Military Health System (MHS) data were analyzed to estimate the prevalence of demographic, military, deployment, physical, mental health, and substance use characteristics of the AWTU cohort (N=31,094) compared to an Army cohort (N=851,997) who returned from OEF/OIF/OND deployments between FY2008-FY2015 and received BH care in the MHS, but were not referred to an AWTU during post-deployment. This study aimed to: (1) compare military and deployment characteristics of Army service members (SMs) who returned from Iraq and Afghanistan deployments from FY2008-FY2015 and were referred to Warrior Transition Units (WTUs) to those who were not referred to WTUs and (2) estimate the prevalence of physical injuries and behavioral health diagnoses of Army service members referred to WTUs from FY2008-FY2015 within 90 days of WTU referral.

1. Behavioral Health Diagnoses among Army Service Members Referred to Warrior Transition Units
Nikki R. Wooten1, Jordan A. Brittingham2, Laura A. Hopkins3, Diana D. Jeffery4, Mary Jo Larson5,
Abbas S. Tavakoli6, Hrishikesh Chakraborty2, Shamika D. Jones1,2, Lena M. Lundgren7, Sue M. Levkoff1
1College of Social Work, University of South Carolina. 2Arnold School of Public Health, University of South Carolina.
3Kennell and Associates, Inc., Falls Church, VA. 4 Clinical Support Division, Defense Health Agency, U. S. Department of Defense, Falls Church, VA. 5 Institute of Behavioral Health,
Brandeis University, Waltham, MA. 6College of Nursing, University of South Carolina. 7School of Social Work, Boston University, Boston, MA.
Funded by the National Institute on Drug Abuse #K01DA037412
 Severe physical and behavioral health conditions pose significant
problems for the U.S. military because of their negative impact on
military health and deployment readiness.
 Physical injuries, mental health and substance use disorders are
associated with functional impairment, decreased work productivity,
increased health care utilization, and early attrition from military
service.
 The Army Warrior Care and Transition Program facilitates the
provision of comprehensive physical and behavioral health care in
Warrior Transition Units (WTUs) for Army SMs worldwide.
 WTUs are military medical units co-located with major military
treatment facilities that provide six months or more of
comprehensive, team-based healthcare to ill, injured, and wounded
SMs with the support of their military and family communities.
 Similarities and differences may exist between deployed Army SMs
referred to WTUs and those not referred to WTUs.
BACKGROUND
 This study: (1) compared military and deployment characteristics
of Army service members (SMs) who returned from Iraq and
Afghanistan deployments from FY2008-FY2015 and were referred
to Warrior Transition Units (WTUs) to those who were not referred
to WTUs and (2) estimated the prevalence of physical injuries and
behavioral health diagnoses of Army service members referred to
WTUs from FY2008-FY2015 within 90 days of WTU referral.
OBJECTIVE
This study was funded by the National Institute on Drug Abuse
(NIDA #K01DA037412, PI: Dr. Wooten). We acknowledge Laura
Hopkins and Kennell and Associates, Inc. for creating data files
and conducting analyses, as well as Dr. Jeffery, Defense Health
Agency project manager, for sponsoring access to these data.
The Defense Health Agency’s Privacy and Civil Liberties Office of
the U.S. Department of Defense approved a data use agreement
for access to these data. The opinions and assertions herein are
those of the authors and do not necessarily reflect the official
views of the U. S. Department of Defense, NIDA, or the National
Institutes of Health. Contact: Dr. Wooten, nwooten@sc.edu.
ACKNOWLEDGEMENTS
 Between FY2008-FY2015, 3.5% of
Army SMs returning from Iraq and
Afghanistan deployments were
referred to WTUs.
 The majority (79.7%) of Army SMs
who were referred to WTUs were
under age 40 (18-39 years).
 The largest proportion of Army SMs
were referred to WTUs in FY2012
(4.5%) and FY 2015 (4.3%).
 Most (57%) Army SMs were
referred to WTUs before their
deployments ended (31%) or more
than 365 days post-deployment
(26%).
 The most common primary
diagnoses within 90 days after
WTU referral among Active,
National Guard, and Reserve Army
SMs were physical injuries, anxiety,
mood, and adjustment disorders.
 Almost 10% of Active Army SMs
referred to WTUs were diagnosed
with SUDs and almost 10% of
Reserve Army SMs were diagnosed
with blindness.
 Future research should examine
pre-deployment, deployment, and
post-deployment factors associated
with WTU referral, behavioral
health diagnoses, and behavioral
health service utilization in Army
SMs referred to WTUs.
DISCUSSION
 Study population included all Army SMs (N= 883,091) who
returned from Iraq and Afghanistan deployments from FY2008-
FY2015, including Active, National Guard, and Reserves.
 WTU members (n=31,094; 3.5%) were Army SMs referred to a
WTU before, during, or after their deployment end date occurring
between FY2008-FY2015. Non-WTU members (n=851,997) were
Army SMs not referred to WTUs between FY2008-FY2015.
 Demographic and military characteristics were identified from the
Defense Enrollment Eligibility Reporting System. WTU begin and
end dates, physical injuries and PTSD diagnoses were identified in
the Ill, Injured, and Wounded database.
 Deployment records were identified in the Contingency Tracking
System; and primary mental health and substance use disorder
diagnoses in the Military Health System Data Repository.
METHODS
Army Service Members Referred to Warrior Transition Units, FY2008-FY2015
RESULTS
38.4%
41.3%
20.4%
50.3%
38.9%
10.8%
0
10
20
30
40
50
60
18-25 26-39 40+
Age Group
WTU Non-WTU
WTU members were significantly older than non-WTU members (Mean age: 30.8 vs. 28 years; p<.0001). Men comprised 89% and
Whites comprised 70% of each group. SMs in both groups were more likely to be active duty (p<.0001), enlisted (p<.0001), and
married (p<.0001). On average, both groups were deployed twice, but non-WTU members were deployed longer than WTU
members (Mean deployment length: 8.7 vs. 9.7 months; p<.0001.
Comparison of Warrior Transition Unit and Non-Warrior Transition Unit Members, FY2008-FY2015
2.0%
8.7%
1.9%
9.7%
0
2
4
6
8
10
12
Avg. No. Deployments Avg. Deployment Length
(months)
Deployments
WTU Non-WTU
51.4%
34.1%
14.5%
68.0%
23.3%
8.8%
0
10
20
30
40
50
60
70
80
Active Duty National Guard Reserves
Military Service Component
WTU Non-WTU
Before deployment
ends
≤30 days
postdeployment31-90 days
91-180 days
181-365 days
postdeployment
>365 days
postdeployment
Timing of First WTU Referral, FY2008-FY2015
31%
20%
9%
6%
8%
26%
SUD=substance use disorder. BH= behavioral health. AUD=alcohol use disorder. PTSD=posttraumatic stress disorder. TBI =traumatic brain injury.
Primary Physical Injuries and Behavioral Health Diagnoses Within 90 Days After WTU Referral
2008
1.2%
2009
2.3%
2010
3.4%
2011
2.9%
2012
4.5%
2013
3.2%
2014
2.9%
2015
4.3%
Proportion of WTU Referrals by Fiscal Year
3.8%
4.6% 4.9% 5.9% 6.0%
8.8%
12.3%
19.7%
24.2%
36.4%
0
5
10
15
20
25
30
35
40
All Army SMs
9.7%
6.0%
6.4%
7.4% 8.3% 8.4%
15.6%
25.3%
28.9%
34.4%
0
5
10
15
20
25
30
35
40
Active Duty
5.1%
3.4% 3.4%
4.6% 3.8%
9.1% 9.2%
12.9%
19.4%
39.3%
0
5
10
15
20
25
30
35
40
45
National Guard
3.9%
2.3% 2.8%
3.6%
2.9%
9.5%
8.0%
15.4%
18.8%
35.4%
0
5
10
15
20
25
30
35
40
Reserves