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2019 HSR&D/QUERI National Conference Abstract

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1085 — Understanding the Characteristics of Justice-Involved Gulf War Era Veterans Receiving VA Care

Lead/Presenter: Brice Terpstra,  COIN - Salt Lake City
All Authors: Terpstra B (Veterans Affairs Salt Lake City Health Care System; Department of Internal Medicine, University of Utah School of Medicine), Amuan, M (Veterans Affairs Salt Lake City Health Care System), Kimbrel, N (Durham VA Medical Center; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center; Durham VA HSRD Center of Innovation (COIN) to Accelerate Discovery and Practice Transformation (ADAPT); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine) Pugh, MJ (Veterans Affairs Salt Lake City Health Care System; Department of Internal Medicine, University of Utah School of Medicine)

Objectives:
It is estimated that 10 percent of the over 2 million individuals incarcerated in the U.S. Criminal Justice System (CJS) are U.S Military Veterans. In general, individuals in the CJS have increased risks of mental illness, substance abuse, and homelessness. Many of these issues coincide with issues Veterans can experience after discharge from military service and often serve as a catalyst for CJS involvement. Gulf War Era Veterans have been noted with experiencing similar issues as well as complicated medical comorbidities, yet little is known about the demographic profile of this population of justice-involved Veterans (JIV). Our objective was to gain a better understanding of the characteristics of Gulf War Era veterans intertwined within the CJS.

Methods:
Within our cohort of 883,463 Gulf War Era Veterans receiving VA care between 2008-2017, 14,040 had a history of incarceration in VETSNET data. Using VA inpatient and outpatient data we identified mental and physical health conditions using ICD-9/ICD-10 codes, and compared demographic characteristics and prevalence of each condition (e.g., substance abuse, alcohol abuse, homelessness, suicide, medical and mental health diagnoses) for JIV vs. non-JIV in the cohort. Reported differences were significant at the p < .001 level.

Results:
Veterans with a history of incarceration were more likely to experience homelessness (60% vs 7%), suicidal ideation/attempt (21.7% vs. 2.7%), alcohol abuse (54% vs. 10.2%), substance abuse (60.5% vs. 11.7%), and opioid abuse (11.3 % vs. 1.1%). Similarly, we found higher rates of mental illness (PTSD, anxiety, depression, bipolar, schizophrenia) and medical ailments (seizures, insomnia, hepatitis C, headache, and backpain).

Implications:
Gulf War era JIV have profound disease burden including elevated rates of homelessness, suicide, substance/alcohol abuse.

Impacts:
While JIV account for 1.6% of the Gulf War era cohort, the need for intensive services is evident. Many may have been released from incarceration before VA JIV programs were fully implemented, or they may be located in areas where JIV services are not available. These findings may better help create a needs profile for programs, such as the Veteran Justice Outreach, which target justice involved veterans not currently receiving VA care.