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Lasprilla JCA, Watson JD, Merced K, Mascialino G, Lequerica AH, Perrin PB. Trajectories of Cognitive and Motor Functional Independence in Hispanic Individuals During the 10 yrs After Traumatic Brain Injury. Am J Phys Med Rehabil 2023; 102:308-315. [PMID: 36098351 DOI: 10.1097/phm.0000000000002092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study examined demographic and injury-related predictors of cognitive and motor functional independence in Hispanics with traumatic brain injury at years 1, 2, 5, and 10 after hospital discharge. DESIGN Hispanic participants ( n = 1360) from the TBI Model Systems Study were included if they had at least one Functional Independence Measure (FIM) Cognitive and Motor score at any time point (years 1, 2, 5, or 10). Hierarchical linear modeling was used to examine baseline predictors of FIM Cognitive and Motor trajectories across this period. RESULTS FIM Cognitive trajectories showed a quadratic movement (initial increase followed by a plateau or slight decrease), whereas FIM Motor trajectories showed a cubic movement (initial increase, followed by a plateau, then another increase). Higher FIM Cognitive trajectories were predicted by younger age, shorter length of posttraumatic amnesia, higher education, and having experienced a nonviolent mechanism of injury. Higher FIM Motor trajectories were predicted by younger age, shorter posttraumatic amnesia, and a nonviolent mechanism of injury. CONCLUSIONS The baseline predictors of functional trajectories identified may help create tailored, evidence-based rehabilitation interventions along the continuum of recovery during the first 10 yrs for Hispanics with traumatic brain injury at risk for reduced functional outcomes.
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Affiliation(s)
- Juan Carlos Arango Lasprilla
- From the Department of Psychology, Virginia Commonwealth University, Richmond, Virginia (JCAL, JDW); Central Virginia Veterans Affairs Health Care System, Department of Psychology, Virginia Commonwealth University, Richmond, Virginia (KM); Escuela de Psicología, Universidad de Las Américas, Quito, Ecuador (GM); Center for Traumatic Brain Injury Research, Kessler Foundation, East Hanover, New Jersey (AHL); Department of Physical Medicine and Rehabilitation, Rutgers-New Jersey Medical School, Newark, New Jersey (AHL); and Departments of Psychology and Physical Medicine and Rehabilitation, Virginia Commonwealth University, Central Virginia Veterans Affairs Health Care System, Richmond, Virginia (PBP)
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Barriers and Facilitators to Accessing Rehabilitation Health Care: A Veterans Affairs Traumatic Brain Injury Model Systems Qualitative Study. Arch Phys Med Rehabil 2023; 104:380-389. [PMID: 36265532 DOI: 10.1016/j.apmr.2022.09.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/21/2022] [Accepted: 09/26/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To compare barriers and facilitators to accessing health care services among service members and veterans (SMVs) by traumatic brain injury (TBI) severity groups. DESIGN Qualitative descriptive study guided by an access to health care services conceptual framework. SETTING Five Veterans Affairs (VA) polytrauma rehabilitation centers. PARTICIPANTS SMVs (N=55, including 10 caregivers as proxies) ≥2 years post-TBI recruited from the VA TBI Model Systems and grouped by TBI severity (mild/moderate, severe). MAIN OUTCOME MEASURES Barriers and facilitators accessing care. RESULTS The main facilitators included ease of communicating with providers to help SMVs identify and utilize appropriate health care, family advocates who promoted engagement in health care, ability to use government and community facilities, and online resources or equipment. Distance to services was uniformly identified as a main barrier for both patient groups. However, facilitators and barriers to health care access differed by TBI severity. SMVs with severe TBI highlighted the role of nonprofit organizations in promoting health care engagement and the availability of VA specialty residential programs in meeting health care needs. Having unrecognized health care needs in chronic stages and communication difficulties with providers were more commonplace for those with greater TBI severity and affected quality of care. Those with mild/moderate TBI highlighted challenges associated with paying for services in the community and scheduling of services. CONCLUSIONS Barriers and facilitators exist across multiple dimensions of a health care access framework and vary by TBI severity. Results suggest possible mechanistic links between health care access and SMV health outcomes. Findings support current policy and practice efforts to facilitate health care access for SMVs with TBI but highlight the need for tailored approaches for those with greater disability.
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Liou-Johnson V, Merced K, Klyce DW, Agtarap S, Finn JA, Chung JS, Campbell T, Harris OA, Perrin PB. Exploring racial/ethnic disparities in rehabilitation outcomes after TBI: A veterans affairs model systems study. NeuroRehabilitation 2023; 52:451-462. [PMID: 36806517 DOI: 10.3233/nre-220225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
BACKGROUND Almost one-third of the U.S. military population is comprised of service members and veterans (SMVs) of color. Research suggests poorer functional and psychosocial outcomes among Black and Hispanic/Latine vs. White civilians following traumatic brain injury (TBI). OBJECTIVE This study examined racial/ethnic differences in 5-year functional independence and life satisfaction trajectories among SMVs who had undergone acute rehabilitation at one of five VA TBI Model Systems (TBIMS) Polytrauma Rehabilitation Centers (PRCs). METHODS Differences in demographic and injury-related factors were assessed during acute rehabilitation among White (n = 663), Black (n = 89) and Hispanic/Latine (n = 124) groups. Functional Independence Measure (FIM) Motor, FIM Cognitive, and Satisfaction with Life Scale (SWLS) scores were collected at 1, 2, and 5 years after injury. Racial/ethnic comparisons in these outcome trajectories were made using hierarchical linear modeling. RESULTS Black SMVs were less likely than White and Hispanic/Latine SMVs to have been deployed to a combat zone; there were no other racial/ethnic differences in any demographic or injury-related variable assessed. In terms of outcomes, no racial/ethnic differences emerged in FIM Motor, FIM cognitive, or SWLS trajectories. CONCLUSION The absence of observable racial/ethnic differences in 5-year outcome trajectories after TBI among SMVs from VA TBIMS PRCs contrasts sharply with previous research identifying disparities in these same outcomes and throughout the larger VA health care system. Individuals enrolled in VA PRCs are likely homogenized on key social determinants of health that would otherwise contribute to racial/ethnic disparities in outcome trajectories.
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Affiliation(s)
- Victoria Liou-Johnson
- Polytrauma Department, VA Palo Alto Healthcare Center, Palo Alto, CA, USA.,Clinical Excellence Research Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Kritzia Merced
- Central Virginia Veterans Affairs Health Care System, Richmond, VA, USA
| | - Daniel W Klyce
- Central Virginia Veterans Affairs Health Care System, Richmond, VA, USA.,Department of Physical Medicine and Rehabilitation, Virginia Common wealth University, Richmond, VA, USA.,Sheltering Arms Institute, Richmond, VA, USA
| | | | - Jacob A Finn
- Rehabilitation and Extended Care, Minneapolis VA Health Care System, Minneapolis, MN, USA.,Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
| | - Joyce S Chung
- Rehabilitation Department, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Thomas Campbell
- Central Virginia Veterans Affairs Health Care System, Richmond, VA, USA
| | - Odette A Harris
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA.,Rehabilitation Department, Traumatic Brain Injury Center of Excellence, VA Palo Alto Health Care System, PaloAlto, CA, USA
| | - Paul B Perrin
- Central Virginia Veterans Affairs Health Care System, Richmond, VA, USA.,Department of Psychology, School of Data Science, University of Virginia, Charlottesville, VA, USA
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Silva MA, Miles SR, O'Neil-Pirozzi TM, Arciniegas DB, Klocksieben F, Dismuke-Greer CE, Walker WC, Nakase-Richardson R. Alternative Structure Models of the Traumatic Brain Injury Rehabilitation Needs Survey: A Veterans Affairs TBI Model Systems Study. Arch Phys Med Rehabil 2023:S0003-9993(23)00048-5. [PMID: 36736804 DOI: 10.1016/j.apmr.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 12/20/2022] [Accepted: 01/03/2023] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To explore the factor structure of the Rehabilitation Needs Survey (RNS). DESIGN Secondary analysis of observational cohort study who were 5-years post-traumatic brain injury (TBI). SETTING Five Inpatient Rehabilitation Facilities. PARTICIPANTS Veterans enrolled in the TBI Model Systems longitudinal study who completed the RNS at 5-year follow-up (N=378). MAIN OUTCOME MEASURE(S) RNS. RESULTS RNS factor structure was examined with exploratory factor analysis (EFA) with oblique rotation. Analyses returned 2- and 3-factor solutions with Cronbach alphas ranging from 0.715 to 0.905 and corrected item-total correlations that ranged from 0.279 to 0.732. The 2-factor solution accounted for 61.7% of the variance with ≥3 exclusively loading items on each factor with acceptable internal consistency metrics and was selected as the most parsimonious and clinically applicable model. Ad hoc analysis found the RNS structure per the EFA corresponded with elements of the International Classification of Functioning, Disability and Health (ICF) conceptual framework. All factors had adequate internal consistency (α≥0.70) and 20 of the 21 demonstrated good discrimination (corrected item-total correlations≥0.40). CONCLUSIONS The 2-factor solution of the RNS appears to be a useful model for enhancing its clinical interpretability. Although there were cross-loading items, they refer to complex rehabilitation needs that are likely influenced by multiple factors. Alternatively, there are items that may require alteration and redundant items that should be considered for elimination.
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Affiliation(s)
- Marc A Silva
- Mental Health & Behavioral Sciences Section (MHBSS), James A. Haley Veterans' Hospital, Tampa, FL; Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL; Department of Psychology, University of South Florida, Tampa, FL; Division of Pulmonary and Sleep Medicine, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL.
| | - Shannon R Miles
- Mental Health & Behavioral Sciences Section (MHBSS), James A. Haley Veterans' Hospital, Tampa, FL; Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL
| | - Therese M O'Neil-Pirozzi
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA; Department of Communication Sciences and Disorders, Northeastern University, Boston, MA
| | - David B Arciniegas
- Marcus Institute for Brain Health, University of Colorado-Anschutz Medical Campus, Aurora, CO; Department of Psychiatry & Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque, NM
| | - Farina Klocksieben
- Research Methodology and Biostatistics Core, Office of Research, University of South Florida, Tampa, FL
| | - Clara E Dismuke-Greer
- Health Economics Resource Center (HERC), Center for Innovation to Implementation (Ci2i), VA Palo Alto Healthcare System, Menlo Park, CA
| | - William C Walker
- Department of Physical Medicine and Rehabilitation (PM&R), School of Medicine, Virginia Commonwealth University, Richmond, VA; PM&R Service, Richmond Veterans Affairs Medical Center, Central Virginia VA Health Care System, Richmond, VA
| | - Risa Nakase-Richardson
- Mental Health & Behavioral Sciences Section (MHBSS), James A. Haley Veterans' Hospital, Tampa, FL; Division of Pulmonary and Sleep Medicine, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL; Defense Health Agency Traumatic Brain Injury Center of Excellence at James A. Haley Veterans Hospital, Tampa, FL
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O'Neil-Pirozzi TM, Pinto SM, Sevigny M, Hammond FM, Juengst SB, Bombardier CH. Factors Associated With High and Low Life Satisfaction 10 Years After Traumatic Brain Injury. Arch Phys Med Rehabil 2022; 103:2164-2173. [PMID: 35202582 PMCID: PMC9484051 DOI: 10.1016/j.apmr.2022.01.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/10/2022] [Accepted: 01/27/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To identify correlates of life satisfaction at 10 years after moderate to severe traumatic brain injury (TBI) using an extreme phenotyping approach. DESIGN Effect sizes were calculated in this observational cohort study to estimate relationships of 10-year postinjury extremely high, extremely low, and moderate life satisfaction with (1) pre-injury demographics, injury-related factors, and functional characteristics at inpatient rehabilitation admission and discharge; and (2) postinjury demographics and clinical and functional measures at 10 years postinjury. SETTING Multicenter longitudinal database study. PARTICIPANTS People identified from the National Institute on Disability, Independent Living, and Rehabilitation Research TBI Database with life satisfaction data at 10 years post TBI (N=4800). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Satisfaction With Life Scale. RESULTS Although few pre-injury factors or clinical and functional factors shortly after injury were associated with 10-year life satisfaction groups, the following 10-year postinjury factors were associated with extremely high vs extremely low life satisfaction group membership: greater independent functioning, less disability, more frequent community participation, being employed, and having fewer depressive and anxiety symptoms. Those with extremely high life satisfaction were distinctly different from those with moderate and extremely low satisfaction. Extremely high life satisfaction was underrepresented among non-Hispanic Black persons relative to non-Hispanic White persons. Relationships between life satisfaction and independent functioning, disability, and participation were attenuated among non-Hispanic Black persons. CONCLUSIONS Extreme phenotyping analysis complements existing knowledge regarding life satisfaction after moderate to severe TBI and may inform acute and postacute clinical service delivery by comparing extremely high and extremely low life satisfaction subgroups. Findings suggest little association among personal, clinical, and functional characteristics early post TBI and life satisfaction 10 years later. Contemporaneous correlates of extremely high life satisfaction exist at 10 years post TBI, although the positive relationship of these variables to life satisfaction may be attenuated for non-Hispanic Black persons.
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Affiliation(s)
- Therese M O'Neil-Pirozzi
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA; Department of Communication Sciences and Disorders, Northeastern University, Boston, MA.
| | - Shanti M Pinto
- Department of Physical Medicine and Rehabilitation, Carolinas Rehabilitation, Charlotte, NC
| | | | - Flora M Hammond
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Rehabilitation Hospital of Indiana, Indianapolis, IN
| | - Shannon B Juengst
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Rehabilitation Hospital of Indiana, Indianapolis, IN; Department of Applied Clinical Research, UT Southwestern Medical Center, Dallas, TX
| | - Charles H Bombardier
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
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Young M, Peterson AH. Neuroethics across the Disorders of Consciousness Care Continuum. Semin Neurol 2022; 42:375-392. [PMID: 35738293 DOI: 10.1055/a-1883-0701] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Pugh MJ, Kennedy E, Gugger JJ, Mayo J, Tate D, Swan A, Kean J, Altalib H, Gowda S, Towne A, Hinds S, Van Cott A, Lopez MR, Jaramillo CA, Eapen BC, McCafferty RR, Salinsky M, Cramer J, McMillan KK, Kalvesmaki A, Diaz-Arrastia R. The Military Injuries: Understanding Post-Traumatic Epilepsy Study: Understanding Relationships among Lifetime Traumatic Brain Injury History, Epilepsy, and Quality of Life. J Neurotrauma 2021; 38:2841-2850. [PMID: 34353118 PMCID: PMC8820288 DOI: 10.1089/neu.2021.0015] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Understanding risk for epilepsy among persons who sustain a mild (mTBI) traumatic brain injury (TBI) is crucial for effective intervention and prevention. However, mTBI is frequently undocumented or poorly documented in health records. Further, health records are non-continuous, such as when persons move through health systems (e.g., from Department of Defense to Veterans Affairs [VA] or between jobs in the civilian sector), making population-based assessments of this relationship challenging. Here, we introduce the MINUTE (Military INjuries-Understanding post-Traumatic Epilepsy) study, which integrates data from the Veterans Health Administration with self-report survey data for post-9/11 veterans (n = 2603) with histories of TBI, epilepsy and controls without a history of TBI or epilepsy. This article describes the MINUTE study design, implementation, hypotheses, and initial results across four groups of interest for neurotrauma: 1) control; 2) epilepsy; 3) TBI; and 4) post-traumatic epilepsy (PTE). Using combined survey and health record data, we test hypotheses examining lifetime history of TBI and the differential impacts of TBI, epilepsy, and PTE on quality of life. The MINUTE study revealed high rates of undocumented lifetime TBIs among veterans with epilepsy who had no evidence of TBI in VA medical records. Further, worse physical functioning and health-related quality of life were found for persons with epilepsy + TBI compared to those with either epilepsy or TBI alone. This effect was not fully explained by TBI severity. These insights provide valuable opportunities to optimize the resilience, delivery of health services, and community reintegration of veterans with TBI and complex comorbidity.
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Affiliation(s)
- Mary Jo Pugh
- VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Eamonn Kennedy
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - James J. Gugger
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jamie Mayo
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - David Tate
- VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Alicia Swan
- Department of Psychology, University of Texas San Antonio, San Antonio, Texas, USA
| | - Jacob Kean
- VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Hamada Altalib
- Epilepsy Center of Excellence VA Connecticut Health Care System, West Haven, Connecticut, USA; Departments of Neurology and Psychiatry, Yale University School of Medicine, West Haven, Connecticut, USA
| | - Shaila Gowda
- Department of Neurology, Baylor School of Medicine, Houston, Texas, USA
| | - Alan Towne
- Hunter Holmes McGuire VA Medical Center, Richmond, Virginia, USA; Department of Neurology, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Sidney Hinds
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Anne Van Cott
- VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA; Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Maria R. Lopez
- Miami VA Health Care System, Miami, Florida, USA; Department of Neurology, University of Miami School of Medicine, Miami, Florida, USA
| | - Carlos A. Jaramillo
- Polytrauma Rehabilitation Center, South Texas Veterans Healthcare System, San Antonio, Texas, USA
| | - Blessen C. Eapen
- VA Greater Los Angeles Healthcare System, Los Angeles, California, USA; University of California Los Angeles, Los Angeles, California, USA
| | | | - Martin Salinsky
- VA Portland Healthcare System, Portland, Oregon, USA; Oregon Health & Sciences University, Portland, Oregon, USA
| | - Joyce Cramer
- Department of Neurology, Baylor School of Medicine, Houston, Texas, USA
- Cramer Consulting, Houston, Texas, USA
| | | | - Andrea Kalvesmaki
- VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Ramon Diaz-Arrastia
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Silva MA, Finn JA, Dillahunt-Aspillaga C, Cotner BA, Stevens LF, Nakase-Richardson R. Development of the traumatic brain injury Rehabilitation Needs Survey: a Veterans Affairs TBI Model Systems study. Disabil Rehabil 2021; 44:4474-4484. [PMID: 33756089 DOI: 10.1080/09638288.2021.1900930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To describe the development of the Rehabilitation Needs Survey (RNS) for persons in the chronic phase of traumatic brain injury (TBI) recovery. MATERIALS AND METHODS RNS items were generated following a literature review (January - March 2015) on the topic of rehabilitation needs and revised via consensus from an expert panel of TBI clinicians and researchers. The RNS was added to the VA TBI Model Systems longitudinal study; data collection occurred between 2015-2019. Needs were classified as current (if endorsed) or absent; if current, needs were classified as unmet if no help was received. Need frequency and association with rehabilitation outcomes were presented. RESULTS Eight studies examined rehabilitation needs and formed the initial item pool of 42 needs. This was reduced to form the 21-item RNS which was administered at year 1 (n = 260) and year 2 (n = 297) post-TBI. Number of needs endorsed was 8-9, and number of unmet needs was 1-2, on average. Number of needs was correlated with functional status, neurobehavioral symptoms, and mental health symptoms (p < 0.05) suggesting support for convergent validity of the RNS. CONCLUSION The RNS is a new measure of rehabilitation needs following TBI. Further investigation into its psychometrics and clinical utility is recommended.Implications for rehabilitationVeterans and Service Members with traumatic brain injury across the severity spectrum have ongoing rehabilitation needs during the chronic phase of recovery.The Rehabilitation Needs Survey is a standardized measure of rehabilitation needs following traumatic brain injury.Identification of unmet rehabilitation needs is important for raising awareness of service gaps and providing justification for resource allocation.
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Affiliation(s)
- Marc A Silva
- Mental Health and Behavioral Sciences Section (MHBSS), James A. Haley Veterans' Hospital, Tampa, FL, USA.,Department of Internal Medicine, University of South Florida, Tampa, FL, USA.,Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, USA.,Department of Psychology, University of South Florida, Tampa, FL, USA
| | - Jacob A Finn
- Extended Care and Rehabilitation (EC&R) Patient Service Line, Minneapolis VA Health Care System, Minneapolis, MN, USA.,Department of Psychiatry and Behavioral Sciences, University of Minnesota Twin Cities, Minneapolis, MN, USA
| | | | - Bridget A Cotner
- Research Service, James A. Haley Veterans' Hospital, Tampa, FL, USA.,Department of Anthropology, University of South Florida, Tampa, FL, USA
| | - Lillian F Stevens
- Mental Health Service, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA
| | - Risa Nakase-Richardson
- Mental Health and Behavioral Sciences Section (MHBSS), James A. Haley Veterans' Hospital, Tampa, FL, USA.,Department of Internal Medicine, University of South Florida, Tampa, FL, USA.,TBI Center of Excellence (TBICoE), James A. Haley Veterans' Hospital, Tampa, FL, USA
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