Racial, ethnic, and sex differences in psychiatric diagnosis, mental health sequelae, and VHA service utilization among justice-involved veterans.

Objective: Intervening in the cycle of symptom exacerbation and recidivism among justice-involved veterans is critical given elevated rates of psychiatric diagnoses and mental health sequelae. To responsively and effectively address justice-involved veterans' needs, it is essential to examine distinct groups who are at heightened risk (e.g., marginalized communities). Although racial and ethnic disparities within the justice system are well established, veteran-focused research remains limited.

Hypotheses: We hypothesized that significant differences exist in service utilization, psychiatric diagnoses, and mental health sequelae among Black, Indigenous, and people of color (BIPOC) and White/non-Hispanic justice-involved veterans, for both male and female cohorts.

Method: We examined a national data set of veterans accessing U.S. Department of Veterans Affairs (VA) justice-related services (i.e., justice-involved veterans) between 2005 and 2018 (N = 183,880; nBIPOC = 73,863, nWhite = 110,017) to elucidate racial and ethnic differences across clinical characteristics documented in the VA electronic medical record. Using linear and logistic analyses, we analyzed male (n = 173,487) and female (n = 10,393) justice-involved veterans separately to capture intersectionality.

Results: In general, BIPOC justice-involved veterans were more likely than White/non-Hispanic justice-involved veterans to be diagnosed with schizophrenia and other psychotic disorders and to use homeless services, p < .001. They were less likely to be diagnosed with mood, anxiety, personality, and opioid use disorders, p < .01. Separate examinations of Black and Hispanic justice-involved veterans, compared with their White/non-Hispanic counterparts, demonstrated some divergent trends (e.g., frequency of use of Veterans Health Administration [VHA] services). Our findings also revealed nuanced sex-related differences in terms of service use and diagnoses. Descriptive characteristics for each racial and ethnic category are reported.

Conclusion: These findings provide support for race and ethnicity as a key social factor of health associated with distinct psychiatric diagnoses and mental health sequelae among justice-involved veterans. We discuss practice and policy implications, including how to adapt existing VHA programming and practices to meet the needs of BIPOC justice-involved veterans. (PsycInfo Database Record (c) 2023 APA, all rights reserved).