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O'Neil-Pirozzi TM, Sevigny M, Pinto SM, Hammond FM, Juengst SB. Early Factors Predictive of Extreme High and Low Life Satisfaction 10 Years Post-Moderate to Severe Traumatic Brain Injury. J Head Trauma Rehabil 2023; 38:448-457. [PMID: 36854110 PMCID: PMC10460820 DOI: 10.1097/htr.0000000000000860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
OBJECTIVE To identify demographic, injury-related, and 1-year postinjury clinical and functional predictors of high and low life satisfaction at 10 years after moderate to severe traumatic brain injury (TBI) using an extreme phenotyping approach. SETTING Multicenter longitudinal database study. PARTICIPANTS A total of 3040 people from the National Institute on Disability, Independent Living, and Rehabilitation Research TBI Model Systems database with life satisfaction data at 10 years post-TBI. DESIGN Multicenter, cross-sectional, observational design. MAIN MEASURES Satisfaction With Life Scale (outcome), Glasgow Coma Scale, Disability Rating Scale, Functional Independence Measure, Participation Assessment with Recombined Tools-Objective, Patient Health Questionnaire-9, and General Anxiety Disorder-7 (standardized predictors). RESULTS Greater cognitive and motor independence, more frequent community participation, and less depressive symptoms 1 year post-moderate to severe TBI predicted extreme high life satisfaction 10 years later. Non-Hispanic White and Hispanic individuals were significantly more likely than Black individuals to have extreme high life satisfaction 10 years post-TBI. CONCLUSIONS Extreme phenotyping analysis complements existing knowledge regarding life satisfaction post-moderate to severe TBI. From a chronic disease management perspective, future studies are needed to examine the feasibility and impact of early postinjury medical and rehabilitative interventions targeting cognitive and motor function, community participation, and mood on the maintenance/enhancement of long-term life satisfaction post-TBI.
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Affiliation(s)
- Therese M O'Neil-Pirozzi
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts (Dr O'Neil-Pirozzi); Department of Communication Sciences and Disorders, Northeastern University, Boston, Massachusetts (Dr O'Neil-Pirozzi); Research Department, Craig Hospital, Denver, Colorado (Mr Sevigny); Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas (Dr Pinto); Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Rehabilitation Hospital of Indiana, Indianapolis (Dr Hammond); Brain Injury Research Center, TIRR Memorial Hermann, Houston, Texas (Dr Juengst); and Department of Physical Medicine and Rehabilitation, UT Houston Health Sciences Center, Houston, Texas (Dr Juengst)
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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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Faurot KR, Cole WR, MacIntosh BA, Dunlap M, Moore CB, Roberson B, Guerra M, Domenichiello AF, Palsson O, Rivera W, Nothwehr A, Arrieux J, Russell K, Jones C, Werner JK, Clark R, Diaz-Arrastia R, Suchindran C, Mann JD, Ramsden CE, Kenney K. Targeted dietary interventions to reduce pain in persistent post-traumatic headache among service members: Protocol for a randomized, controlled parallel-group trial. Contemp Clin Trials 2022; 119:106851. [PMID: 35842107 PMCID: PMC9662694 DOI: 10.1016/j.cct.2022.106851] [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: 02/15/2022] [Revised: 07/05/2022] [Accepted: 07/10/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Post-traumatic headache (PTH) is common after traumatic brain injury (TBI), especially among active-duty service members (SMs), affecting up to 35% of patients with chronic TBI. Persistent PTH is disabling and frequently unresponsive to treatment and is often migrainous. Here, we describe a trial assessing whether dietary modifications to increase n-3 eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) and reduce n-6 linoleic acid (LA), will alter nociceptive lipid mediators and result in clinical improvements in persistent PTH. METHODS This prospective, randomized, controlled trial tests the efficacy, safety, and biochemical effects of targeted, controlled alterations in dietary n-3 and n-6 fatty acids in 122 adult SMs and military healthcare beneficiaries with diagnosed TBI associated with actively managed persistent frequent (>8 /month) PTH with migraine. Following a 4-week baseline, participants are randomized to one of two equally intensive dietary regimens for 12 additional weeks: 1) increased n-3 EPA + DHA with low n-6 LA (H3L6); 2) usual US dietary content of n-3 and n-6 fatty acids (Control). During the intervention, participants receive diet arm-specific study oils and foods sufficient for 75% of caloric needs and comprehensive dietary counseling. Participants complete daily headache diaries throughout the intervention. Clinical outcomes, including the Headache Impact Test (HIT-6), headache hours per day, circulating blood fatty acid levels, and bioactive metabolites, are measured pre-randomization and at 6 and 12 weeks. Planned primary analyses include pre-post comparisons of treatment groups on clinical measures using ANCOVA and mixed-effects models. Similar approaches to explore biochemical and exploratory clinical outcomes are planned. CLINICALTRIALS gov registration: NCT03272399.
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Affiliation(s)
- Keturah R Faurot
- Department of Physical Medicine & Rehabilitation, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America.
| | - Wesley R Cole
- Department of Brain Injury Medicine, Intrepid Spirit Center, Womack Army Medical Center, Fort Bragg, NC, United States of America; Matthew Gfeller Center, Department of Exercise and Sport Science, the University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Beth A MacIntosh
- Metabolic and Nutrition Research Core, University of North Carolina Health, Chapel Hill, NC, United States of America
| | - Margaret Dunlap
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America; National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, United States of America; Traumatic Brain Injury Clinic, Neurology Department, Fort Belvoir Community Hospital, Fort Belvoir, VA, United States of America
| | - Carol B Moore
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America
| | - Brittney Roberson
- Department of Physical Medicine & Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America; The Geneva Foundation, Bethesda, MD, United States of America
| | - Melissa Guerra
- Department of Physical Medicine and Rehabilitation, South Texas Veterans Healthcare System, San Antonio, TX, United States of America
| | - Anthony F Domenichiello
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States of America
| | - Olafur Palsson
- Department of Medicine, the University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Wanda Rivera
- Traumatic Brain Injury Clinic, Neurology Department, Fort Belvoir Community Hospital, Fort Belvoir, VA, United States of America; Intrepid Spirit Center, Fort Belvoir Community Hospital, Fort Belvoir, VA, United States of America; Department of Neurology, Fort Belvoir Community Hospital, Fort Belvoir, VA, United States of America
| | - Ann Nothwehr
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, United States of America
| | - Jacques Arrieux
- Department of Brain Injury Medicine, Intrepid Spirit Center, Womack Army Medical Center, Fort Bragg, NC, United States of America
| | - Katie Russell
- Jack, Joseph, and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH, United States of America
| | - Cecily Jones
- Kent State University, Kent, OH, United States of America
| | - J Kent Werner
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America
| | - Ruth Clark
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America; National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, United States of America
| | - Ramon Diaz-Arrastia
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States of America
| | - Chirayath Suchindran
- Department of Biostatistics, Gillings School of Global Public Health, the University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - J Douglas Mann
- Department of Neurology, the University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Christopher E Ramsden
- Lipid Peroxidation Unit, Laboratory of Clinical Investigation, National Institute on Aging, National Institutes of Health, Baltimore, MD, United States of America; National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, United States of America
| | - Kimbra Kenney
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America; National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, United States of America
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Niemeier JP, Hammond FM, O'Neil-Pirozzi TM, Venkatesan UM, Bushnik T, Zhang Y, Kennedy RE. Refining understanding of life satisfaction in elderly persons with traumatic brain injury using age-defined cohorts: a TBI model systems study. Brain Inj 2021; 35:1284-1291. [PMID: 34516315 DOI: 10.1080/02699052.2021.1972153] [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: 10/20/2022]
Abstract
OBJECTIVE Examine effects of age cohort on post-injury life satisfaction in elderly persons with TBIDesign: Retrospective cohortSetting: TBI Model Systems centers. PARTICIPANTS 5,109 elderly participants with TBI in the TBI Model Systems National DatabaseInterventions: Not applicableMain Outcome Measures: Demographics, injury characteristics and cause, outcomes, age at time of analysis, time to follow commands, maximum follow-up period, and scores on the Satisfaction With Life Scale (SWLS) and Participation Assessment with Recombined Tools-Objective (PART-O) scores at 1, 2, 5, or 10 years post-injury. RESULTS Life satisfaction post-TBI across groups increased with age. The young-old sub-group demonstrated the poorest life satisfaction outcomes, while the oldest sub-group experienced greatest life satisfaction. In contrast, participation decreased with age. CONCLUSIONS Findings show diversity in satisfaction with life following moderate to severe TBI for three elderly age-cohorts. Differences may be due to variations in generation-based lived experience, in perceived meaningfulness of participation, could echo prior evidence of greater resilience in the oldest group, or could reflect bias within the study sample. Further research into between- and within- differences for elderly TBI age cohorts is needed to more precisely meet their needs for physical and functional rehabilitation as well as psychological supports.
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Affiliation(s)
- Janet P Niemeier
- Department of Psychology, University of Alabama, Birmingham, Alabama, United States
| | - Flora M Hammond
- Indiana University School of Medicine, Rehabilitation Hospital of Indiana, Indianapolis, Indiana, United States
| | - Therese M O'Neil-Pirozzi
- Spaulding Rehabilitation Hospital, Northeastern University, Boston, Massachusetts, United States
| | | | - Tamara Bushnik
- Rusk Rehabilitation, New York University Langone Health, New York, New York, United States
| | - Yue Zhang
- University of Alabama, Birmingham, Alabama, United States
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Mahoney EJ, Silva MA, Reljic T, Dams-O'Connor K, Hammond FM, Monden KR, Chung JS, Dillahunt-Aspillaga C, Nakase-Richardson R. Rehabilitation Needs at 5 Years Post-Traumatic Brain Injury: A VA TBI Model Systems Study. J Head Trauma Rehabil 2021; 36:175-185. [PMID: 33201036 DOI: 10.1097/htr.0000000000000629] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Describe rehabilitation needs and factors associated with unmet needs at 5 years post-traumatic brain injury (TBI). SETTING Five Veterans Affairs (VA) polytrauma rehabilitation centers (PRCs). PARTICIPANTS VA TBI Model Systems participants (N = 283; 96% male, 75%, 57% severe TBI). DESIGN Prospective observational cohort. MAIN MEASURES Rehabilitation Needs Survey (21-item survey that assesses cognitive, emotional, social, and functional needs); Craig Hospital Inventory of Environmental Factors (25-item survey of potential environmental barriers). RESULTS Participants endorsed a mean of 8 (SD: 6.2) ongoing and 3 (SD: 4.7) unmet rehabilitation needs at 5 years post-TBI. Approximately 65% of participants reported at least 1 rehabilitation need that remained unmet. The number and nature of needs differed across TBI severity groups. In unadjusted and adjusted linear regression models, Black race and environmental barriers (Craig Hospital Inventory of Environmental Factors total score) were predictive of unmet needs (P < .001). Those with greater unmet needs reported the physical environment (54%-63%), informational sources (54%), social attitudes (55%), healthcare access (40%), public policy (32%-37%), transportation availability (33%), and in-home assistance (32%) as the most frequent environmental barriers at 5 years post-TBI. CONCLUSION Veterans and Service Members continue to have rehabilitation needs at 5 years post-TBI. Veterans Affairs programs to address ongoing needs and policy to support them are needed.
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Affiliation(s)
- Elaine J Mahoney
- Mental Health and Behavioral Sciences (MHBS) (Drs Mahoney, Silva, and Nakase-Richardson) and Defense and Veterans Brain Injury Center (DVBIC) (Drs Silva and Nakase-Richardson), James A. Haley Veterans' Hospital, Tampa, Florida; Departments of Psychiatry and Behavioral Neurosciences (Dr Silva), Psychology (Dr Silva), Child & Family Studies (Dr Dillahunt-Aspillaga), and Internal Medicine, Division of Pulmonary and Sleep Medicine (Dr Nakase-Richardson), University of South Florida, Tampa; Morsani College of Medicine, University of South Florida, Tampa (Ms Reljic); Departments of Rehabilitation Medicine (Dr Dams-O'Connor) and Neurology (Dr Dams-O'Connor), Icahn School of Medicine at Mount Sinai, New York, New York; Department of Physical Medicine & Rehabilitation, Indiana University School of Medicine, Indianapolis (Dr Hammond); Rehabilitation Hospital of Indiana, Indianapolis (Dr Hammond); Research Department, Craig Hospital, Englewood, Colorado (Dr Monden); Department of Rehabilitation Medicine, University of Minnesota, Minneapolis (Dr Monden); VA Palo Alto Health Care System, Palo Alto, California (Dr Chung); and Research Service, James A. Haley Veterans' Hospital, Tampa, Florida (Dr Dillahunt-Aspillaga)
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Pittet JF, Hu PJ, Honavar J, Brandon AP, Evans CA, Muthalaly R, Ding Q, Wagener BM. Estrogen Alleviates Sex-Dependent Differences in Lung Bacterial Clearance and Mortality Secondary to Bacterial Pneumonia after Traumatic Brain Injury. J Neurotrauma 2020; 38:989-999. [PMID: 33203297 DOI: 10.1089/neu.2020.7327] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Traumatic brain injury (TBI) is the leading cause of injury-related death and disability in patients under the age of 46 years. Survivors of the initial injury often endure systemic complications such as pulmonary infection, and Pseudomonas aeruginosa is one of the most common causes of nosocomial pneumonia in intensive care units. Female patients are less likely to develop secondary pneumonia after TBI, and pre-clinical studies have revealed a salutary role for estrogen after trauma. Therefore, we hypothesized that female mice would experience less mortality after post-TBI pneumonia with P. aeruginosa. We employed a mouse model of TBI followed by P. aeruginosa pneumonia. Male mice had greater mortality and impaired lung bacterial clearance after post-TBI pneumonia compared with female mice. This was confirmed as a difference in sex hormones, as oophorectomized wild-type mice had mortality and lung bacterial clearance similar to male mice. There were differences in tumor necrosis factor-α secretion in male and female alveolar macrophages after P. aeruginosa infection. Finally, injection of male or oophorectomized wild-type female mice with estrogen restored lung bacterial clearance and prevented mortality. Our model of TBI followed by P. aeruginosa pneumonia is among the first to reveal sex dimorphism in secondary, long-term TBI complications.
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Affiliation(s)
- Jean-Francois Pittet
- Divisions of Critical Care Medicine and University of Alabama at Birmingham, Birmingham, Alabama, USA.,Molecular and Translational Biomedicine, Department of Anesthesiology and Perioperative Medicine and University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Parker J Hu
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jaideep Honavar
- Molecular and Translational Biomedicine, Department of Anesthesiology and Perioperative Medicine and University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Angela P Brandon
- Molecular and Translational Biomedicine, Department of Anesthesiology and Perioperative Medicine and University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Cilina A Evans
- Molecular and Translational Biomedicine, Department of Anesthesiology and Perioperative Medicine and University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Rebekah Muthalaly
- Molecular and Translational Biomedicine, Department of Anesthesiology and Perioperative Medicine and University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Qiang Ding
- Molecular and Translational Biomedicine, Department of Anesthesiology and Perioperative Medicine and University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Brant M Wagener
- Divisions of Critical Care Medicine and University of Alabama at Birmingham, Birmingham, Alabama, USA.,Molecular and Translational Biomedicine, Department of Anesthesiology and Perioperative Medicine and University of Alabama at Birmingham, Birmingham, Alabama, USA
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Silva MA, VandenBussche Jantz AB, Klocksieben F, Monden KR, Rabinowitz AR, Cotner BA, Dillahunt-Aspillaga C, Nakase-Richardson R. Unmet Rehabilitation Needs Indirectly Influence Life Satisfaction 5 Years After Traumatic Brain Injury: A Veterans Affairs TBI Model Systems Study. Arch Phys Med Rehabil 2020; 102:58-67. [PMID: 32949552 DOI: 10.1016/j.apmr.2020.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/14/2020] [Accepted: 08/18/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To describe the association between unmet rehabilitation needs and life satisfaction 5 years after traumatic brain injury (TBI). DESIGN Prospective observational cohort. SETTING Five Veterans Affairs (VA) Polytrauma Rehabilitation Centers. PARTICIPANTS VA TBI Model Systems participants (N=301); 95% male; 77% white; average age, 39±14y). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Satisfaction With Life Scale (SWLS). RESULTS Average SWLS score was 22±8. Univariable analyses demonstrated several statistically significant predictors of life satisfaction, including employment status, participation, psychiatric symptom severity, past year mental health treatment, and total number of unmet rehabilitation needs (all P<.05). Multivariable analyses revealed that depression and participation were each associated with life satisfaction. An ad hoc mediation model suggested that unmet rehabilitation needs total was indirectly related to life satisfaction. Total unmet rehabilitation needs ranged from 0-21 (mean, 2.0±3.4). Correlational analyses showed that 14 of the 21 unmet rehabilitation needs were associated with life satisfaction. CONCLUSIONS Findings support the need for rehabilitation engagement in later stages of TBI recovery. Ongoing assessment of and intervention for unmet rehabilitation needs in the chronic phase of recovery have the potential to mitigate decline in life satisfaction.
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Affiliation(s)
- Marc A Silva
- Mental Health & Behavioral Sciences Section (MHBSS), James A. Haley Veterans' Hospital, Tampa, Florida; Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, Florida; Department of Psychology, University of South Florida, Tampa, Florida; Defense and Veterans Brain Injury Center (DVBIC), James A. Haley Veterans' Hospital, Tampa, Florida.
| | | | - Farina Klocksieben
- Department of Internal Medicine, University of South Florida, Tampa, Florida
| | - Kimberley R Monden
- Craig Hospital, Research Department, Englewood, Colorado; Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota
| | | | - Bridget A Cotner
- Research Service, James A. Haley Veterans' Hospital, Tampa, Florida; Department of Anthropology, University of South Florida, Tampa, Florida
| | | | - Risa Nakase-Richardson
- Mental Health & Behavioral Sciences Section (MHBSS), James A. Haley Veterans' Hospital, Tampa, Florida; Defense and Veterans Brain Injury Center (DVBIC), James A. Haley Veterans' Hospital, Tampa, Florida; Department of Internal Medicine, University of South Florida, Tampa, Florida
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Merritt VC, Jurick SM, Crocker LD, Keller AV, Hoffman SN, Jak AJ. Factors associated with employment and work perception in combat-exposed veterans. Rehabil Psychol 2020; 65:279-290. [PMID: 32297778 PMCID: PMC8409174 DOI: 10.1037/rep0000323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE/OBJECTIVE The purpose of this study was 2-fold: (a) to evaluate whether perception of work ability is associated with employment status in a sample of combat-exposed veterans, and (b) to determine whether the same sets of variables that are associated with employment status are also associated with perception of work ability. Research Method/Design: In this cross-sectional study, veterans (N = 83) underwent a neuropsychological assessment and completed questionnaires assessing demographic characteristics, combat-related experiences, and psychiatric and neurobehavioral/health-related symptoms. Primary outcomes of interest were employment status (unemployed vs. employed) and veterans' perception of whether their ability to work has declined due to an ongoing condition (yes vs. no). RESULTS A chi-square analysis revealed a significant relationship between perception of work ability and employment status. Additionally, psychiatric and neurobehavioral/health-related symptoms were associated with employment status and perception of work ability, whereas demographic characteristics (i.e., service-connected disability rating) and combat-related experiences (i.e., mTBI history) were only associated with perception of work ability. Objective cognitive functioning was not associated with employment status or perception of work ability. CONCLUSIONS/IMPLICATIONS Although preliminary, results suggest that perception of work ability is an important factor to consider when evaluating employment-related outcomes in veterans. Moreover, results indicate that while there is some overlap among the variables associated with employment status and perception of work ability, additional variables are linked with perception of work ability. Taken together, these findings suggest that perception of one's ability to work and factors that influence it may be particularly important treatment targets in the veteran population. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | - Sarah M. Jurick
- VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
- Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, USA
| | - Laura D. Crocker
- VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
- Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, USA
| | | | | | - Amy J. Jak
- VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
- Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, USA
- Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, CA, USA
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Cornis-Pop M, Hinds SR, Picon LM, Tapia RN. Rehabilitation in the Department of Veterans Affairs Polytrauma System of Care. Phys Med Rehabil Clin N Am 2019; 30:1-12. [DOI: 10.1016/j.pmr.2018.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Merritt BP, Kretzmer T, McKenzie-Hartman TL, Gootam P. Neurobehavioral Management of the Polytrauma Veteran. Phys Med Rehabil Clin N Am 2018; 30:133-154. [PMID: 30470418 DOI: 10.1016/j.pmr.2018.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Since the inception of the Afghanistan and Iraq wars, an increasing number of veterans have sought treatment from the Department of Veterans Affairs for combat-related injuries. Many veterans experience postconcussive symptoms, traumatic stress, chronic pain, sensory deficits, and/or headaches. The goal of this article was to highlight some of the challenges treatment providers may face, while providing rehabilitation specialists with important evaluation and treatment considerations in working with this population to maximize outcomes for these veterans.
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Affiliation(s)
- Bryan P Merritt
- James A. Haley Veterans Hospital, 13000 Bruce B Downs Boulevard #117, Tampa, FL 33612, USA; Department of Neurology, University of South Florida Medical School, 4202 E Fowler Avenue, Tampa, FL 33620, USA.
| | - Tracy Kretzmer
- James A. Haley Veterans Hospital, 13000 Bruce B Downs Boulevard #117, Tampa, FL 33612, USA; Department of Psychology, University of South Florida Medical School, 4202 E Fowler Avenue, Tampa, FL 33620, USA
| | - Tamara L McKenzie-Hartman
- James A. Haley Veterans Hospital, 13000 Bruce B Downs Boulevard #117, Tampa, FL 33612, USA; Defense and Veterans Brain Injury Center (DVBIC), Silver Spring, MD, USA
| | - Praveen Gootam
- James A. Haley Veterans Hospital, 13000 Bruce B Downs Boulevard #117, Tampa, FL 33612, USA; Department of Psychiatry and Behavioral Neurosciences, University of South Florida Medical School, 4202 E Fowler Avenue, Tampa, FL 33620, USA
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Informing the Needs of Veterans and Service Members With TBI and Their Families: Leveraging the VA TBI Model System Program of Research. J Head Trauma Rehabil 2017; 32:215-218. [PMID: 28678116 DOI: 10.1097/htr.0000000000000336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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