Army Warrior Care Project (AWCP): Rationale and methods for a longitudinal study of behavioral health care in Army Warrior Transition Units using Military Health System data, FY2008-2015

Abstract

Objectives: Warrior Transition Units (WTUs) are specialized military units co-located with major military treatment facilities providing a Triad of Care involving primary care physicians, case managers, and military leadership to soldiers needing comprehensive medical care. We describe the rationale and methods for studying behavioral health care in WTUs and characterize soldiers assigned to WTUs.

Methods: The Army Warrior Care Project (AWCP) analyzes U.S. Department of Defense Military Health System data to examine behavioral health problems and service utilization among Army soldiers who were assigned to WTUs after returning from Afghanistan and Iraq deployments, FY2008-2015.

Results: WTU members (N = 31,094) comprised 3.5% of the AWCP cohort (N = 883,091). Almost all (96.5%) had one WTU assignment for a median of 327 days; 77.3% were assigned before deployment ended, ≤30 or >365 days post-deployment; 59.4% had deployment-related behavioral health diagnoses.

Conclusions: An overwhelming majority of soldiers had one WTU assignment for almost a year. A substantial proportion of WTU soldiers had psychological impairment, which limited performance of their military duties. The AWCP is the first longitudinal study of redeployed soldiers assigned to WTUs and provides a unique opportunity to advance our understanding of behavioral health among soldiers needing comprehensive medical care after combat deployments.

Keywords: U.S. Army veterans; Warrior Transition Units; combat deployments; military behavioral health; military medicine.

Figure 1

Army Warrior Care Project's conceptualization of behavioral health vulnerability in U.S. Army soldiers deployed for Operations Enduring Freedom, Iraqi Freedom, and New Dawn. Abbreviations: ED: emergency department; WTU: Warrior Transition Unit

Figure 2

Flow diagram of Army Warrior Care Project cohort selection criteria. ¹Includes Active, National Guard, and Reserves, but service members may not be Inactive National Guard/Reserves, Discharged, or Retired

Figure 3

Number and percent of soldiers assigned to Warrior Transition Units and median length of Warrior Transition Unit assignment, by military service component and fiscal year of Warrior Transition Unit entry, FY2008–2015. Abbreviation: WTU: Warrior Transition Unit

Figure 4

Number and percent of Warrior Transition Unit soldiers discharged by fiscal year of Warrior Transition Unit entry, FY2008–2015, by military service component. Abbreviation: WTU, Warrior Transition Unit

Figure 5

Number and percent of WTU soldiers diagnosed with behavioral health disorders within 30 days after WTU assignment begin date, by fiscal year of WTU assignment, FY2008–FY2015, by military service component. Abbreviation: WTU, Warrior Transition Unit