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Traumatic Brain Injury Severity, Comorbidity, Social Support, Family Functioning, and Community Reintegration Among Veterans of the Afghanistan and Iraq Wars

  • Mary Jo Pugh
    Correspondence
    Corresponding author Mary Jo Pugh, PhD, RN, South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX 78229.
    Affiliations
    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
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  • Alicia A. Swan
    Affiliations
    Veterans Health Administration, South Texas Veterans Health Care System, San Antonio, TX
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  • Kathleen F. Carlson
    Affiliations
    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
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  • Carlos A. Jaramillo
    Affiliations
    Veterans Health Administration, South Texas Veterans Health Care System, San Antonio, TX
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  • Blessen C. Eapen
    Affiliations
    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
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  • Christina Dillahunt-Aspillaga
    Affiliations
    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
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  • Megan E. Amuan
    Affiliations
    Center for Health Quality, Outcomes and Economic Research, Edith Nourse Rogers Memorial VA Hospital, Bedford, MA
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  • Roxana E. Delgado
    Affiliations
    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
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  • Kimberly McConnell
    Affiliations
    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
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  • Erin P. Finley
    Affiliations
    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
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  • Jordan H. Grafman
    Affiliations
    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
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  • the
    Affiliations
    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

    Department of Rehabilitation Medicine, University of Texas Health San Antonio, San Antonio, TX

    Department of Psychiatry, University of Texas Health San Antonio, San Antonio, TX

      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.

      Keywords

      List of abbreviations:

      CTBIE (Comprehensive Traumatic Brain Injury Evaluation), DoDTR (Department of Defense Trauma Registry), DRRI-2 (Deployment Risk and Resilience Inventory-2), FY (fiscal year), ICD-9-CM (International Classification of Diseases–9th Revision–Clinical Modifications), mTBI (mild traumatic brain injury), OEF (Operation Enduring Freedom), OIF (Operation Iraqi Freedom), PTSD (posttraumatic stress disorder), TBI (traumatic brain injury), VA (Department of Veterans Affairs)
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