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Clark JMR, Ozturk ED, Chanfreau-Coffinier C, Merritt VC. Evaluation of clinical outcomes and employment status in veterans with dual diagnosis of traumatic brain injury and spinal cord injury. Qual Life Res 2024; 33:229-239. [PMID: 37856045 DOI: 10.1007/s11136-023-03518-7] [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] [Accepted: 09/12/2023] [Indexed: 10/20/2023]
Abstract
PURPOSE To examine clinical outcomes and employment status in Veterans with and without a dual diagnosis of traumatic brain injury (TBI) and spinal cord injury (SCI). METHODS This cross-sectional study examined a national sample of Veterans enrolled in the VA Million Veteran Program who completed the Comprehensive TBI Evaluation (CTBIE) as part of the Veterans Health Administration's TBI Screening and Evaluation Program. Veterans (N = 12,985) were classified into the following TBI/SCI groups using CTBIE data: those with a dual diagnosis of TBI and SCI (TBI+/SCI+); those with a history of TBI but no SCI (TBI+/SCI-); and those with no history of TBI or SCI (TBI-/SCI-; i.e., the control group). CTBIE-derived outcomes included neurobehavioral symptoms, comorbid psychiatric symptoms, pain and pain interference, and employment status. RESULTS Chi-square analyses showed significant associations between TBI/SCI group and all clinical outcomes evaluated (all p's < .001; V = 0.07-0.11). In general, the TBI+/SCI+ and TBI +/SCI- groups endorsed comparable levels of neurobehavioral symptoms, psychiatric symptoms, and pain, but significantly greater rates of symptoms and pain relative to the TBI-/SCI- group. Effect sizes for all pairwise comparisons were small (φ = 0.01-0.11). Finally, there was no significant association between TBI/SCI group and employment status (p = .170; V = 0.02), with all three groups showing relatively comparable rates of unemployment. CONCLUSIONS Regardless of SCI status, Veterans with TBI history endorsed poorer clinical outcomes than Veterans without TBI and SCI. However, rates of unemployment were similarly high across all three groups. Findings suggest that any Veteran completing the CTBIE may be at risk for poor clinical and employment outcomes.
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Affiliation(s)
- Jillian M R Clark
- Psychology & Research Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
| | - Erin D Ozturk
- Psychology & Research Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
- San Diego Joint Doctoral Program, San Diego State University/University of California, San Diego, CA, USA
| | | | - Victoria C Merritt
- Psychology & Research Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA.
- Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, CA, USA.
- Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, USA.
- VA San Diego Healthcare System (151B), 3350 La Jolla Village Drive, San Diego, CA, 92161, USA.
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Tate DG, Forchheimer M, Reber L, Meade M, Tan N, Clarke P. Factors enabling comorbidities and secondary conditions in older adults with spinal cord injury. J Spinal Cord Med 2023; 46:929-940. [PMID: 35993788 PMCID: PMC10653777 DOI: 10.1080/10790268.2022.2108662] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
Abstract
OBJECTIVE To examine the role of personal, social, and environmental factors predicting comorbidities and secondary conditions among older adults with spinal cord injury (SCI). DESIGN Cross-sectional study utilizing survey methods were used to collect the data analyzed with two distinct general linear models. SETTING Community-dwelling participants who resided in rural and urban areas. PARTICIPANTS One hundred and eighty-three (183) participants with SCI ages 45 and over at least five years post injury. INTERVENTIONS Not applicable. MEASURES Spinal Cord Injury Secondary Conditions Scale (SCI-SCS); Comorbidities Questionnaire; Spinal Cord Injury Functional Index Assistive Technology (SCI-FI/AT) Basic - Mobility; Spinal Cord Injury Quality of Life (SCI-QOL) Satisfaction with Social Roles and Activities Scale (SSRA); Cohen's Social Network-Social Integration Index, the Medical Outcomes Study (MOS) Social Support Emotional/Informational Support Scale, and the Facilitators and Barriers Survey for Mobility (FABS-Mv2). Questions were also asked from the Behavioral Risk Factor Surveillance System (BRFSS). RESULTS Common predictors of comorbidities and secondary conditions included age, basic mobility, primary health care payer and parking limitations. An interaction between parking and neurological classification was observed for comorbidities. Neurological classification and employment were significantly associated with comorbidities while for secondary conditions, sex, years since injury, education, satisfaction with social roles and the home environment were critical factors. CONCLUSIONS Our study shows the effects of demographic and injury factors, physical functioning, satisfaction with social roles, access to home environment adaptations and health resources in predicting comorbidities and secondary conditions among older adults with SCI.
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Affiliation(s)
- Denise G Tate
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Martin Forchheimer
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Lisa Reber
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Michelle Meade
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Nasya Tan
- Department of Epidemiology, School of Public Health, Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Philippa Clarke
- Department of Epidemiology, School of Public Health, Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
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Budd MA, Gater DR, Channell I. Psychosocial Consequences of Spinal Cord Injury: A Narrative Review. J Pers Med 2022; 12:jpm12071178. [PMID: 35887675 PMCID: PMC9320050 DOI: 10.3390/jpm12071178] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 07/09/2022] [Accepted: 07/15/2022] [Indexed: 11/26/2022] Open
Abstract
Consequences of a spinal cord injury (SCI) entail much more than damage to the spinal cord. The lives of people with SCI, along with those around them, experience profound long-lasting changes in nearly every life domain. SCI is a physical (biological) injury that is inextricably combined with various psychological and social consequences. The objective of this review is to present psychosocial challenges following SCI through the biopsychosocial model, beginning with acknowledgement of the larger societal effects of ableism and stigma before addressing the many unique psychosocial aspects of living with SCI. Included in this review are qualitative studies and systematic reviews on current psychosocial outcomes and consequences. This paper attempts to structure this information by dividing it into the following sections: relationships and family; changes in finances and employment; issues related to the person’s living situation; community reintegration; factors associated with mood and coping (e.g., depression, anxiety, substance use, and PTSD); self-harm behaviors (ranging from nonadherence to suicide); effects of traumatic brain injury; considerations regarding sexual health; aging with SCI; and concludes with a brief discussion about post-traumatic growth. Cultivating an understanding of the unique and interrelated psychosocial consequences of people living with SCI may help mitigate the psychosocial aftermath and serve as a reminder to providers to maintain a person-centered approach to care.
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Affiliation(s)
- Maggi A. Budd
- Spinal Cord Injury/Disease Service, VA Boston Healthcare System, Boston, MA 02130, USA;
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
- Center for Bioethics, Harvard Medical School, Boston, MA 02115, USA
- Correspondence:
| | - David R. Gater
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL 33136, USA;
- Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis, Miami, FL 33136, USA
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Isabella Channell
- Spinal Cord Injury/Disease Service, VA Boston Healthcare System, Boston, MA 02130, USA;
- Mental Health Counseling and Behavioral Medicine Graduate Program, Boston University School of Medicine, Boston, MA 02128, USA
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Ottomanelli L, Goetz LL, Barnett SD, Njoh E, Fishalow J. Factors associated with past and current employment of veterans with spinal cord injury. J Spinal Cord Med 2022; 45:137-147. [PMID: 32634338 PMCID: PMC8890580 DOI: 10.1080/10790268.2020.1769950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Objective: The purpose of this study was to examine variables predictive of post-SCI return to employment and current employment among a large cohort of veterans with Spinal Cord Injury (SCI) treated within the Veterans Health Administration (VHA) SCI System of Care.Design: Cross sectional analysis of data obtained during in-person baseline interviews and follow-up phone interviews.Setting: Seven SCI Centers within Veteran Affairs Medical Centers.Participants: 1047 veterans with SCI receiving inpatient or outpatient care in VHA.Results: Only 29.8% were employed post-SCI, 27.9% reported employment within the immediate 5 years before the baseline interview, but only 9.2% reported current employment at the time of the baseline interview. Significant predictors of current employment among these veterans with SCI included recent employment experience, history of legal problems, duration of SCI, education, and life satisfaction.Conclusions: The baseline employment rate following SCI of a large, representative sample, was 29.8%. Greater duration of SCI predicted unemployment, likely due to the older age of this population. Additional years of education promoted current and post-SCI employment, while a history of legal problems was a barrier to employment.
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Affiliation(s)
- Lisa Ottomanelli
- James A. Haley Veterans’ Hospital and Clinics, Tampa, Florida, USA,Department of Mental Health and Rehabilitation Counseling, University of South Florida, Tampa, Florida, USA,Correspondence to: Lisa Ottomanelli, James A. Haley Veterans’ Hospital and Clinics, 8900 Grand Oaks Circle, Tampa, FL33637, USA.
| | - Lance L. Goetz
- Hunter Holmes McGuire VA Medical Center and Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Scott D. Barnett
- James A. Haley Veterans’ Hospital and Clinics, Tampa, Florida, USA
| | - Eni Njoh
- James A. Haley Veterans’ Hospital and Clinics, Tampa, Florida, USA
| | - Jaclyn Fishalow
- James A. Haley Veterans’ Hospital and Clinics, Tampa, Florida, USA
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Sociodemographic Risk Factors for Serious Psychological Distress among U.S. Veterans: Findings from the 2016 National Health Interview Survey. Psychiatr Q 2019; 90:637-650. [PMID: 31240597 DOI: 10.1007/s11126-019-09651-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Serious Psychological Distress (SPD) is a measure of mental health associated with poor functioning. This study identified sociodemographic risk factors for SPD, among veterans using Veterans Health Administration (VHA), TRICARE or the Civilian Health and Medical Programs for Uniformed Services (CHAMP) (all referred herein as VA coverage) and compared risk factors for SPD to non-veterans. VA coverage offers preventative care and treatment for illnesses and injuries to veterans with the aim of improving their quality of life. Veterans with and with no SPD, using VA coverage aged 18 to 64 years were sampled from the 2016 National Health Interview Survey (NHIS) (n = 525 total, n = 48 veterans with serious psychological distress) were compared to each other and to non-veterans sampled from the NHIS (n = 24,121 total and n = 1055 with serious psychological distress), by sex, age group, race/ethnicity, education level, living arrangements, education level, number of chronic health conditions, and region of residence. The greatest proportion of veterans with SPD were female, middle aged (45-64 years), white, had less than a high school education, and lived alone or with other adults (compared to those living with a spouse/partner). The greatest proportion of veterans with SPD lived in the Southern and Western U.S. regions, and the smallest proportion lived in the Northeastern U.S. region. Hispanic and white veterans were at increased risk for SPD relative to black veterans, and relative to their same race/ethnic counterparts in the non-veteran civilian population. Additional analyses suggest that veterans with SPD experience greater barriers to care compared to veterans without SPD. Further research is warranted to examine access to mental and physical health care providers in U.S. regions with the greatest proportions of veterans with SPD. Particular attention is needed for female veterans due to their high rates of SPD relative to male veterans.
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Abstract
Spinal cord injury results in multiple secondary comorbidities, which vary based on injury severity and other characteristics. Persons with spinal cord injury are at lifelong risk for many complications, most of which are at least partially preventable with proper medical care. The Veterans Health Administration Spinal Cord Injury and Disorders (SCI&D) System of Care offers these evaluations to all persons in their registries. Annual evaluations are performed at any of the 24 SCI&D Veterans Administration Centers nationwide. This allows veterans to receive the care from an interdisciplinary team that specializes in the care of veterans with spinal cord injury.
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