Understanding risk in younger Veterans: Risk and protective factors associated with suicide attempt, homelessness, and arrest in a nationally representative Veteran sample

Scoping review of military veterans involved in the criminal legal system and their health and healthcare: 5-year update and map to the Veterans-Sequential Intercept Model

BACKGROUND

A previous scoping review of legal-involved veterans' health and healthcare (1947-2017) identified studies and their limitations. Given the influx of literature published recently, this study aimed to update the previous review and map articles to the Veterans-Sequential Intercept Model (V-SIM) - a conceptual model used by key partners, including Veterans Health Administration, veteran advocates, criminal justice practitioners, and local governments to identify intercept points in the criminal legal system where resources and programming can be provided. Developing an updated resource of literature is essential to inform current research, discover gaps, and highlight areas for future research.

METHODS

A systematic search of 5 databases identified articles related to legal-involved veterans' health and healthcare published between December 2017 through December 2022. The first and senior authors conducted abstract reviews, full-text reviews, and data extraction of study characteristics. Finally, each article was sorted by the various intercept points from the V-SIM.

RESULTS

Of 903 potentially relevant articles, 107 peer-reviewed publications were included in this review, most related to mental health (66/107, 62%) and used an observational quantitative study design (95/107, 89%). Although most articles did not explicitly use the V-SIM to guide data collection, analyses, or interpretation, all could be mapped to this conceptual model. Half of the articles (54/107, 50%) collected data from intercept 5 (Community Corrections and Support Intercept) of the V-SIM. No articles gathered data from intercepts 0 (Community and Emergency Services Intercept), 1 (Law Enforcement Intercept), or 2 (Initial Detention and Court Hearings Intercept).

CONCLUSIONS

There were 107 articles published in the last five years compared to 190 articles published in 70 years covered in the last review, illustrating the growing interest in legal-involved veterans. The V-SIM is widely used by front-line providers and clinical leadership, but not by researchers to guide their work. By clearly tying their research to the V-SIM, researchers could generate results to help guide policy and practice at specific intercept points. Despite the large number of publications, research on prevention and early intervention for legal-involved veterans is lacking, indicating areas of great need for future studies.

Prevalence of youth experiencing homelessness and its association with suicidal thoughts and behaviors: Findings from a population-based study

Although various studies have examined factors associated with suicidal behaviors among youth, few studies have investigated the association between youth experiencing homelessness (YEH) and suicidal thoughts and behaviors (STBs) using a large nationally representative sample. The objectives of this study were to investigate prevalence of YEH and its association with STBs. Data for this study came from the 2021 Youth Risk Behavior Survey. An analytic sample of 17,033 youth aged 14-18 (51.7 % male) was analyzed using binary logistic regression. Of the 17,033 youth examined, 3 % experienced homelessness during the past 30 days, 21.3 % experienced suicidal ideation, 17.3 % made a suicide plan, and 10.9 % attempted suicide during the past 12 months. Controlling for demographic characteristics and feeling sad or hopeless, YEH was associated with 2.48 times higher odds of experiencing suicidal ideation (AOR=2.48, p<.001), 2.46 times higher odds of making a suicide plan (AOR=2.46, p<.001), and 4.38 times higher odds of making a suicide attempt (AOR=4.38, p<.001). The findings of this study highlight the importance of identifying youth who are at risk of experiencing homelessness to ensure early interventions are put in place to prevent suicidal behaviors.

Juvenile Violent Victimization and Adult Criminal Outcomes: The Role of Military Service as a Turning Point in Young Adulthood

Previous research has consistently shown that juvenile violent victimization is associated with an increased risk of future criminal involvement, a phenomenon commonly known as victim-offender overlap. Despite a growing interest in the factors underlying this overlap, potential roles of major life transitions and turning points that may interrupt and reshape the nature of this developmental association have garnered less academic attention. Analyzing nationally representative data from waves I, IV, and V of the National Longitudinal Study of Adolescent to Adult Health (Add Health; n = 10,205), this study investigates the association between juvenile violent victimization and adult criminal outcomes (i.e., violent offending, non-violent offending, arrest, and incarceration) and whether this association is moderated by military service with and without combat experience in young adulthood. Employing a series of logistic regression analyses and adjusting for a host of covariates, measures of selection, and criminogenic traits, we found that juvenile violent victimization was significantly associated with greater odds of violent offending, arrest, and incarceration in adulthood. Among individuals with violent victimization histories, military service with no combat experience was associated with a 16% decrease in the odds of incarceration in adulthood. Combat experience, however, was associated with over seven times greater odds of violent offending in adulthood for these individuals. These findings have important implications for theory, research, and practice, and highlight the relevance of life transitions and turning points in general, and military service in particular, in mitigating or perpetuating the criminogenic impacts of violent victimization in the life course.

The mediating role of social support in associations between childhood adversity, military sexual trauma, and homelessness in a nationally representative sample of US veterans

Among veterans, availability of social support and histories of military sexual trauma (MST) and/or adverse childhood experiences (ACEs) are particularly salient correlates of homelessness. Using path analyses, we investigated whether social support (i.e., interpersonal social support and community integration) would at least partially account for the relationships of MST and ACEs with any lifetime homelessness in a large, nationally representative sample of veterans (N = 4069, 9.8% female). Interpersonal social support and community integration partially explained the relationship between ACEs and any lifetime homelessness. However, they did not mediate the relationship between MST and any lifetime homelessness. Female veterans also reported higher trauma rates and lower perceived social support than male counterparts during correlational analyses. These results reinforce existing literature on the importance of research and interventions tailored to veterans with low social support and integration. Results have potential to inform interventions and policy for veterans experiencing and/or at risk for homelessness.

Rural former service members participate in meaningful occupations to 'fill the void' after military service

INTRODUCTION

Over 50% of former service members report debilitating health conditions and difficulty adjusting to civilian life. Former service members living in rural areas are even more likely to experience poor health outcomes and have decreased access to specialist health-care services. Participation in meaningful occupations can support health and adjustment after military service. However, little is known about rural former service members' perspectives and experiences of participating in occupations after separating from military service. This study explored rural former service members' experiences of participating in occupations during their transition and their perceptions of how these experiences influenced their health and adjustment.

METHODS

Purposive sampling was used to recruit 10 rural former Australian Defence Force members discharged from service between 1 July 2013 and 1 July 2018. Former service members participated in a series of semi-structured interviews. Interpretative phenomenological analysis was used to determine themes for individual participants and then overarching themes that characterised the experiences of the group.

FINDINGS

A single overarching theme, 'It can't all be for nothing': Searching for ways to fill 'the void' through meaningful occupational participation, reflected rural former service members' experiences. The different ways that participants sought to fill 'the void' after military service were interpreted through two sub-themes: (1) 'You can't heal if you're still in a battlefield': Participating in occupations to re-establish safety and wellbeing, and (2) 'I was in a uniform and I could still do well': Participating in occupations to reconnect with self and continue the mission to serve.

CONCLUSION

Rural former service members participated in various occupations to establish safety, wellbeing, and reconnection after transitioning from military service. The findings point to the need for further research to inform the development of consumer-led occupation-based interventions that are sensitive to individuals' service history, environmental context, and trauma recovery needs.