Advertisement

Aspects of Executive Dysfunction and Racial/Ethnic Minority Status Are Associated With Unemployment Duration in Veterans With a History of Mild-to-Moderate Traumatic Brain Injury

  • Author Footnotes
    ∗ Clark and Seewald contributed equally to this work.
    Jillian M.R. Clark
    Footnotes
    ∗ Clark and Seewald contributed equally to this work.
    Affiliations
    Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, California

    Department of Psychiatry, University of California San Diego, La Jolla, California
    Search for articles by this author
  • Author Footnotes
    ∗ Clark and Seewald contributed equally to this work.
    P. Michelle Seewald
    Footnotes
    ∗ Clark and Seewald contributed equally to this work.
    Affiliations
    Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, California

    VA San Diego Healthcare System, Research Service, San Diego, California
    Search for articles by this author
  • Kevin Wu
    Affiliations
    Psychology Department, University of California San Diego, La Jolla, California
    Search for articles by this author
  • Amy J. Jak
    Affiliations
    Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, California

    Department of Psychiatry, University of California San Diego, La Jolla, California

    VA San Diego Healthcare System, Psychology Service, San Diego, California
    Search for articles by this author
  • Elizabeth W. Twamley
    Correspondence
    Corresponding author Elizabeth W. Twamley, PhD, VA San Diego Healthcare System, 3350 La Jolla Village Drive (116A), San Diego, CA 92161.
    Affiliations
    Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, California

    Department of Psychiatry, University of California San Diego, La Jolla, California

    VA San Diego Healthcare System, Research Service, San Diego, California
    Search for articles by this author
  • Author Footnotes
    ∗ Clark and Seewald contributed equally to this work.

      Abstract

      Objective

      To examine demographic, psychiatric symptom, and neuropsychological performance factors associated with duration of unemployment in Iraq/Afghanistan Veterans with a history of mild-to-moderate traumatic brain injury (TBI).

      Design

      Cross-sectional, secondary data analysis of baseline measures in a supported employment study.

      Setting

      VA medical center.

      Participants

      Participants (N=50) were veterans with a history of mild-to-moderate TBI who were unemployed, stating a goal of returning to work, and had documented impairment in at least 1 neuropsychological domain. Participants were referred from VA vocational and assessment-based clinics.

      Interventions

      Not applicable.

      Main Outcome Measures

      Duration of unemployment, neuropsychological, and psychiatric symptom assessments.

      Results

      Bivariate correlations revealed that longer duration of unemployment was associated with greater posttraumatic stress disorder (P<.10) and depressive (P<.05) symptom severity, worse executive functioning (P<.05), and racial/ethnic minority status (P<.05). A multiple linear regression analysis including these independent variables explained 26.5% of the variance in duration of unemployment. Worse executive functioning, specifically reasoning and set-shifting, and minority status were each associated with longer duration of unemployment in the context of multiple independent variables.

      Conclusions

      Our results underscore the importance of objective assessment of cognitive functioning in job-seeking Veterans with TBI histories. It may be useful to target aspects of executive functioning in vocational rehabilitation interventions and to provide additional assistance to Veterans from racial/ethnic minority groups.

      Keywords

      List of abbreviations:

      CAPS (Clinician-Administered Posttraumatic Stress Disorder Scale), HAM-D (Hamilton Depression Rating Scale), mTBI (mild traumatic brain injury), PTSD (posttraumatic stress disorder), TBI (traumatic brain injury), WCST-64 (Wisconsin Card Sorting Test 64-card version), WRAT-3 (Wide Range Achievement Test-3rd edition)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Tanielian T.
        • Jaycox L.H.
        Invisible wounds of war: psychological and cognitive injuries, their consequences, and services to assist recovery.
        RAND Corporation, Santa Monica2008
        • Carlson K.F.
        • Pogoda T.K.
        • Gilbert T.A.
        • et al.
        Supported employment for veterans with traumatic brain injury: patient perspectives.
        Arch Phys Med Rehabil. 2018; 99: S4-13
        • Olsen D.C.
        • Hays C.C.
        • Orff H.J.
        • Jak A.J.
        • Twamley E.W.
        Correlates of employment and postsecondary education enrolment in Afghanistan and Iraq veterans with traumatic brain injuries.
        Brain Injury. 2018; 32: 544-549
        • Pogoda T.K.
        • Stolzmann K.L.
        • Iverson K.M.
        • et al.
        Associations between traumatic brain injury, suspected psychiatric conditions, and unemployment in operation enduring Freedom/Operation Iraqi Freedom veterans.
        J Head Trauma Rehabil. 2016; 31: 191-203
        • Amick M.M.
        • Meterko M.
        • Fortier C.B.
        • Fonda J.R.
        • Milberg W.P.
        • McGlinchey R.E.
        The deployment trauma phenotype and employment status in veterans of the wars in Iraq and Afghanistan.
        J Head Trauma Rehabil. 2018; 33: E30-40
        • Abraham K.M.
        • Yosef M.
        • Resnick S.G.
        • Zivin K.
        Competitive employment outcomes among veterans in VHA therapeutic and supported employment services programs.
        Psychiatr Serv. 2017; 68: 938-946
        • Scaratti C.
        • Leonardi M.
        • Sattin D.
        • Schiavolin S.
        • Willems M.
        • Raggi A.
        Work-related difficulties in patients with traumatic brain injury: a systematic review on predictors and associated factors.
        Disabil Rehabil. 2017; 39: 847-855
        • Gary K.W.
        • Arango-Lasprilla J.C.
        • Ketchum J.M.
        • et al.
        Racial differences in employment outcome after traumatic brain injury at 1, 2, and 5 years postinjury.
        Arch Phys Med Rehabil. 2009; 90: 1699-1707
        • National Center for Veterans Analysis and Statistics
        Minority veterans report: military service history and VA benefit utilization statistics.
        US Department of Veterans Affairs, Washington (DC)2017
        • Belanger H.G.
        • Curtiss G.
        • Demery J.A.
        • Lebowitz B.K.
        • Vanderploeg R.D.
        Factors moderating neuropsychological outcomes following mild traumatic brain injury: a meta-analysis.
        J Int Neuropsychol Soc. 2005; 11: 215-227
        • Kalechstein A.D.
        • Newton T.F.
        • van Gorp W.G.
        Neurocognitive functioning is associated with employment status: a quantitative review.
        J Clin Exp Neuropsychol. 2003; 25: 1186-1191
        • Drake A.I.
        • Gray N.
        • Yoder S.
        • Pramuka M.
        • Llewellyn M.
        Factors predicting return to work following mild traumatic brain injury: a discriminant analysis.
        J Head Trauma Rehabil. 2000; 15: 1103-1112
        • Taylor B.C.
        • Hagel E.M.
        • Carlson K.F.
        • et al.
        Prevalence and costs of co-occurring traumatic brain injury with and without psychiatric disturbance and pain among Afghanistan and Iraq War veteran V.A. users.
        Med Care. 2012; 50: 342-346
        • Adler D.A.
        • Possemato K.
        • Mavandadi S.
        • et al.
        Psychiatric status and work performance of veterans of Operations Enduring Freedom and Iraqi Freedom.
        Psychiatr Serv. 2011; 62: 39-46
        • Dillahunt-Aspillaga C.
        • Nakase-Richardson R.
        • Hart T.
        • et al.
        Predictors of employment outcomes in veterans with traumatic brain injury: a VA traumatic brain injury model systems study.
        J Head Trauma Rehabil. 2017; 32: 271-282
        • Twamley E.W.
        • Jak A.J.
        • Delis D.C.
        • Bondi M.W.
        • Lohr J.B.
        Cognitive symptom management and rehabilitation therapy (CogSMART) for veterans with traumatic brain injury: pilot randomized controlled trial.
        J Rehabil Res Dev. 2014; 51: 59-70
        • Management of Concussion/mTBI Working Group
        VA/DoD clinical practice guideline for management of concussion/mild traumatic brain injury.
        J Rehabil Res Dev. 2009; 46: CP1-68
        • Blake D.D.
        • Weathers F.W.
        • Nagy L.M.
        • et al.
        The development of a Clinician-Administered PTSD Scale.
        J Trauma Stress. 1995; 8: 75-90
        • Hamilton M.
        Development of a rating scale for primary depressive illness.
        Br J Soc Clin Psychol. 1967; 6: 278-296
        • Cicerone K.D.
        • Kalmar K.
        Persistent postconcussion syndrome: the structure of subjective complaints after mild traumatic brain injury.
        J Head Trauma Rehabil. 1995; 10: 1-17
        • Wilkinson G.S.
        Wide Range Achievement Test administration manual.
        3rd ed. Wide Range Inc, Wilmington1993
        • Raskin S.
        Memory for intentions screening test.
        J Int Neuropsychol Soc. 2004; 10: 110
        • Wechsler D.
        WAIS-III: Wechsler Adult Intelligence Scale.
        3rd ed. Psychological Corp, San Antonio1997
        • Delis D.C.
        • Kramer J.H.
        • Kaplan E.
        • Ober B.A.
        CVLT-II: California Verbal Learning Test.
        2nd ed. Psychological Corp, San Antonio2000
        • Delis D.C.
        • Kramer J.H.
        • Kaplan E.
        Delis–Kaplan Executive Function System: examiner’s manual.
        Psychological Corp, San Antonio2001
        • Kongs S.K.
        WCST-64: Wisconsin Card Sorting Test-64 card version: professional manual.
        Psychological Assessment Resources, Odessa2000
        • US Bureau of Labor Statistics
        Unemployment rate and employment-population ratio vary by race and ethnicity.
        The Economics Daily, 2017 (Available at:)
        • Fan J.
        • Lv J.
        Sure independence screening for ultrahigh dimensional feature space.
        J R Stat Soc Series B Stat Methodol. 2008; 70: 849-911
        • Ritter J.A.
        • Taylor L.J.
        Racial disparity in unemployment.
        Rev Econ Stat. 2011; 93: 30-42
        • Lo C.C.
        • Cheng T.C.
        Race, unemployment rate, and chronic mental illness: a 15-year trend analysis.
        Soc Psychiatry Psychiatr Epidemiol. 2014; 49: 1119-1128
        • Storzbach D.
        • Twamley E.W.
        • Roost M.S.
        • et al.
        Compensatory cognitive training for Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn veterans with mild traumatic brain injury.
        J Head Trauma Rehabil. 2017; 32: 16-24