RESUMEN
OBJECTIVES: The goal of this study was to investigate predictors of employment status in male and female post-9/11 Veterans evaluated for traumatic brain injury (TBI) in the Veterans Health Administration. Prior research suggests there are gender differences in psychosocial characteristics among this cohort. METHODS: This was a cross-sectional analysis of post-9/11 Veterans who completed a TBI evaluation between July 2009 and September 2013. RESULTS: Women had lower prevalence of deployment-related TBI (65.5%) compared with men (75.3%), but the percentages of those unemployed across the TBI diagnostic categories were similar for men (38%) and women (39%). Adjusted log-binomial regression found that unemployment was significantly associated with age, education, marital status, moderate/severe TBI, suspected posttraumatic stress disorder, depression, and drug abuse/dependence, and neurobehavioral symptom severity for men, whereas for women only more severe affective and cognitive symptoms were associated with unemployment. CONCLUSIONS: Although the unemployment rate was similar across gender, there was a clearer pattern of demographic and health factors, including TBI severity, that was significantly associated with employment status in men. There may be other factors contributing to the female Veteran unemployment rate, underscoring the need to investigate unique contributors to unemployment, as well as how treatment and employment services can be expanded and tailored for post-9/11 Veterans.
Asunto(s)
Lesiones Traumáticas del Encéfalo/epidemiología , Empleo/estadística & datos numéricos , Veteranos , Adulto , Factores de Edad , Estudios Transversales , Depresión/epidemiología , Escolaridad , Femenino , Humanos , Masculino , Estado Civil , Trastornos por Estrés Postraumático/epidemiología , Trastornos Relacionados con Sustancias/epidemiología , Índices de Gravedad del Trauma , Estados Unidos/epidemiología , Adulto JovenRESUMEN
OBJECTIVE: To examine the relations among demographic characteristics, traumatic brain injury (TBI) history, suspected psychiatric conditions, current neurobehavioral health symptoms, and employment status in Veterans evaluated for TBI in the Department of Veterans Affairs. STUDY DESIGN: Retrospective cross-sectional database review of comprehensive TBI evaluations documented between October 2007 and June 2009. PARTICIPANTS: Operation Enduring Freedom/Operation Iraqi Freedom Veterans (n = 11 683) who completed a comprehensive TBI evaluation. MAIN MEASURES: Veterans Affairs clinicians use the comprehensive TBI evaluations to obtain information about TBI-related experiences, current neurobehavioral symptoms, and to identify suspected psychiatric conditions. RESULTS: Approximately one-third of Veterans in this sample were unemployed, and of these, the majority were looking for work. After simultaneously adjusting for health and deployment-related variables, significant factors associated with unemployment included one or more suspected psychiatric conditions (eg, posttraumatic stress disorder, anxiety, depression), neurobehavioral symptom severity (ie, affective, cognitive, vestibular), former active duty status, injury etiology, age, lower education, and marital status. The associations of these factors with employment status varied by deployment-related TBI severity. CONCLUSIONS: Simultaneously addressing health-related, educational, and/or vocational needs may fill a critical gap for helping Veterans readjust to civilian life and achieve their academic and vocational potential.
Asunto(s)
Lesiones Traumáticas del Encéfalo/epidemiología , Trastornos Mentales/epidemiología , Desempleo , Veteranos/psicología , Adolescente , Adulto , Campaña Afgana 2001- , Estudios Transversales , Femenino , Humanos , Guerra de Irak 2003-2011 , Masculino , Estudios Retrospectivos , Adulto JovenRESUMEN
OBJECTIVE: To determine the demographic and service characteristics that differentially impact utilization and cost of Veterans Health Administration (VHA) services for Operation Enduring Freedom and Operation Iraq Freedom (OEF/OIF) Veterans screened or evaluated for traumatic brain injury (TBI). SETTING: We examined Department of Defense (DoD) and VHA administrative records of OEF/OIF Veterans who were screened or evaluated for TBI. PARTICIPANTS: Our study population was OEF/OIF Veterans who separated from DoD in Fiscal Years 2003-2009 and who were screened or evaluated in VHA for TBI between October 2008 and July 2009. DESIGN: We describe the demographics and service characteristics of separated Veterans and those who accessed the VHA. We report the cost of VHA utilization and estimate a probit regression model to assess determinants of VHA utilization and costs by OEF/OIF Veterans screened and evaluated for TBI by VHA. RESULTS: Females and Veterans older than 37 years utilize VHA services more intensely. Across all services, the Reserve Components utilize health services more than the Active Components placing more demand on VHA for services. CONCLUSION: VHA utilization and costs is impacted by the demographic and service characteristics of Veterans. The variation in Veteran groups incurring higher costs and utilization indicates different usage patterns of VHA services by each group with implications for patient load as the DoD deploys higher numbers of females and the Reserve Components.
Asunto(s)
Lesiones Encefálicas/economía , Lesiones Encefálicas/epidemiología , Hospitales de Veteranos/economía , Hospitales de Veteranos/estadística & datos numéricos , Tamizaje Masivo/economía , Veteranos , Adulto , Campaña Afgana 2001- , Demografía , Femenino , Humanos , Guerra de Irak 2003-2011 , Masculino , Estados Unidos/epidemiología , United States Department of Veterans AffairsRESUMEN
The concordance of Department of Veterans Affairs (VA) clinician judgment of mild traumatic brain injury (mTBI) history with American Congress of Rehabilitation Medicine (ACRM)-based criteria was examined for Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) Veterans. In order to understand inconsistencies in agreement, we also examined the associations between evaluation outcomes and conceptually relevant patient characteristics, deployment-related events, current self-reported health symptoms, and suspected psychiatric conditions. The Veteran sample comprised 14,026 OIF/OEF VA patients with deployment-related mTBI history (n = 9,858) or no history of mTBI (n = 4,168) as defined by ACRM-based criteria. In the majority of cases (76.0%), clinician judgment was in agreement with the ACRM-based criteria. The most common inconsistency was between clinician judgment (no) and ACRM-based criteria (yes) for 21.3% of the patients. Injury etiology, current self-reported health symptoms, and suspected psychiatric conditions were additional factors associated with clinician diagnosis and ACRM-based criteria disagreement. Adherence to established diagnostic guidelines is essential for accurate determination of mTBI history and for understanding the extent to which mTBI symptoms resolve or persist over time in OIF/OEF Veterans.
Asunto(s)
Lesiones Encefálicas/diagnóstico , Lesiones Encefálicas/psicología , Trastornos Mentales/etiología , Guías de Práctica Clínica como Asunto , Veteranos/psicología , Adolescente , Adulto , Campaña Afgana 2001- , Amnesia/etiología , Ansiedad/etiología , Lesiones Encefálicas/etiología , Trastornos de la Conciencia/etiología , Estudios Transversales , Depresión/etiología , Femenino , Estado de Salud , Humanos , Guerra de Irak 2003-2011 , Masculino , Anamnesis , Examen Físico , Estudios Retrospectivos , Autoinforme , Trastornos por Estrés Postraumático/etiología , Estados Unidos , Adulto JovenRESUMEN
BACKGROUND: Female service members' presence in combat zones during Operation Enduring Freedom and Operation Iraqi Freedom is unprecedented both in terms of the number of women deployed and the nature of their involvement. In light of changing Department of Defense policy governing the deployment of women in combat zones, this article intends to set the groundwork for estimating future combat-related injuries and subsequent Veterans Health Administration (VHA) utilization while focusing on traumatic brain injury (TBI). METHODS: The article summarizes and presents the results of a study that examines veterans who present to VHA for TBI evaluation. For a national sample of veterans, a dataset including information on post-screening utilization, diagnoses, and location of care was constructed. The dataset included self-reported health symptoms and other information obtained from a standardized national VHA post-screening clinical evaluation, the comprehensive TBI evaluation (CTBIE). FINDINGS: Both women and men utilize high levels of VHA health care after a CTBIE. However, there are gender differences in the volume and types of services used, with women utilizing different services than their male counterparts and incurring higher costs, including higher overall and outpatient costs. CONCLUSION: As women veterans seek more of their health care from the VHA, there will be a need for more coordinated care to identify and manage deployment-related TBI and common comorbidities such as posttraumatic stress disorder, depression, and chronic pain. Deployment-connected injuries are likely to rise because of the rescinding of the ban on women in combat. This in turn has critical implications for VHA strategic planning and budgeting.
Asunto(s)
Lesiones Encefálicas/diagnóstico , Necesidades y Demandas de Servicios de Salud , Evaluación de Necesidades , Política Organizacional , United States Department of Veterans Affairs/estadística & datos numéricos , Veteranos/psicología , Adulto , Campaña Afgana 2001- , Lesiones Encefálicas/epidemiología , Comorbilidad , Femenino , Humanos , Guerra de Irak 2003-2011 , Masculino , Persona de Mediana Edad , Autoinforme , Trastornos por Estrés Postraumático/diagnóstico , Trastornos por Estrés Postraumático/epidemiología , Estados Unidos/epidemiología , United States Department of Defense , United States Department of Veterans Affairs/organización & administración , Salud de los Veteranos , Adulto JovenRESUMEN
BACKGROUND: VHA screens for traumatic brain injury (TBI) among patients formerly deployed to Afghanistan or Iraq, referring those who screen positive for a Comprehensive TBI Evaluation (CTBIE). METHODS: To assess the programme, rates were calculated of positive screens for potential TBI in the population of patients screened in VHA between October 2007 through March 2009. Rates were derived of TBI confirmed by comprehensive evaluations from October 2008 through July 2009. Patient characteristics were obtained from Department of Defense and VHA administrative data. RESULTS: In the study population, 21.6% screened positive for potential TBI and 54.6% of these had electronic records of a CTBIE. Of those with CTBIE records, evaluators confirmed TBI in 57.7%, yielding a best estimate that 6.8% of all those screened were confirmed to have TBI. Three quarters of all screened patients and virtually all those evaluated (whether TBI was confirmed or not) had VHA care the following year. CONCLUSIONS: VHA's TBI screening process is inclusive and has utility in referring patients with current symptoms to appropriate care. More than 90% of those evaluated received further VHA care and confirmatory evaluations were associated with significantly higher average utilization. Generalizability is limited to those who seek VHA healthcare.
Asunto(s)
Traumatismos por Explosión/diagnóstico , Lesiones Encefálicas/diagnóstico , Trastornos del Conocimiento/diagnóstico , Tamizaje Masivo , Trastornos por Estrés Postraumático/diagnóstico , Heridas no Penetrantes/diagnóstico , Heridas Penetrantes/diagnóstico , Adulto , Campaña Afgana 2001- , Traumatismos por Explosión/epidemiología , Traumatismos por Explosión/psicología , Lesiones Encefálicas/epidemiología , Lesiones Encefálicas/psicología , Trastornos del Conocimiento/epidemiología , Trastornos del Conocimiento/etiología , Investigación Empírica , Femenino , Humanos , Puntaje de Gravedad del Traumatismo , Guerra de Irak 2003-2011 , Masculino , Personal Militar , Derivación y Consulta , Trastornos por Estrés Postraumático/epidemiología , Trastornos por Estrés Postraumático/etiología , Encuestas y Cuestionarios , Estados Unidos/epidemiología , United States Department of Veterans Affairs , Heridas no Penetrantes/epidemiología , Heridas no Penetrantes/psicología , Heridas Penetrantes/epidemiología , Heridas Penetrantes/psicologíaRESUMEN
OBJECTIVE: To describe the prevalence of self-reported rates of auditory, visual, and dual sensory impairment (DSI) in Afghanistan and Iraq war Veterans receiving traumatic brain injury (TBI) evaluations. DESIGN: Retrospective medical chart review. PARTICIPANTS: Thirty-six thousand nine hundred nineteen Veterans who received a TBI evaluation between October 2007 and June 2009. Final sample included 12,521 subjects judged to have deployment-related TBI and a comparison group of 9106 participants with no evidence of TBI. MAIN OUTCOME MEASURE: Self-reported auditory and visual impairment. RESULTS: Self-reported sensory impairment rates were: 34.6% for DSI, 31.3% for auditory impairment only, 9.9% for visual impairment only, and 24.2% for none/mild sensory impairment. Those with TBI and blast exposure had highest rate of DSI. Regression analyses showed that auditory impairment was the strongest predictor of visual impairment, and vice versa, suggesting these impairments may derive from a common source. CONCLUSIONS: Veterans who self-report clinically significant hearing or vision difficulty during routine TBI evaluation should be evaluated systematically and comprehensively to determine the extent of sensory impairment. Identifying DSI could allow clinicians to collaborate and maximize rehabilitation.