Mary Jo Pugh1, Alicia A Swan2, Kathleen F Carlson3, Carlos A Jaramillo2, Blessen C Eapen4, Christina Dillahunt-Aspillaga5, Megan E Amuan6, Roxana E Delgado7, Kimberly McConnell7, Erin P Finley8, Jordan H Grafman9. 1. Veterans Health Administration, South Texas Veterans Health Care System, San Antonio, TX; Departments of Epidemiology and Biostatistics, University of Texas Health San Antonio, San Antonio, TX; Division of General and Hospital Medicine, University of Texas Health San Antonio, San Antonio, TX. Electronic address: pughm@uthscsa.edu. 2. Veterans Health Administration, South Texas Veterans Health Care System, San Antonio, TX. 3. Center to Improve Veteran Involvement in Care, Veterans Affairs (VA) Portland Health Care System, Portland, OR; National Center for Rehabilitative Auditory Research; VA Portland Health Care System, Portland, OR; School of Public Health, Oregon Health and Science University, Portland, OR. 4. Veterans Health Administration, South Texas Veterans Health Care System, San Antonio, TX; Department of Rehabilitation Medicine, University of Texas Health San Antonio, San Antonio, TX. 5. Rehabilitation and Mental Health Counseling Program, Department of Child and Family Studies, University of South Florida, Tampa, FL; Center of Innovation on Disability and Rehabilitation Research, James A. Haley Veterans Hospital, Tampa, FL. 6. Center for Health Quality, Outcomes and Economic Research, Edith Nourse Rogers Memorial VA Hospital, Bedford, MA. 7. Veterans Health Administration, South Texas Veterans Health Care System, San Antonio, TX; Departments of Epidemiology and Biostatistics, University of Texas Health San Antonio, San Antonio, TX. 8. Veterans Health Administration, South Texas Veterans Health Care System, San Antonio, TX; Division of General and Hospital Medicine, University of Texas Health San Antonio, San Antonio, TX; Department of Psychiatry, University of Texas Health San Antonio, San Antonio, TX. 9. Rehabilitation Institute of Chicago, Chicago, IL; Departments of Physical Medicine & Rehabilitation, Neurology, Cognitive Neurology and Alzheimer's Center, Department of Psychiatry, Feinberg School of Medicine & Department of Psychology, Weinberg College of Arts and Sciences, Northwestern University, Chicago, IL.
Abstract
OBJECTIVE: To examine the association between traumatic brain injury (TBI) severity; social, family, and community reintegration outcomes; and return to work status among post-9/11 veterans in Department of Veterans Affairs (VA) care. DESIGN: Retrospective observational cohort study. SETTING: Mail/online survey fielded to a national sample of veterans. PARTICIPANTS: Sample of post-9/11 veterans with at least 3 years of VA care stratified according to TBI severity and comorbidities who completed and returned surveys (N=2023). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Deployment Risk and Resilience Inventory-2 family functioning and social support subscales; Military to Civilian Questionnaire; and employment status. RESULTS: Bivariate analyses revealed that veterans with every classification of TBI severity reported significantly more difficulty on social, family, and community reintegration outcomes than those with no TBI. In the fully adjusted model, veterans with unclassified and moderate/severe TBI reported significantly more difficulty with community reintegration and were less likely to be employed relative to those with no TBI; those with unclassified TBI also reported significantly more difficulty with family functioning. Veterans with mild TBI also reported significantly more difficulty with community reintegration. CONCLUSIONS: This study provides insight into long-term outcomes associated with TBI in post-9/11 veterans and suggests that exposure to TBI has a negative effect on social and family functioning, community reintegration, and return to work even after controlling for comorbidity, deployment experiences, and sociodemographic characteristics. Additional research is required to explicate what appears to be complex interactions among TBI severity, psychosocial well-being, combat exposures, and socioeconomic resources in this population. Published by Elsevier Inc.
OBJECTIVE: To examine the association between traumatic brain injury (TBI) severity; social, family, and community reintegration outcomes; and return to work status among post-9/11 veterans in Department of Veterans Affairs (VA) care. DESIGN: Retrospective observational cohort study. SETTING: Mail/online survey fielded to a national sample of veterans. PARTICIPANTS: Sample of post-9/11 veterans with at least 3 years of VA care stratified according to TBI severity and comorbidities who completed and returned surveys (N=2023). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Deployment Risk and Resilience Inventory-2 family functioning and social support subscales; Military to Civilian Questionnaire; and employment status. RESULTS: Bivariate analyses revealed that veterans with every classification of TBI severity reported significantly more difficulty on social, family, and community reintegration outcomes than those with no TBI. In the fully adjusted model, veterans with unclassified and moderate/severe TBI reported significantly more difficulty with community reintegration and were less likely to be employed relative to those with no TBI; those with unclassified TBI also reported significantly more difficulty with family functioning. Veterans with mild TBI also reported significantly more difficulty with community reintegration. CONCLUSIONS: This study provides insight into long-term outcomes associated with TBI in post-9/11 veterans and suggests that exposure to TBI has a negative effect on social and family functioning, community reintegration, and return to work even after controlling for comorbidity, deployment experiences, and sociodemographic characteristics. Additional research is required to explicate what appears to be complex interactions among TBI severity, psychosocial well-being, combat exposures, and socioeconomic resources in this population. Published by Elsevier Inc.
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