The nonprofit Wounded Warrior Project (WWP) offers support for and raises public awareness of service members who have experienced physical or mental health conditions associated with their service on or after September 11, 2001. Since 2002, the organization has strived toward supporting Wounded Warriors through three strategic objectives:
- Ensure that Wounded Warriors are well adjusted in mind and spirit.
- Ensure that Wounded Warriors are well adjusted in body.
- Ensure that Wounded Warriors are economically empowered.
Each year, WWP conducts an annual assessment of its members (known as alumni), to understand how well its programs and services are achieving the three objectives—that is, supporting the mental, physical, and financial well-being of alumni. The survey administrator, Westat, makes general survey results available to WWP in an initial report.
After the initial Westat results were presented to WWP, the organization, as well as its Physical Health and Wellness Program staff and Policy and Government Affairs team, asked RAND to offer an additional interpretation of survey results to supplement those by Westat. This report documents RAND's supplemental analysis.
How to Use This Analysis
RAND's interpretation does not evaluate the impact or success of WWP programs. Rather, the results here are designed for use as a tool for WWP to understand the needs and status of its current alumni. More specifically, the physical, mental, and financial status and self-perceptions of WWP alumni are presented to provide WWP leaders with an opportunity to take a step back and reflect upon the needs of current participants in order to determine how best to meet the needs of this group. The results here may be used to foster further examination of the ways WWP can serve and support this constituency of alumni, thus better realizing WWP's three strategic objectives.
WWP 2013 Alumni Survey, Survey Respondents, and Analytic Method
The analysis is based on a sample of WWP alumni drawn from the 2013 WWP Alumni Survey. Survey questions cover alumni characteristics as well as questions pertaining to mental and physical health and educational and economic outcomes. Out of 26,886 alumni eligible to take the survey, 13,956 chose to participate. This resulted in a response rate of 51.9 percent.
On average, most 2013 survey respondents were white (73 percent), male (88 percent), between ages 26 to 35 (49 percent), and married (65 percent). In terms of education, most (62 percent) had not completed an associate's degree or higher. Most respondents had served in the Army (66 percent), were out of the military (67 percent), and had reached pay grades between E5 and E9 (62 percent). Because WWP serves wounded warriors, it is not surprising that most respondents had a Department of Veterans Affairs (VA) disability rating of 50 percent or higher (59 percent). Respondents reported many different types of service-related injuries and conditions, with the highest percentages reporting posttraumatic stress disorder (PTSD) (76 percent); anxiety (75 percent); depression (70 percent); severe back, neck, or shoulder problems (58 percent); and tinnitus (53 percent).
The data were assembled to determine underlying variables of interest, and regression was employed to estimate the quantitative effect of variables upon the physical and mental health and educational and economic outcomes of survey participants. Results of the survey sample were weighted to represent the entire population of WWP alumni, not just survey respondents. However, the data analyzed are from a single point in time, and thus the relationships among variables cannot be interpreted as being causal in nature.
At Least Half of Alumni Have Mental Health Symptoms and Face Barriers to Mental Health Care
Many alumni identified themselves as suffering or having suffered from mental health conditions in the 2013 WWP survey. Screening measures allowed assessment of probable depression, PTSD, and problem drinking at the time of the survey. In all, WWP alumni screened positively for probable depression, PTSD, and problem drinking at rates greater than 50 percent—higher than Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) veterans in general (Tanielian and Jaycox, 2008; Calhoun et al., 2008).
Of the alumni screening positive, 37 to 47 percent reported having difficulty accessing mental health care, delaying it, or not getting the care they need. They attribute these challenges to accessing care to reasons ranging from practical barriers to care access (e.g., canceled appointments) to barriers related to stigma and discrimination (e.g., fear of negative repercussions for their careers). Female alumni and younger alumni reported slightly more difficulty, delay, or lack of care in getting the mental health care they need relative to male alumni and older alumni.
Physical Health of Alumni Is Challenged by Unhealthy Weight
Because obesity is linked with many negative health outcomes, data on the body mass index (BMI) of alumni and the relationship of BMI to other physical health outcomes are important to WWP. A large proportion of alumni are overweight (42 percent) or obese (41 percent). This rate of obesity is slightly higher than the estimate of 35.7 percent for the general U.S. adult population (Ogden et al., 2012).
Obese alumni were more likely to report their general health status as being fair or poor, and they experience greater limitations in their daily activities and work due to their physical health than do the alumni who are overweight or of normal weight.
In general, WWP alumni engage in moderate-intensity physical activity or exercise (such as brisk walking, jogging, or cycling) a little more than twice per week (on average). Regardless of BMI, the most frequently endorsed barriers to exercise and physical activity are discomfort in social situations, concerns about safety and reinjury, and finding time to train and participate. Obese WWP alumni endorsed these barriers at greater rates than overweight and healthy-weight alumni.
Survey results also made clear the relationship between the mental and the physical health of alumni. Mental health conditions and physical injuries were both associated with reports of fair or poor health status. However, perhaps counterintuitively, those who do not consume alcohol were most likely to indicate fair or poor health status, followed by those who are nonproblem drinkers, and, finally, potential problem drinkers.
Many Alumni Are Unemployed, Do Not Access Veteran Employment and Education Benefits
The 2013 survey results suggest that unemployed alumni (whether looking for work or not) make up almost half of all WWP alumni. However, the combined number of alumni employed full time and part time surpass the number of nonworking groups at 52 percent (45 percent work full time and 7 percent work part time). Still, 17.8 percent of alumni are unemployed and looking for work. Those with high VA disability ratings were more likely to be not working, and alumni reporting certain injury types—depression; spinal cord injury; severe back, neck, or shoulder problems; severe knee injuries or problems; or other severe mental injuries—were less likely to be employed than alumni who did not report these injuries.
Overall, there is low alumni participation in veteran-specific employment and education programs. Only about 9 percent of the WWP alumni eligible for the VA Vocational Rehabilitation and Employment Program (VR&E) reported that they are using VR&E benefits, and only about 27 percent of all alumni reported using the Post-9/11 GI Bill.* Alumni who reported amputation, traumatic brain injury (TBI), or severe back, neck, or shoulder problems were slightly more likely to use the VR&E benefits than those who did not report these injury types. Alumni with most types of injuries were equally likely to use Post-9/11 GI Bill benefits, with the exception of alumni with amputation or who screened positive for probable depression. These alumni were less likely to use Post-9/11 GI Bill benefits.
Several topics are presented that may warrant further discussion by WWP staff. These include carefully considering barriers to mental health care when determining strategies for improving mental health and mental health care access, particularly for alumni reporting mental health conditions, female alumni, and younger alumni. Other topics for discussion include considering what interventions and program efforts might be used to promote weight loss among alumni and exploring the issue of overweight and obesity more thoroughly. Finally, the issue of how best to encourage use of education and employment benefits may warrant further consideration.
Calhoun, P. S., J. R. Elter, E. R. Jones Jr., H. Kudler, and K. Straits-Troster, “Hazardous Alcohol Use and Receipt of Risk-Reduction Counseling Among U.S. Veterans of the Wars in Iraq and Afghanistan,” J Clin Psychiatry, Vol. 69, No. 11, November 2008, pp. 1686–1693.
Ogden, C. L., M. D. Carroll, B. K. Kit, and K. M. Flegal, “Prevalence of Obesity in the United States, 2009–2010,” U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics Data Brief, No. 82, January 2012. As of November 1, 2013:
Tanielian, T., and L. H. Jaycox, eds., Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery, Santa Monica, Calif.: RAND Corporation, MG-720-CCF, 2008. As of April 11, 2014:
* Only VR&E-eligible alumni, who are defined here as the alumni with a VA disability rating of 10 percent or more, are included in the VR&E use analysis. Alumni with a pending VA rating, no VA rating, or with a VA rating of 0 are excluded. Seventy percent of the total sample (67 percent of the alumni), 9,833 respondents, are eligible for VR&E.
The research described in this article was sponsored by the Wounded Warrior Project and conducted within the Forces and Resources Policy Center of the RAND National Security Research Division.