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Employment Stability in Veterans and Service Members With Traumatic Brain Injury: A Veterans Administration Traumatic Brain Injury Model Systems Study

  • Christina Dillahunt-Aspillaga
    Affiliations
    Rehabilitation and Mental Health Counseling Program, Department of Child and Family Studies, University of South Florida, Tampa, FL

    Health Services Research and Development Service Center of Innovation on Disability and Rehabilitation Research, James A. Haley Veterans Hospital, Tampa, FL
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  • Mary Jo Pugh
    Affiliations
    Audie L. Murphy Veterans Affairs Hospital, South Texas Veterans Healthcare System, San Antonio, TX
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  • Bridget A. Cotner
    Correspondence
    Corresponding author Bridget A. Cotner, PhD, Health Services Research and Development Service Center of Innovation on Disability and Rehabilitation Research, 8900 Grand Oak Circle, Tampa, FL 33637.
    Affiliations
    Health Services Research and Development Service Center of Innovation on Disability and Rehabilitation Research, James A. Haley Veterans Hospital, Tampa, FL

    Department of Anthropology, University of South Florida, Tampa, FL
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  • Marc A. Silva
    Affiliations
    Health Services Research and Development Service Center of Innovation on Disability and Rehabilitation Research, James A. Haley Veterans Hospital, Tampa, FL

    Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, Defense and Veterans Brain Injury Center, Tampa, FL

    Mental Health and Behavioral Sciences Service, James A. Haley Veterans Hospital, Tampa, FL

    Department of Psychology, University of South Florida, Tampa, FL
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  • Adam Haskin
    Affiliations
    Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, Defense and Veterans Brain Injury Center, Tampa, FL

    General Dynamics Health Solutions, Tampa, FL
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  • Xinyu Tang
    Affiliations
    Department of Pediatrics, Biostatistics Program, University of Arkansas for Medical Sciences, Little Rock, AR
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  • Marie E. Saylors
    Affiliations
    Department of Pediatrics, Biostatistics Program, University of Arkansas for Medical Sciences, Little Rock, AR
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  • Risa Nakase-Richardson
    Affiliations
    Health Services Research and Development Service Center of Innovation on Disability and Rehabilitation Research, James A. Haley Veterans Hospital, Tampa, FL

    Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, Defense and Veterans Brain Injury Center, Tampa, FL

    Mental Health and Behavioral Sciences Service, James A. Haley Veterans Hospital, Tampa, FL

    Department of Medicine, University of South Florida, Tampa, FL
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      Abstract

      Objective

      To examine incidence and predictors of employment stability in veterans and military service members with traumatic brain injury (TBI) who return to work.

      Design

      Prospective observational cohort study.

      Setting

      Four rehabilitation centers.

      Participants

      Veterans and military service members (N=110) with mild (26%), moderate (22%), or severe (52%) TBI enrolled in the Department of Veterans Affairs Polytrauma Rehabilitation Centers TBI Model Systems database within 2 years of injury who were discharged between January 2009 and June 2015.

      Interventions

      Not applicable.

      Main Outcome Measure

      Employment stability as reflected by competitive employment at 1- and/or 2-year follow-up.

      Results

      Over half (n=61, 55%) of the participants had stable employment at the time the first competitive employment date was recorded. Individuals with stable employment were more likely to be white (79%) and to have slightly higher cognitive and motor discharge scores on the FIM. Based on univariate analysis, more severe TBI and higher FIM motor scores at discharge were significantly associated with employment stability. At follow-up, compared with veterans and military service members who had unstable employment, those with stable employment had higher scores on motor and cognitive FIM and lower scores of self-report symptoms on the Neurobehavioral Symptom Inventory, the 9-item Patient Health Questionnaire-Depression, the 7-item Generalized Anxiety Disorder Questionnaire, and the PTSD Checklist-Civilian version.

      Conclusions

      A number of unique factors affect employment stability in veterans and military service members with TBI. Study findings identify veterans and military service members who have stable employment and predictors of employment stability.

      Keywords

      List of abbreviations:

      GAD-7 (7-item Generalized Anxiety Disorder Scale), GCS (Glasgow Coma Scale), GOAT (Galveston Orientation and Amnesia Test), mTBI (mild traumatic brain injury), NSI (Neurobehavioral Symptom Inventory), PCL-C (PTSD Checklist-Civilian Version), PHQ-9 (9-item Patient Health Questionnaire), PRC (Polytrauma Rehabilitation Center), PTA (posttraumatic amnesia), PTSD (posttraumatic stress disorder), TBI (traumatic brain injury), TBIMS (Traumatic Brain Injury Model Systems), VA (Department of Veterans Affairs)
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