI: 1.72, 14.57) remained significant. In addition, PTSD symptoms (OR= 1.04, 95% CI: 1.02, 1.06) were significantly associated with non-honorable discharge status, though combat experiences were not. For both non-routine and routine discharge status groups, a greater percentage of study participants reported DUI, arrest, DV, and substance use legal problems in-service than pre-service. Also notable is that the mean PCL-5 (PTSD) score was roughly twenty points higher for those with non-honorable (51.44) compared to honorable (31.19) discharge status.

Conclusion: Both in-service and pre-service legal problems significantly predicted non-routine discharge status. In addition, each additional unit of increase in PTSD symptoms was associated with a 4% increase in the odds of non-honorable discharge status, and non-honorably discharged veterans endorsed substantially higher PTSD burdens than honorably discharged veterans. This suggests that in-service process and characteristics may be prime drivers of non-honorable discharge, and that PTSD symptom burden may be a core component of this risk.