Mental Health and Readiness in the United States Military
Restricted (Penn State Only)
- Author:
- Fansler, Joshua
- Graduate Program:
- Health Policy and Administration
- Degree:
- Doctor of Philosophy
- Document Type:
- Dissertation
- Date of Defense:
- February 13, 2025
- Committee Members:
- John Dattilo, Outside Unit & Field Member
Joel Segel, Chair & Dissertation Advisor
John Moran, Major Field Member
Charleen Hsuan, Major Field Member
David Vanness, Professor in Charge/Director of Graduate Studies - Keywords:
- military
mental health
military readiness
suicidal ideation
residential treatment
depression
PTSD
homophily - Abstract:
- This dissertation examines critical factors influencing the mental health and readiness of active-duty service members, offering novel insights into inpatient care, peer dynamics, and disparities in mental health treatment within the Military Health System (MHS). Utilizing a proprietary dataset, I evaluate the causal effects of inpatient admission for suicidal ideation and gender homophily in residential treatment facilities (RTFs). Finally, I explore racial and ethnic disparities in meeting mental health treatment targets. In Chapter 2, I use provider propensity to admit patients with suicidal ideation as an instrumental variable to estimate the impact of inpatient admission on retention (remaining on active duty), subsequent encounters for suicidal behaviors, and promotions. Two-stage least squares (2SLS) results show that service members admitted to inpatient mental health care are 11 percentage points less likely to remain on active duty at two-years post-discharge but are also 6.4 percentage points less likely to have subsequent emergency encounters for suicidal behavior. These findings support a positive clinical impact of inpatient admission but highlight a need to address stigma and improve reintegration policies following hospitalization. Chapter 3 explores the effect of female peer groupings in MHS inpatient RTFs. Research has demonstrated that group dynamics and peer support in RTFs is consistent with improved adherence to treatment and better patient outcomes, although most studies include only males due to historically low numbers of female patients. I find wide variation in the number of female peers and total peer days those female patients in treatment experience. I find evidence to suggest that female service members in high-homophily peer environments (i.e., those with any female peer, numbers of female peers, and peer saturation) may have improved outcomes, including fewer emergency department visits and higher retention rates. Kaplan-Meier survival analysis supports the evidence that high homophily peer experiences may improve retention, emphasizing the importance of intentional peer group formation in fostering recovery and retention. In Chapter 4, I use logistic regression models to assess racial and ethnic disparities in adherence to a 2018 Defense Health Agency (DHA) policy requiring three mental health visits within 90 days for patients diagnosed with major depressive disorder (MDD) or posttraumatic stress disorder (PTSD). Results indicate no statistically significant difference in the likelihood of meeting this treatment target for MDD between racial and ethnic minority patients and non-Hispanic White (NHW) patients. While there is some evidence suggesting that Hispanic service members may be less likely to meet the 90-day treatment requirement for PTSD, the estimate falls outside the conventional 95% confidence interval.