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
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References
- Invisible wounds of war: psychological and cognitive injuries, their consequences, and services to assist recovery.RAND Corporation, Santa Monica2008
- Supported employment for veterans with traumatic brain injury: patient perspectives.Arch Phys Med Rehabil. 2018; 99: S4-13
- Correlates of employment and postsecondary education enrolment in Afghanistan and Iraq veterans with traumatic brain injuries.Brain Injury. 2018; 32: 544-549
- 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
- The deployment trauma phenotype and employment status in veterans of the wars in Iraq and Afghanistan.J Head Trauma Rehabil. 2018; 33: E30-40
- Competitive employment outcomes among veterans in VHA therapeutic and supported employment services programs.Psychiatr Serv. 2017; 68: 938-946
- Work-related difficulties in patients with traumatic brain injury: a systematic review on predictors and associated factors.Disabil Rehabil. 2017; 39: 847-855
- Racial differences in employment outcome after traumatic brain injury at 1, 2, and 5 years postinjury.Arch Phys Med Rehabil. 2009; 90: 1699-1707
- Minority veterans report: military service history and VA benefit utilization statistics.US Department of Veterans Affairs, Washington (DC)2017
- Factors moderating neuropsychological outcomes following mild traumatic brain injury: a meta-analysis.J Int Neuropsychol Soc. 2005; 11: 215-227
- Neurocognitive functioning is associated with employment status: a quantitative review.J Clin Exp Neuropsychol. 2003; 25: 1186-1191
- Factors predicting return to work following mild traumatic brain injury: a discriminant analysis.J Head Trauma Rehabil. 2000; 15: 1103-1112
- 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
- Psychiatric status and work performance of veterans of Operations Enduring Freedom and Iraqi Freedom.Psychiatr Serv. 2011; 62: 39-46
- 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
- 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
- VA/DoD clinical practice guideline for management of concussion/mild traumatic brain injury.J Rehabil Res Dev. 2009; 46: CP1-68
- The development of a Clinician-Administered PTSD Scale.J Trauma Stress. 1995; 8: 75-90
- Development of a rating scale for primary depressive illness.Br J Soc Clin Psychol. 1967; 6: 278-296
- Persistent postconcussion syndrome: the structure of subjective complaints after mild traumatic brain injury.J Head Trauma Rehabil. 1995; 10: 1-17
- Wide Range Achievement Test administration manual.3rd ed. Wide Range Inc, Wilmington1993
- Memory for intentions screening test.J Int Neuropsychol Soc. 2004; 10: 110
- WAIS-III: Wechsler Adult Intelligence Scale.3rd ed. Psychological Corp, San Antonio1997
- CVLT-II: California Verbal Learning Test.2nd ed. Psychological Corp, San Antonio2000
- Delis–Kaplan Executive Function System: examiner’s manual.Psychological Corp, San Antonio2001
- WCST-64: Wisconsin Card Sorting Test-64 card version: professional manual.Psychological Assessment Resources, Odessa2000
- Unemployment rate and employment-population ratio vary by race and ethnicity.The Economics Daily, 2017 (Available at:)https://www.bls.gov/opub/ted/2017/unemployment-rate-and-employment-population-ratio-vary-by-race-and-ethnicity.htmDate accessed: October 22, 2019
- Sure independence screening for ultrahigh dimensional feature space.J R Stat Soc Series B Stat Methodol. 2008; 70: 849-911
- Racial disparity in unemployment.Rev Econ Stat. 2011; 93: 30-42
- Race, unemployment rate, and chronic mental illness: a 15-year trend analysis.Soc Psychiatry Psychiatr Epidemiol. 2014; 49: 1119-1128
- 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
Article info
Publication history
Published online: May 13, 2020
Footnotes
Supported by the Department of Defense (award no. W81XWH-08-2-0193 to Dr Elizabeth Twamley) and the VA Center of Excellence for Stress and Mental Health (CESAMH) and the Office of Academic Affiliations, CESAMH Advanced Fellowship Program in Mental Illness Research and Treatment, Department of Veterans Affairs.
Disclosures: none.
Identification
Copyright
Published by Elsevier Inc. on behalf of the American Congress of Rehabilitation Medicine
