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Research Questions

  1. What health, social, housing, and financial challenges do airmen face?
  2. What is the current status of well-being among the Air Force's wounded warriors, and has that changed over time?

The U.S. Air Force (AF) wanted to gain greater insight into the well-being of its members who have sustained mental or physical injuries in combat or combat-related situations, with an eye toward improving services provided and enabling wounded airmen to become fully functioning members of society. It also wanted to take advantage of ongoing research into how best to do so. Areas of interest include quality of life and the challenges that will impede wounded veterans' reintegration after they leave AF. AF asked RAND Project AIR FORCE to help gauge the current status of AF's wounded warriors, including their use of and satisfaction with AF programs designed to serve them. The research team surveyed AF wounded warriors (wave 1) and published the results in 2015. This report presents the analysis of the second such survey, called wave 2.

The team developed a notional model that drove a survey that assessed well-being on a range of critical indicators. These indicators included psychological health, social support, housing instability, and perceived financial security. They also included questions to assess AF services used, focusing on the AF Wounded Warrior, AF Recovery Care Coordinator, and Family Liaison Officer programs. Because the programs were established relatively recently, this longitudinal investigation represents an independent program evaluation to determine the array and extent of the needs of intended program recipients, assess how well the program meets these needs, and suggest ways to improve the programs.

Key Findings

Airmen in the Sample Experience Challenges in Several Domains

  • A high proportion of airmen surveyed screened positive for posttraumatic stress disorder (PTSD) and major depressive disorder (MDD), with 67 percent screening positive for both.
  • They self-report lower rates of perceived physical health than the U.S. general population does.
  • About half reported at least one instance in which they wanted but did not obtain mental health treatment.
  • More than one-half of respondents identified their primary supporter as being a spouse or domestic partner, although about 20 percent said that no one played this role for them.
  • About 10 percent of those surveyed fall below the U.S. Department of Health and Human Services' poverty guidelines.
  • Close to 15 percent of the sample would be considered unemployed based on the Bureau of Labor Statistics' U3 (official) measure of unemployment.
  • About 10 percent of the new cohort indicated that their first experience with housing instability occurred after they returned from most-recent deployment. About 8 percent of the longitudinal subset reported having experienced housing instability since the previous survey.
  • However, some domains showed evidence of improvement. Between waves 1 and 2, airmen's perceptions of their physical impairments improved, the proportion of airmen who reported the presence of a primary supporter increased, and the proportion of airmen who were unemployed and looking for work decreased. Moreover, high numbers of respondents eligible for and in receipt of services from the varying programs available to support them reported overall very high levels of satisfaction with these programs.

Recommendations

  • To help airmen overcome barriers to mental health treatment, AF (and other related systems of care) should continue to collect and publicize data on the quality of care provided, and evaluate new approaches to treating mental health problems; discuss availability and quality of care with airmen; evaluate, emphasize, and enhance confidential treatment options; pilot-test the efficacy of empowering nonmedical case managers to help address scheduling difficulties; and explore and facilitate social support interventions.
  • To mitigate challenges that non–active duty respondents reported regarding employment and other types of nonmedical support, AF should explore specific reasons for this anxiety, and consider efficacy interventions focused on employment issues; focus employment support on individual skill sets and their translation to new contexts; continue systemizing and resourcing services to integrate social support generally, including the family liaison officers; and systematically assess how often airmen want nonmedical case managers to contact them.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    Brief Literature Review: A Holistic Approach to Reintegration Is Necessary

  • Chapter Three

    Survey Administration, Method, and Measures

  • Chapter Four

    Mental Health, Mental Health Service Utilization, and Physical Health

  • Chapter Five

    Social and Occupational Functioning and Financial and Housing Stability

  • Chapter Six

    Program Evaluation

  • Chapter Seven

    Conclusions and Recommendations

  • Appendix A

    October 2013 Air Force Wounded Warrior Newsletter Study Summary

  • Appendix B

    January 2014 Air Force Wounded Warrior Newsletter Announcement

  • Appendix C

    Detailed Measure Information

  • Appendix D

    Wave 2 Survey Instrument

  • Appendix E

    Preliminary Analyses

  • Appendix F

    Additional Results

Research conducted by

The research reported here was commissioned by the Assistant Secretary of the Air Force for Manpower and Reserve Affairs, the director of the Air Force Directorate of Services, and the Air Force Surgeon General and conducted by the Manpower, Personnel, and Training Program within RAND Project AIR FORCE.

This report is part of the RAND Corporation research report series. RAND reports present research findings and objective analysis that address the challenges facing the public and private sectors. All RAND reports undergo rigorous peer review to ensure high standards for research quality and objectivity.

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