Risk of Incarceration and Other Characteristics of Iraq and Afghanistan Era Veterans in State and Federal Prisons

Of the total sample of 30,968 veterans assessed by the HCRV program, 1,201 (3.9%) were veterans of OEF/OIF/OND. Among the 29,767 (96.1%) other veterans, 3.0% (N=893) served before the Vietnam War, 27.9% (N=8,305) during the Vietnam War era, 47.8% (N=14,229) during the post-Vietnam era, and 18.7% (N=5,566) during the Persian Gulf War. A total of 2.6% (N=774) served after September 11, 2001, but were not deployed for OEF/OIF/OND.

National representative data from the 2010 National Survey of Veterans were used to compare the risk of incarceration among nonincarcerated veterans and OEF/OIF/OND veterans in HCRV. As Table 1 shows, across age groups, even the youngest, OEF/OIF/OND veterans were less than half as likely as other veterans to be incarcerated. This remained true for analyses of only males, only whites, only blacks, and only Hispanics (who may also have identified themselves as white or black).

Table 2 shows the sociodemographic characteristics, criminal history, clinical status, and homelessness history of all veterans in the HCRV program. A majority of veterans were unmarried white men in their late forties who did not report combat exposure, were not working, and had little income in the past month. At the time of interview, veterans had been incarcerated for an average of over four years, and the most common current incarceration offense was a violent offense, property offense, or drug offense. Veterans reported an average age at their first arrest of 26 and an average of eight lifetime arrests. Nearly half reported using substances at the time of offense, but the response rate for that question was only 55.6%.

Most veterans reported serious medical problems and had an alcohol or drug abuse or dependence diagnosis, but most were not currently homeless and reported no recent homelessness history. Most veterans had not used the VA in the past six months but reported being willing to use VA mental health and medical services.

Bivariate analyses revealed that compared with other veterans, OEF/OIF/OND veterans were significantly younger and were more likely to be white, be married, and have some income in the past month. OEF/OIF/OND veterans were expected to be incarcerated for a shorter duration of time, were more likely to have been using only alcohol (as opposed to alcohol and drugs) at the time of the offense, and were less likely to be homeless or have a history of recent homelessness. OEF/OIF veterans were less likely to have serious medical problems and to report drug abuse or dependence but were more likely to have a mood disorder, an adjustment disorder, and other mental health problems. Most notably, OEF/OIF/OND veterans were dramatically more likely to report combat exposure and combat-related posttraumatic stress disorder (PTSD). Compared with other veterans, OEF/OIF/OND veterans were also more likely to have used the VA in the past six months and were more willing to use VA mental health services but were less willing to use VA residential treatment.

Multivariate logistic regression analyses (Table 3) showed that among HCRV clients, younger age, being married, reporting combat exposure, having a shorter duration of incarceration, being first arrested at an older age, having combat-related PTSD, and not having a drug abuse or dependence diagnosis were all independently associated with OEF/OIF/OND service, with the largest effect sizes for combat exposure and combat-related PTSD.

National administrative data from the HCRV program revealed that OEF/OIF/OND veterans represented a small minority (3.9%) of the veteran population incarcerated in state and federal prisons. Moreover, even among the youngest age group (aged 20–29 years) and within different ethnic groups, OEF/OIF/OND veterans were less than half as likely to be incarcerated as other veterans, suggesting this finding is not simply an artifact of age or race. This finding may reflect the increased attention and service supports provided to OEF/OIF/OND veterans by the VA (11,12) and other organizations (13,14) and is consistent with reports that the proportion of prisoners who are veterans has declined steadily over the past three decades (5). It is also in accord with studies showing less risk of homelessness (15) and substance abuse (16) among OEF/OIF/OND veterans than among veterans of earlier service eras.

Of incarcerated OEF/OIF/OND veterans, a majority were unmarried white men in their early thirties who were not homeless, were not working, and had no income. Multivariate analyses showed that compared with other veterans, OEF/OIF/OND veterans were younger, were more likely to be married, and expected to have shorter incarceration periods. The most common current incarceration offense was a violent offense, reported by 38% of OEF/OIF/OND veterans and 35% of other veterans; these proportions are consistent with, although slightly lower than, the proportions contained in a previous report (5). After the data were controlled for age, OEF/OIF/OND veterans still had a shorter incarceration period and reported being arrested fewer times in their lifetime than other veterans.

Alcohol abuse or dependence was most common diagnosis for both OEF/OIF/OND veterans (43%) and other veterans (45%). Psychotic disorder was the least common diagnosis among OEF/OIF/OND veterans (7%), and combat-related PTSD was the least common diagnosis among other veterans (5%). Most incarcerated veterans had some mental health or substance abuse problems, which is consistent with previous studies (14,17). The high rates of substance use disorders among all incarcerated veterans suggest that the HCRV program should aggressively seek to address substance abuse problems. It is likely that many offenses leading to incarceration were either directly or indirectly related to substance abuse, as evidenced by the sizable proportion of veterans who endorsed using substances at the time of their offense and the number of veterans who were currently incarcerated for drug offenses.

Incarcerated OEF/OIF/OND veterans were less likely than other veterans to have a drug abuse or dependence diagnosis, which may be due to notable decreases over the past 28 years in the use of illegal drugs and cigarettes among military personnel, likely reflecting the military’s implementation in the1980s of a zero tolerance policy for drug abuse (18).

Perhaps the most salient clinical finding was that incarcerated OEF/OIF/OND veterans were three times more likely than other incarcerated veterans to have combat-related PTSD, probably reflecting their greater likelihood of combat exposure. This finding may have important clinical implications, given that PTSD has been associated with a host of negative health, psychosocial, and functional problems among OEF/OIF/OND veterans (19–21). Incarcerated adults often do not receive needed mental health treatment (22,23), and provision of these services after their release may be particularly important to prevent recidivism, homelessness, and other negative outcomes (24,25). Thus, programs like HCRV can hope to be instrumental in helping incarcerated veterans connect to needed mental health services upon their release and successfully integrate into the community.

Previous efforts to link incarcerated veterans to VA health care services have been challenging, but specialized outreach services have shown promise (26). Further research is needed to evaluate the success of prerelease outreach efforts in linking veterans to needed health and mental health services after discharge and to both preventing criminal justice system recidivism and homelessness and improving health.

Several limitations of this study deserve mention. Although the HCRV program did not formally target particular groups of veterans for outreach, the representativeness of the national sample in this study of the population of incarcerated veterans is undetermined. The HCRV program was directed at veterans soon to be discharged, so the sample may underrepresent younger veterans with longer sentences, although this possibility could not be empirically evaluated. However, one might expect that the VA’s focus on OEF/OIF/OND veterans and the extensive media attention paid to this group of veterans may lead to an oversampling of this group. Yet, this expectation only strengthens the credibility of the finding that incarcerated OEF/OIF/OND veterans are less likely to be incarcerated than other veterans.

Causal directionality of the associations between OEF/OIF/OND status and other characteristics is unknown, and causal risk factors cannot be conclusively determined from these data. The diagnoses of mental disorders, including PTSD, were not assessed with structured, standardized measures and relied on veteran self-report and the clinical skills and judgment of HCRV specialists. Moreover, PTSD from noncombat-related events was not assessed, which may be an area worthy of future study.

Data about whether veterans in the sample had filed VA disability claims were not available. However, given that combat-related PTSD is the most common VA psychiatric disability claim filed among veterans (27,28), it would have been useful to examine how pending disability claims or intent to apply for disability influenced the clinical presentation of incarcerated veterans (29) and the study results, especially because older veterans may be more likely than younger veterans to have had their disability claims settled.

HCRV data suggested that OEF/OIF/OND veterans are at lower risk of incarceration than veterans of other service eras. However, incarcerated OEF/OIF/OND veterans reported higher rates of combat exposure and PTSD than other incarcerated veterans, suggesting that some incarcerated OEF/OIF/OND veterans may especially benefit from PTSD treatment and VA services upon their release.

The authors report no competing interests.