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. Author manuscript; available in PMC: 2026 Jan 30.
Published in final edited form as: Law Hum Behav. 2022 Oct;46(5):385–394. doi: 10.1037/lhb0000497

Criminal Legal Involvement among Recently Separated Veterans: Findings from the LIMBIC Consortium Study

Eric B Elbogen 1,2,3, Megan Amuan 4, Eamonn Kennedy 4,5, Shannon M Blakey 2,6, Robert C Graziano 6, Dina Hooshyar 1,8, Jack Tsai 1,9, Richard E Nelson 4,5, Megan E Vanneman 4,5,7, Audrey L Jones 4,5, Mary Jo Pugh 4,5
PMCID: PMC12854079  NIHMSID: NIHMS2138161  PMID: 36227321

Abstract

Objective:

To investigate individual-level and neighborhood-level predictors of criminal legal involvement of veterans during the critical transition period from military to civilian life.

Hypotheses:

Substance use, mental health, and personality disorders will each increase incidence of criminal legal involvement, which will be highest among veterans living in socioeconomically disadvantaged neighborhoods after military discharge.

Method:

Data was analyzed from a longitudinal cohort study of 418,624 veterans who entered Veterans Affairs (VA) healthcare after leaving the military. Department of Defense (DoD) data on clinical diagnoses, demographics, and military history were linked to VA data on neighborhood of residence and criminal legal involvement.

Results:

Criminal legal involvement in the 2 years following military discharge was most strongly predicted by younger age, substance use disorder, and being male. Other predictors included military branch, deployment history, traumatic brain injury, serious mental illness, personality disorder, having fewer physical health conditions, and living in socioeconomically disadvantaged neighborhoods. These factors combined in multivariable analysis yielded a very large effect size for predicting criminal legal involvement after military separation (AUC=0.82). Veterans with co-occurring substance use disorder, serious mental illness, and personality disorder had 10 times higher incidence of criminal legal involvement than veterans with none of these diagnoses, with rates highest among veterans residing in more socioeconomically disadvantaged neighborhoods.

Conclusions:

To our knowledge, this is the largest longitudinal study of risk factors for criminal legal involvement in veterans following military discharge. The findings supported the hypothesis that veterans with co-occurring mental disorders living in socioeconomically disadvantaged neighborhoods were at higher risk of criminal legal involvement, underscoring the complex interplay of individual- and neighborhood-level risk factors for criminal legal involvement after veterans leave the military. The results will inform policy and programs to prevent criminal legal involvement and enhance community reintegration of veterans transitioning from military to civilian life.

Keywords: criminal legal involvement, military, veterans, social disadvantage, substance use

Among service members transitioning from military to civilian life, one adverse outcome indicative of poor reintegration is criminal legal involvement (Blonigen et al., 2016; Greenberg et al., 2007; Institute of Medicine, 2010; Lucas et al., 2022; Short et al., 2018). Recent data estimate that 8% of the incarcerated population in the United States (U.S.) served in the military (Timko et al., 2020). A nationally representative U.S. survey revealed that a higher percentage of veterans (31%) than civilians (18%) reported past criminal arrests (Snowden et al., 2017). Factors associated with criminal legal involvement among veterans include substance use disorder (Elbogen et al., 2012; Finlay et al., 2019; Lucas et al., 2022; Short et al., 2018), serious mental illness (SMI) (Short et al., 2018; Timko et al., 2020), and posttraumatic stress disorder (PTSD) (Bennett et al., 2018; Elbogen et al., 2012; Finlay et al., 2019; Hartwell et al., 2014).

Despite the scope and importance of criminal legal involvement among transitioning service members, scant research has investigated criminal legal involvement among veterans as they reintegrate into civilian life. Although studies of post-9/11 veterans recruit samples from the most recent U.S. military conflict, they do not necessarily characterize the reintegration difficulties of service members when they transition out of the military (Park et al., 2021; Vogt et al., 2021). Some post-9/11 veterans may have separated from the military nearly 2 decades prior to data collection in these studies. As a result, relatively little is known about criminal legal involvement during the critical transition period from active duty to civilian status.

Community factors may contribute to criminal legal involvement (Rotter & Compton, 2022) because separating from the military involves a veteran moving to a new living environment. The transition period involves changes in veterans’ lives in multiple social-environmental domains. After leaving the military, veterans need to find a job, attain housing stability, meet their basic needs financially, and develop a social support network. Lack of these protective factors is related to adverse outcomes in veterans (Elbogen et al., 2020). Moreover, lacking transportation and access to medical care in the community are potential barriers to the use of health services among veterans immediately following discharge from the military (Aronson et al., 2020). As a result, the research literature on factors associated with criminal legal involvement must examine the social context and situation in which the veteran lives after separation from the military.

Such examination is supported by conceptual models and empirical research on criminal legal involvement. The “situational action theory” posits that criminal behavior is essentially an outcome of the interaction between the individual-level and environment-level settings in which they take part (Wikstrom, 2014). Empirical research has supported the theory that social disadvantage and crime are linked (Pauewels et al., 2018; Raiher, 2022; Wikström & Treiber, 2016). Further, social disadvantage mediates the relationship between individual-level factors (e.g., mental disorders) and criminal behavior (Draine et al., 2002; Rotter & Compton, 2022). Finally, the MacArthur Violence Risk Assessment Study demonstrated that neighborhood disadvantage was a significant factor in the perpetuation of violent behavior among individuals discharged from psychiatric hospitals (Silver, 2000).

Transitioning from the military to the community involves changing one’s social environment, and living in a social environment of higher disadvantage is related to criminal legal involvement. For these reasons, it is crucial to determine whether transitioning service members residing in neighborhoods of a higher disadvantage after military discharge are at higher risk of criminal legal involvement. However, we are unaware of research examining these risk factors for criminal legal involvement in military veterans. Further, a review of empirical studies shows gaps in potential predictors of criminal legal involvement in veterans. There is mixed evidence that military-related variables relate to post-military incarceration (Bennett et al., 2018; Elbogen et al., 2012; Finlay et al., 2019; Larson & Norman, 2014). Further, research on the link between traumatic brain injury (TBI) and incarceration in veterans has also shown mixed results (Elbogen et al., 2012), though TBI is a demonstrated risk factor in civilians (Durand et al., 2017). Similarly, there is relatively little research about whether personality disorders predict criminal legal involvement in veterans (Edens et al., 2011). In a national survey of inmates, however, personality disorders were more prevalent among incarcerated veterans than incarcerated non-veterans (Bronson et al., 2015). Personality disorder also represents a risk factor for incarceration in the general population (Baillargeon et al., 2009), so might function as a risk factor in the veteran population as well.

Additionally, this body of empirical research on veterans is further limited by available means of measuring criminal legal involvement. While a single study in the United Kingdom linked military to criminal legal system record data (MacManus et al., 2013), studies of U.S. veterans have used one of three methods. First, studies have enrolled samples of incarcerated veterans (Brooks Holliday et al., 2021). The use of incarcerated veteran samples carries the advantage of verifying criminal legal involvement but the disadvantage of lacking a comparison group of veterans without criminal legal involvement. Second, studies have measured criminal legal involvement with self-report (Elbogen et al., 2012). Reliance on self-reported criminal legal involvement carries the inverse benefits and limitations of using incarcerated samples. Veterans with and without criminal legal involvement can be easily determined and compared. However, criminal legal involvement status cannot be verified and is subject to retrospective and other self-report biases.

A third approach uses Department of Veterans Affairs (VA) medical records documenting a veteran received justice program services (Finlay et al., 2014; Palframan et al., 2020; Tsai et al., 2017). This assessment method parallels that used in studies of other veteran psychosocial functioning outcomes (e.g., homelessness). It enables comparison of veterans with and without VA-documented criminal legal involvement. Although this measurement is specific to involvement in Veterans Justice programs, it is desirable because the veteran’s involvement in the criminal legal system is substantiated and verified. Furthermore, this indicator captures a wide array of veteran points of entry into the criminal legal system, ranging from 35% involved through Veterans Treatment Courts to 61% involved through traditional criminal courts (i.e., not through any diversion or problem-solving court program) (Tsai et al., 2017).

Finally, most research on veteran criminal legal involvement relies on cross-sectional sampling frames and relatively small samples. This limitation restricts understanding of prospective risk factors for criminal legal involvement among veterans. Medical record information verifying criminal legal involvement of veterans would be especially valuable for longitudinal studies. With these considerations in mind, the current study was designed to address important gaps in the scientific literature by linking DoD and VA data to investigate veterans’ pre-military discharge risk factors for criminal legal involvement during the first 2 years after military discharge, particularly concerning previously uninvestigated relationships with personality disorders and social disadvantage.

Theories of criminal behavior (Wikström, 2014) and empirical research show that individual-level factors (e.g., mental disorders) and environment-level factors (e.g., social disadvantage) are essential to understanding criminal legal involvement (Draine et al., 2002; Rotter & Compton, 2022). Therefore, we hypothesized that substance use, mental health, and personality disorders would each increase the incidence of criminal legal involvement, with veterans living in socioeconomically disadvantaged neighborhoods after military discharge demonstrating the highest incidence of criminal legal involvement.

Method

Study Population

We analyzed data from the Long-term Impact of Military Relevant Brain Injury Consortium (LIMBIC) Study (Cifu, 2022). In this national longitudinal study, a cohort of post-9/11 veterans (N=418,624) was identified who served in the U.S. military active duty component and who had met all four of the following criteria: (1) received Veterans Health Administration (VHA) care between October 1, 2001 through September 30, 2014; 2) had 2 years of VHA inpatient, outpatient, and/or pharmacy care anytime between fiscal years 2002-2018; (3) entered VHA care within 1 year of their last date of active duty; and (4) received DoD health care during the year before military discharge. Individuals who entered VHA care before military discharge were excluded. This study received institutional review board approval from the University of Utah with a waiver of informed consent.

This study analyzed data from DoD and VHA sources. DoD data included demographic characteristics, health status, and clinical diagnoses associated with inpatient/outpatient service utilization, and personal identifiers from the DoD and VA Infrastructure for Clinical Intelligence (DaVINCI) data sources (DuVall et al., 2019). VHA data included VHA Corporate Data Warehouse inpatient/outpatient service utilization and VHA vital status file mortality information. Diagnosed physical health conditions were identified using International Classification of Diseases (Ninth and Tenth Edition), Clinical Modification (ICD-9-CM/10) codes.

Measures

We used DoD data to construct variables related to the veterans’ demographic characteristics, including age at VHA entry, biological sex, race/ethnicity, marital status at the time of military discharge, and military background such as service branch, deployment history, and rank. For rank, we delineated between enlisted (someone who performed specific job functions in areas of specialty), warrant (highly trained specialist), and officer (someone who provided management and leadership) designations.

Concerning individual-level risk factors, DoD Health Risk file data were used to identify individuals in our cohort who had been diagnosed with a personality disorder, TBI, PTSD, serious mental illness (major depressive disorder, schizophrenia, or bipolar disorder), and conduct disturbance prior to military discharge. DoD classifies these conditions based on Medicaid managed care algorithms requiring either one inpatient diagnosis or two outpatient diagnoses at least 7 days apart. ICD-9-CM/10 was used to identify DoD diagnoses of substance use disorder.

Specific personality disorders are relevant to understanding criminal legal involvement but not available in the data used in main analysis, which relied on the Health Risk file in the DaVinci data source. However, participants’ specific personality disorders were available in inpatient and outpatient institutional data (CAPER and SIDR) and inpatient and outpatient TRICARE data. From these, we conducted a single post-hoc analysis on the rate of criminal legal involvement in the 2 years following separation based on antisocial, borderline, and other personality disorders with the same sample of veterans.

We also computed the Selim physical comorbidity index (Selim et al., 2004), developed for military veterans using ICD-9-CM/10 codes for 30 chronic physical diseases. Physical comorbidities were categorized as 0, 1, 2-3, or ≥4 conditions.

Regarding environment-level risk factors, veterans’ residence after military discharge was determined by the 9-digit zip code added to the VHA record closest to the VHA entry date. Next, an Area Deprivation Index (ADI) was calculated by linking these zip codes to Census block group crosswalk (Health, 2021; Kind & Buckingham, 2018). The ADI is a validated measure of socioeconomic disadvantage derived from income, education, employment, and housing quality built at the Census block group level (Durfey et al., 2019; Meza et al., 2020). Veterans were classified into ADI quartiles (higher ADI scores/quartiles represent greater disadvantage). Missing data for ADI was due to only 5-digit zip codes available in records for 12% of the sample (coded as ‘unknown’), whereas 9-digit zip codes to determine ADI were available for the vast majority of the sample and coded accordingly by ADI quartiles.

Consistent with other studies of criminal legal involvement of veterans (Finlay et al., 2014; Palframan et al., 2020; Tsai et al., 2017), we constructed the dependent variable by coding VHA-documented criminal legal involvement in one of two programs: (1) Veterans Justice Outreach (a program that identifies justice-involved veterans to facilitate their access to VA services at the earliest possible point in the criminal legal process), and (2) Health Care for Reentry Veterans (a program that identifies veterans in jail or prison who will reenter the community and connects them to services to prevent homelessness after incarceration). Medical documentation of VHA clinic code for either program denotes a substantiated instance of criminal legal involvement. In the case of the current analysis, this code was recorded within 2 years after the DoD-documented military discharge date. Criminal legal involvement was classified as either present (1) or absent (0).

Results

Plan of Analysis

All statistical analyses were conducted using SAS. First, we computed descriptive statistics for demographic and military background information, clinical status variables, and post-discharge residential neighborhood socioeconomic disadvantage separately within (1) the entire sample and (2) within the subset of veterans with criminal legal involvement within 2 years after military discharge.

Next, we conducted multivariable logistic regression analyses (assuming a two-tailed alpha of 0.05) predicting the occurrence of criminal legal involvement during the first 2 years after military discharge based on pre-military discharge variables (i.e., demographics, military background information, and clinical status variables) and post-military discharge socioeconomic disadvantage. To correct for multiple comparisons, the p values were converted to q values that report significance in terms of the false discovery rate rather than the false positive rate (Benjamini & Hochberg, 1995). Cohen’s d was calculated to ascertain effect sizes for each variable.

Finally, we calculated the mean incidence of criminal legal involvement as a function of combined status on three risk factors (serious mental illness, substance use disorder, and personality disorder), stratified by ADI quartile. This analysis examined the interrelationships between individual-level and environment-level risk factors for criminal legal involvement in transitioning service members.

Descriptive Statistics of Transitioning Service Members

Table 1 presents descriptive statistics of study variables for the entire sample (N=418,624) and the subsample of veterans with VHA-documented criminal legal involvement during the 2 years after military discharge (n=3,221). Relative to the full sample, the subsample of veterans with criminal legal involvement included a greater proportion of veterans who were younger, male, and enlisted; had served in the Army; had military deployment history; had DoD-documented mental disorders; and lived in more socioeconomically disadvantaged neighborhoods after military discharge. In terms of age, the overall sample had a mean of 30.4 years (SD=8.8). The subsample of those with criminal legal involvement had a mean age of 26.7 years (SD=5.2).

Table 1.

Sample Characteristics of Transitioning Service Members

Entire Sample (N=418,624) Criminal Legal Involvement within 2 Years After Military Discharge (n=3,221)
Characteristic % (n) % (n)
Age (years)
17-29 61.30 (256,619) 79.45 (2559)
30-39 18.72 (78,382) 16.52 (532)
40-49 16.64 (69,659) 3.91 (126)
50+ 3.34 (13,964) 0.12 (4)
Male 82.63 (345,911) 94.88 (3056)
Race/Ethnicity
White 58.93 (246,675) 62.85 (2120)
Black 18.42 (77,106) 15.62 (503)
Hispanic 9.98 (41,765) 11.95 (385)
Asian 2.70 (11,301) 1.33 (43)
Native American/Pacific Islander 1.82 (7630) 2.51 (81)
Unknown 8.16 (34,147) 2.76 (89)
Married 46.73 (195,641) 27.76 (894)
Branch of Service
Army 44.85 (187,742) 62.71 (2020)
Air Force 15.59 (65,256) 5.46 (176)
Marines 19.51 (81,665) 22.23 (716)
Navy/Coast Guard 19.64 (82,200) 9.56 (308)
Other 0.42 (1761) 0.03 (1)
Highest Rank
Officer 7.32 (30,660) 1.71 (55)
Warrant 1.25 (5212) 0.50 (16)
Enlisted 91.41 (982,649) 97.80 (3150)
Unknown 0.02 (103) 0
Deployment During Service 67.72 (283,511) 87.33 (2813)
TBI in DoD 3.74 (15,672) 10.74 (346)
Serious Mental Illness in DoD 15.98 (66,909) 34.40 (1108)
Substance Use Disorder in DoD 23.52 (98,464) 62.31 (2007)
PTSD in DoD 8.28 (34,675) 20.55 (662)
Personality Disorder in DoD 1.65 (6910) 6.18 (199)
Conduct Disturbance in DoD 0.43 (1814) 1.77 (57)
Physical Conditions in DoD
None 46.76 (195,751) 53.99 (1739)
1 Condition 23.64 (98,955) 28.56 (920)
2-3 Conditions 17.37 (72,717) 14.25 (459)
4+ Condition 12.23 (51,201) 3.20 (103)
Area Deprivation Index (ADI)
Lowest Quartile (1-25) 18.47 (77,340) 16.86 (543)
Quartile 2 (26-50) 29.28 (122,577) 29.06 (936)
Quartile 3 (51-75) 24.07 (100,769) 28.28 (911)
Highest Quartile (76-100) 15.81 (66,203) 21.79 (702)
Unknown ADI Quartile 12.36 (51,735) 4.00 (129)
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Note. DoD = Department of Defense; TBI = Traumatic brain injury; PTSD = Posttraumatic stress disorder

Post-hoc descriptive analyses revealed that among veterans with criminal legal involvement within 2 years of military discharge, 4.27% were diagnosed with antisocial personality disorder, 1.29% with borderline personality disorder, and 1.69% with other personality disorders.

Predictors of Criminal Legal Involvement

Results from multivariable logistic regression models identifying prospective risk factors for criminal legal involvement during the 2 years after military discharge are shown in Table 2. This model was statistically significant and yielded an Area under the Curve (AUC) of 0.823 for predicting criminal legal involvement after military separation, equivalent to a Cohen’s d=1.36 representing a strong effect size (Rice & Harris, 2005; Sullivan & Feinn, 2012). With respect to the specific risk factors in the multivariable model, the risk factors with the largest effect sizes were substance use disorder, younger age, and being male. Other variables significantly associated with criminal legal involvement included: serving in the Army, being enlisted, being deployed, having fewer physical conditions, serious mental illness, TBI, PTSD, and a personality disorder.

Table 2.

Multivariable Logistic Regression Model of Criminal Legal Involvement within the 2-Year Period Immediately Following Military Discharge.

Criminal Legal Involvement
Characteristic Odds Ratio 95% CI p-value Effect size, d
Lower Upper
Age (years)
30-39 0.83 0.75 0.92 <0.001 0.10
40-49 0.41 0.34 0.50 <0.001 0.49
50+ 0.12 0.04 0.32 <0.001 1.17
Female 0.34 0.28 0.39 <0.001 0.60
Race/Ethnicity
Asian 0.68 0.50 0.93 0.022 0.21
Black 1.11 1.00 1.23 0.057 0.06
Hispanic 1.11 0.99 1.24 0.082 0.06
Native American/Pacific Islander 1.22 0.98 1.53 0.099 0.11
Unknown 0.58 0.46 0.71 <0.001 0.31
Marital Status
Unmarried 1.86 1.72 2.02 <0.001 0.34
Unknown Marriage Status 0.88 0.60 1.28 0.54 0.07
Branch of Service
Air Force 0.43 0.37 0.50 <0.001 0.47
Marines 0.85 0.77 0.92 <0.001 0.09
Navy/Coast Guard 0.52 0.46 0.590 <0.001 0.36
Other 0.43 0.06 3.11 0.45 0.46
Highest Rank
Officer 0.50 0.38 0.66 <0.001 0.38
Warrant Officer 0.71 0.43 1.17 0.22 0.19
Deployment During Service 1.87 1.67 2.08 <0.001 0.34
TBI in DoD 1.59 1.41 1.79 <0.001 0.26
Serious Mental Illness in DoD 1.99 1.82 2.18 <0.001 0.38
Substance Use Disorder in DoD 3.59 3.32 3.87 <0.001 0.70
PTSD in DoD 1.20 1.09 1.33 <0.001 0.10
Physical Conditions in DoD
1 Condition 0.98 0.90 1.07 0.69 0.01
2-3 Conditions 0.85 0.76 0.95 0.009 0.09
4+ Condition 0.46 0.37 0.58 <0.001 0.42
Personality Disorder in DoD 1.45 1.24 1.70 <0.001 0.20
Conduct Disturbance in DoD 1.41 1.07 1.86 0.023 0.19
Area Deprivation Index (ADI)
Quartile 2 (26-50) 1.03 0.92 1.14 0.64 0.02
Quartile 3 (51-75) 1.05 0.94 1.17 0.44 0.03
Quartile 4 (76-100) 1.13 1.01 1.27 0.047 0.07
Unknown ADI Quartile 0.46 0.38 0.56 <0.001 0.43
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Note. CI = Confidence interval. To correct for multiple comparisons, p values were converted to q values that report significance of the false discovery rate rather than the false positive rate.

In terms of main effects, there was a small but statistically significant association between living in a disadvantaged neighborhood and higher odds of criminal legal involvement. Furthermore, the analysis showed that socioeconomic status was associated with an higher risk of criminal legal involvement across multiple permutations of clinical risk factors. Specifically, Figure 1 illustrates mean incidence of criminal legal involvement during the 2 years following military discharge as a function of combined status on serious mental illness, substance use disorder, and personality disorder diagnoses, stratified by ADI quartile. Veterans in the highest ADI quartile (i.e., with greatest socioeconomic disadvantage) had higher rates of criminal legal involvement. Veterans with substance use disorder, serious mental illness, and personality disorder had 10 times higher means of justice involvement compared to veterans with none of these clinical risk factors. In the highest ADI quartile, the mean incidence of criminal legal involvement was 5.25% for veterans with substance use disorder, serious mental illness, and personality disorder, compared to 0.47% for veterans with none of these risk factors.

Figure 1.

Figure 1.

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Mean Incidence of Criminal Legal Involvement within 2 Years after Military Discharge broken out by risk factor combinations and stratified by ADI Quartiles.

Note. ADI = Area of Deprivation Index. PD=Personality disorder; SUD=Substance use disorder; SMI=Serious mental illness. Q1 represents the quartile of the least social disadvantage whereas Q4 represents the quartile of the greatest social disadvantage.

Discussion

This study examined risk factors predicting criminal legal involvement during service members’ transition from military to civilian life. To our knowledge, this is the most extensive longitudinal study of risk factors for criminal legal involvement in veterans recently separated from the military. Findings corroborated past research linking criminal legal involvement in veterans to being male (Elbogen et al., 2012), deployment history (Bennett et al., 2018; Finlay et al., 2019; Larson & Norman, 2014), substance use disorder (Elbogen et al., 2012; Finlay et al., 2019; Lucas et al., 2022), PTSD (Bennett et al., 2018; Elbogen et al., 2012; Finlay et al., 2019), and serious mental illness (Timko et al., 2020). Consistent with studies in civilian populations, it also found a higher likelihood of criminal legal involvement for those with TBI (Farrer & Hedges, 2011; McIsaac et al., 2016). The current study suggests these risk factors apply to veterans during the critical 2-year period immediately after military discharge.

The current study yielded several novel findings regarding risk of criminal legal involvement among transitioning service members. First, the data largely supported our hypothesis about the role of community deprivation and criminal legal involvement among transitioning service members, consistent with the situational action theory of crime (Wikstrom, 2014). Although the effect size of social disadvantage on criminal legal involvement was small, it still reached a level of statistical significance, even after correction using false discovery rate. Perhaps more importantly, our analyses revealed that socioeconomic status was associated with higher risk of criminal legal involvement across multiple permutations of clinical risk factors. As illustrated in Figure 1, although clinical risk factors of serious mental illness, substance use disorder, and personality disorder were related to criminal legal involvement, these relationships varied as a function of veterans’ community living environments. In other words, even controlling for clinical factors, the predicted probability of criminal legal involvement was highest in neighborhoods of greatest disadvantage.

The analyses also suggest that individual-level risk factors interact with neighborhood-level risk factors. In particular, frequency of criminal legal involvement was similar across ADI quartiles for the no-individual-risk factor group (top of Figure 1). But in the all-individual-risk factor group, there was notable increase in higher risk of criminal legal involvement as neighborhoods became more disadvantaged (bottom of Figure 1). The set of findings highlight the importance of understanding veterans’ risk for adverse outcomes in the context of neighborhood of residence. There could be various mechanisms behind this finding (Raiher, 2022), such as veterans living in more disadvantaged neighborhoods having higher likelihood of being more exposed to crime, drugs, or violence, which in turn could exacerbate substance use or symptoms of SMI (Draine et al., 2002). Regardless of etiology, the currently results indicate that societal-level risk factors, such as neighborhoods where veterans will be living after military discharge, should be considered in policy and clinical practice facilitating community reintegration among transitioning service members (Glynn et al., 2016; Timko et al., 2014).

Second, our analyses identified other risk factors for criminal legal involvement that have received less attention in previous research. One new finding was that documented personality disorder diagnoses predicted future criminal legal involvement, consistent with studies on personality disorders in veterans receiving VA mental health care (Edens et al., 2011). Post-hoc descriptive analyses of the national study sample showed that this association was largely attributed to antisocial personality disorder. Given these findings, more research is needed regarding possible additive effects of co-occurring serious mental illness, substance use disorder, and personality disorder among transitioning service members (see Figure 1). Additionally, 11% of veterans with criminal legal involvement had DoD diagnoses of TBI, inconsistent with some research on criminal legal involvement in veterans (Elbogen et al., 2012; Finlay et al., 2019) but consistent with results shown for civilians (Durand et al., 2017).

Third, this study identified military-related variables associated with criminal legal involvement in transitioning service members. In particular, criminal legal involvement was predicted by deployment history and Army service, as well as PTSD and TBI—diagnoses considered “invisible wounds” of the conflicts in Iraq and Afghanistan (Tanielian et al., 2008). Analyses also identified military-unrelated demographic factors associated with criminal legal involvement, such as being male, younger age, and being unmarried. Each of these non-military variables is also a known risk factor for criminal legal involvement in civilians (Elbogen et al., 2012). Age and sex were notably more robust predictors of criminal legal involvement in our sample than military-related variables. This study’s findings are relevant to public perceptions about the role military training might have on veterans’ lives, showing that while certain aspects of military experience may increase the risk for criminal legal involvement, non-military related risk factors might in fact be most strongly associated with criminal legal involvement during the military to civilian transition period.

Fourth, because this study included a large national sample and a large number of covariates compared to previous related research, it affords more precise point estimates of the association between risk factors and criminal legal involvement among veterans. DoD-documented substance use disorder before military discharge had a large effect size for VA-documented criminal legal involvement after military discharge. Specifically, 62% of veterans who became involved in the criminal legal system within 2 years of military discharge were diagnosed with substance use disorder before leaving the military. DoD-documented personality disorder and serious mental showed medium effect sizes. Consistent with other research (Finlay et al., 2019), Figure 1 showed that serious mental illness and substance use disorder co-occurrence was associated with higher rates of veteran criminal legal involvement. Thus, while not surprising that pre-military discharge serious mental illness and substance use disorder related to post-military discharge psychosocial functioning, an important contribution of this study is the documented magnitude of these effects, relative to other criminal legal involvement risk factors.

Law, Policy, and Program Implications

The current findings have policy implications for reducing transitioning service members’ chances of criminal legal involvement after military discharge. In recent years, law and policy have advanced to ensure veterans successfully integrate into the community. Before discharge from the military, the DoD Transition Assistance Program (TAP) provides opportunities and training for transitioning service members in their preparation to meet post-military goals, including assessment of post-discharge needs in healthcare, employment, housing, and finances. Specifically, the U.S. Congress National Defense Authorization Act (NDAA) of Fiscal Year 2019 Section 552 (NDAA, 2019, p.134-137) and DoD Instruction 1332.35 (DoD, 2019) mandates that TAP provides every military service member with individualized counseling in the 365 days before discharge to develop plans for healthcare, employment, housing, and transportation for after discharge.

After discharge from the military, the VA Military to Civilian Readiness Pathway (M2C Ready) program addresses the goals of the NDAA of 2019 and Executive Order 13822 “Supporting our Veterans during Their Transition from Uniformed Service to Civilian Life” (White House, 2018) by continuing to provide support to veterans as they transition to civilian life. In particular, the VA Solid Start Program in M2C Ready involves calling every newly separated service member three times during the 365 days after discharge to help veterans with resources for housing, health care (including mental health), and work.

How can findings from the current study be applied in these programs to help improve outcomes for transitioning service members? First, increasing awareness within the above-described DoD and VA programs that veterans’ neighborhood of residence is linked to criminal legal involvement would enable TAP counselors and VA Solid Start staff to consider how veterans’ place of residence may or may not affect transportation, housing stability, access to health care, and employment opportunities, each of which are standard areas for DoD review. Indeed, the NDAA of 2019 explicitly states that in TAP, each service member must “receive information from the counselor regarding resources…located in the community in which the member will reside after separation, retirement, or discharge” (NDAA, 2019, p. 135, emphasis added). This statement is consistent with the current findings on considering veterans’ neighborhood of residence and social-environment when assisting transitioning service members. Identifying potential neighborhood-related barriers to these critical psychosocial protective factors can be directly incorporated into DoD and VA programs.

Second, while the current paper does not develop a psychometrically valid assessment tool to predict criminal legal involvement in transitioning service members, the DoD and VA programs, at a minimum, could use results from multivariable analyses in Table 2 as a structured checklist to ensure that individual-level and environment-level variables that significantly predicted criminal legal involvement are evaluated and not overlooked. While TAP counselors meet with service members to develop employment and housing plans, it may be prudent to review with the service member the multiple risk factors that may place them at higher risk of criminal legal involvement after discharge, especially given the high predictive validity of the multivariable model (AUC=0.82). This may be particularly important to do in the case of service members who had criminal legal involvement before military service, which previous work has shown is a risk factor for future criminal legal involvement not only in the general population but also in veterans after they leave the military (Elbogen et al., 2012; Finlay et al., 2019).

Third, the analyses indicate that substance use and co-occurring personality disorders and serious mental illness are critical to treat to prevent criminal legal involvement. DoD Instruction 1332.35 (DoD, 2019) does discuss the assessment of “health (including mental health).” Our analysis revealed that over half of the transitioning service members with criminal legal involvement had been diagnosed with substance use disorders before they left the military. This result speaks to the benefit of including TAP requirements to permit assessment of specific mental disorders, particularly substance use. Serious mental illness and personality disorders, especially antisocial personality disorder, also seem warranted to evaluate when TAP counselors create plans for service members to access mental health services after military separation. Finally, policies and programs aimed at preventing criminal legal involvement among veterans might therefore benefit from a strong focus on making sure to assess for co-occurring mental disorders (Finlay et al., 2019; Glynn et al., 2016), which our data signals elevated risk of criminal legal involvement in transitioning service members.

In addition to policy and programs addressing transitioning service members, the findings in this study also have relevance to courts and programs addressing veterans currently involved in the criminal legal system. Over 500 Veterans Treatment Courts across 43 states have been integrated with criminal legal systems to link veterans to mental health services (Gallagher & Ashford, 2021; Hartley & Baldwin, 2019). Additionally, as described above, VA Veterans Justice programs include Veterans Justice Outreach to facilitate access to VA services for justice-involved veterans and Health Care for Reentry Veterans to connect veterans in jail or prison to services to prevent homelessness when they reenter the community.

Veterans Treatment Courts and VA Justice Programs would benefit from recognizing the risk factors associated with elevated risk in the areas presented in Table 2 if veterans are recently separated from the military. In particular, consideration of these factors, especially regarding the neighborhood of residence, may be especially relevant to accessing health services and obtaining adequate transportation to engage in those health services. The current findings could also prompt consideration of other environment-level variables linked to a neighborhood, such as housing and financial stability, as well as consideration of co-occurring disorders, including personality disorders, which may increase future risk.

Limitations and Future Directions

There are several limitations that should be considered. First, not all transitioning service members use VHA services after discharge, which limits generalizability to the all U.S. veterans. Relatedly, our measurement of criminal legal involvement relied on VHA clinic codes for the veterans justice programs; as a result, instances of criminal legal involvement may have been missed. Nevertheless, 3,221 veterans in the sample of 418,624 had criminal legal involvement after military discharge, a rate of 0.8%, which is comparable to the 855 veterans incarcerated per 100,000 adult U.S. veteran residents (a rate of 0.855%) reported by the Bureau of Justice Statistics on incarcerated veterans between 2011-2012 (Bronson et al., 2015). Second, while our study’s measurement of criminal legal involvement confers the benefit of verifying criminal legal involvement without excluding veteran participants without criminal legal involvement, it does not specify the type of involvement (e.g., jail, prison, arrest) and represents release from incarceration rather that incidence of incarceration. Accordingly, future work should address these nuanced facets of criminal legal involvement.

Third, although many risk factors were examined, we did not measure all possible risk factors (e.g., income, employment after discharge, history of arrests/incarceration before military service). Fourth, the the dataset did not distinguish race (Black, white, Asian) and ethnicity (Hispanic) and therefore we were unable to provide a more nuanced breakdown by race and ethnicity. Thus, future study is needed to make these distinctions. Fifth, we created broad variable domains for certain health conditions (e.g., serious mental illness, substance use disorder, TBI, chronic medical conditions). More work is needed to examine which specific psychiatric and physical health conditions may (or may not) be associated with criminal legal involvement among transitioning service members. Similarly, because we used a broad ADI measure of neighborhood disadvantage, specific aspects of the neighborhood are relevant to transitioning service members that would be critical to explore in future studies. Are veterans in these neighborhoods more likely to perceive barriers to accessing care? Problems with transportation? Greater unemployment? Financial Strain? Homelessness? Each could increase the risk of adverse outcomes in veterans (Elbogen et al., 2020). The current study takes a preliminary step to examining the environmental level risk factors that may play a role in criminal legal involvement after veterans leave the military.

Sixth, because we used medical records data for zip codes, there is no way to confirm veterans’ current residence. Further, we cannot verify whether veterans experiencing homelessness may have been missed because they had no address with zip code. As a result, this study offers preliminary findings on socioeconomic disadvantage that should be more precisely measured in the future to determine if findings replicate across sampling frames.

Conclusions

This study examed criminal legal involvement during the transition from military to civilian life in a large national veteran sample. We identified risk factors that can be prioritized for addressing by the DoD, VA, and other healthcare systems to optimize community reintegration among veterans recently discharged from military service. Such empirical data have direct implications for programs serving transitioning service members at DoD (e.g., TAP) and VA (e.g., Solid Start, M2C Ready) as well as for Veterans Treatment Courts and Veterans Justice programs. Pragmatically, these programs and courts could benefit from using the results from multivariable modeling as a structured checklist to evaluate individual-level and environment-level variables that significantly predicted criminal legal involvement. Further, the analyses indicate that DoD and VA programs should consider substance use and co-occurring disorders to prevent criminal legal involvement. At the same time, veterans’ social environment must also be considered. Programs should address potential barriers to care and impediments to economic, work, and housing stability that might be faced by veterans living in more disadvantaged neighborhoods. Each could contribute to an increased risk of criminal legal involvement and points an essential direction for future research. In sum, the current paper provides valuable information for policies to proactively address risk factors and improve the likelihood of transitioning service members reintegrating successfully into the community.

Public Significance Statement.

We linked DoD and VA data of more than 400,000 veterans to identify factors predicting criminal legal involvement in the 2 years after their leaving the military. We found that living in socioeconomically disadvantaged neighborhoods increased risk of criminal legal involvement, highest among veterans with co-occurring substance use, mental health, and personality disorders. The findings from this study will inform law, policy, and programs to help veterans successfully integrate into the community.

Acknowledgments

This work was supported by the Assistant Secretary of Defense for Health Affairs endorsed by the Department of Defense, through the Psychological Health/Traumatic Brain Injury Research Program Long-Term Impact of Military-Relevant Brain Injury Consortium (LIMBIC) Award/W81XWH-18-PH/TBIRP-LIMBIC under Awards No. W81XWH1920067 and W81XWH-13-2-0095, and by the U.S. Department of Veterans Affairs Awards No. I01 CX002097, I01 CX002096, I01 HX003155, I01 RX003444, I01 RX003443, I01 RX003442, I01 CX001135, I01 CX001246, I01 RX001774, I01 RX 001135, I01 RX 002076, I01 RX 001880, I01 RX 002172, I01 RX 002173, I01 RX 002171, I01 RX 002174, and I01 RX 002170. The U.S. Army Medical Research Acquisition Activity, 839 Chandler Street, Fort Detrick MD 21702-5014 is the awarding and administering acquisition office. Mary Jo Pugh is also supported by a VA Health Services Research and Development (HSR&D) service Research Career Scientist Award (RCS 17-297, Award No, IK6HX002608). Megan E. Vanneman and Audrey L. Jones are supported by HSR&D Career Development Awards (CDA 15-259, Award No 1IK2HX00262; and CDA 19-233, Award No IK2HX003090). Richard E. Nelson is supported by an HSR&D Investigator Initiated Research grant (IIR 17-029, Award No I01 HX002425). Shannon Blakey was supported by a Department of Veterans Affairs Office of Academic Affiliations Advanced Fellowship in Mental Illness Research and Treatment.

Footnotes

There are no conflicts of interest to report and there are no financial relationships to report. Opinions, interpretations, conclusions and recommendations are those of the author and are not necessarily endorsed by the Department of Defense. Any opinions, findings, conclusions recommendations expressed in this publication are those of the authors and do not necessarily reflect the views of the U.S. Government, the U.S. Department of Veterans Affairs or the Department of Defense and no official endorsement should be inferred.

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