Sex differences in mental health and substance use disorders and treatment entry among justice-involved Veterans in the Veterans Health Administration

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Department of Psychiatry, Systems and Psychosocial Advances Research Center

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Adult; Female; Humans; Male; Mental Disorders; Middle Aged; Prevalence; *Prisoners; Retrospective Studies; Risk Factors; Sex Factors; Substance-Related Disorders; United States; *United States Department of Veterans Affairs; *Veterans; *Women's Health


Health Services Administration | Health Services Research | Psychiatric and Mental Health | Psychiatry | Psychiatry and Psychology | Substance Abuse and Addiction


BACKGROUND: Over half of veterans in the criminal justice system have mental health or substance use disorders. However, there is a critical lack of information about female veterans in the criminal justice system and how diagnosis prevalence and treatment entry differ by sex.

OBJECTIVES: To document prevalence of mental health and substance use disorder diagnoses and treatment entry rates among female veterans compared with male veterans in the justice system.

RESEARCH DESIGN: Retrospective cohort study using national Veterans Health Administration clinical/administrative data from veterans seen by Veterans Justice Outreach Specialists in fiscal years 2010-2012.

SUBJECTS: A total of 1535 females and 30,478 male veterans were included.

MEASURES: Demographic characteristics (eg, sex, age, residence, homeless status), mental health disorders (eg, depression, post-traumatic stress disorder), substance use disorders (eg, alcohol and opioid use disorders), and treatment entry (eg, outpatient, residential, pharmacotherapy).

RESULTS: Among female veterans, prevalence of mental health and substance use disorders was 88% and 58%, respectively, compared with 76% and 72% among male veterans. Women had higher odds of being diagnosed with a mental health disorder [adjusted odds ratio (AOR)=1.98; 95% confidence interval (CI), 1.68-2.34] and lower odds of being diagnosed with a substance use disorder (AOR=0.50; 95% CI, 0.45-0.56) compared with men. Women had lower odds of entering mental health residential treatment (AOR=0.69; 95% CI, 0.57-0.83).

CONCLUSIONS: Female veterans involved in the justice system have a high burden of mental health disorders (88%) and more than half have substance use disorders (58%). Entry to mental health residential treatment for women is an important quality improvement target.

DOI of Published Version



Med Care. 2015 Apr;53(4 Suppl 1):S105-11. doi: 10.1097/MLR.0000000000000271. Link to article on publisher's site

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Medical care

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