Traumatic Brain Injury Severity, Comorbidity, Social Support, Family Functioning, and Community Reintegration Among Veterans of the Afghanistan and Iraq Wars

Mary Jo Pugh, Alicia A. Swan, Kathleen Carlson, Carlos A. Jaramillo, Blessen C. Eapen, Christina Dillahunt-Aspillaga, Megan E. Amuan, Roxana E. Delgado, Kimberly McConnell, Erin P. Finley, Jordan H. Grafman

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Objective: To examine the association between traumatic brain injury (TBI) severity; social, family, and community reintegration outcomes; and return to work status among post-9/11 veterans in Department of Veterans Affairs (VA) care. Design: Retrospective observational cohort study. Setting: Mail/online survey fielded to a national sample of veterans. Participants: Sample of post-9/11 veterans with at least 3 years of VA care stratified according to TBI severity and comorbidities who completed and returned surveys (N=2023). Interventions: Not applicable. Main Outcome Measures: Deployment Risk and Resilience Inventory-2 family functioning and social support subscales; Military to Civilian Questionnaire; and employment status. Results: Bivariate analyses revealed that veterans with every classification of TBI severity reported significantly more difficulty on social, family, and community reintegration outcomes than those with no TBI. In the fully adjusted model, veterans with unclassified and moderate/severe TBI reported significantly more difficulty with community reintegration and were less likely to be employed relative to those with no TBI; those with unclassified TBI also reported significantly more difficulty with family functioning. Veterans with mild TBI also reported significantly more difficulty with community reintegration. Conclusions: This study provides insight into long-term outcomes associated with TBI in post-9/11 veterans and suggests that exposure to TBI has a negative effect on social and family functioning, community reintegration, and return to work even after controlling for comorbidity, deployment experiences, and sociodemographic characteristics. Additional research is required to explicate what appears to be complex interactions among TBI severity, psychosocial well-being, combat exposures, and socioeconomic resources in this population.

Original languageEnglish (US)
JournalArchives of Physical Medicine and Rehabilitation
DOIs
StateAccepted/In press - 2017

Fingerprint

Afghanistan
Iraq
Veterans
Social Support
Comorbidity
Return to Work
Brain Concussion
Traumatic Brain Injury
Warfare
Postal Service
Observational Studies
Cohort Studies
Outcome Assessment (Health Care)

Keywords

  • Brain injuries
  • Mental health
  • Rehabilitation
  • Stress disorders, post-traumatic
  • Veterans

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation

Cite this

Traumatic Brain Injury Severity, Comorbidity, Social Support, Family Functioning, and Community Reintegration Among Veterans of the Afghanistan and Iraq Wars. / Pugh, Mary Jo; Swan, Alicia A.; Carlson, Kathleen; Jaramillo, Carlos A.; Eapen, Blessen C.; Dillahunt-Aspillaga, Christina; Amuan, Megan E.; Delgado, Roxana E.; McConnell, Kimberly; Finley, Erin P.; Grafman, Jordan H.

In: Archives of Physical Medicine and Rehabilitation, 2017.

Research output: Contribution to journalArticle

Pugh, Mary Jo ; Swan, Alicia A. ; Carlson, Kathleen ; Jaramillo, Carlos A. ; Eapen, Blessen C. ; Dillahunt-Aspillaga, Christina ; Amuan, Megan E. ; Delgado, Roxana E. ; McConnell, Kimberly ; Finley, Erin P. ; Grafman, Jordan H. / Traumatic Brain Injury Severity, Comorbidity, Social Support, Family Functioning, and Community Reintegration Among Veterans of the Afghanistan and Iraq Wars. In: Archives of Physical Medicine and Rehabilitation. 2017.
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abstract = "Objective: To examine the association between traumatic brain injury (TBI) severity; social, family, and community reintegration outcomes; and return to work status among post-9/11 veterans in Department of Veterans Affairs (VA) care. Design: Retrospective observational cohort study. Setting: Mail/online survey fielded to a national sample of veterans. Participants: Sample of post-9/11 veterans with at least 3 years of VA care stratified according to TBI severity and comorbidities who completed and returned surveys (N=2023). Interventions: Not applicable. Main Outcome Measures: Deployment Risk and Resilience Inventory-2 family functioning and social support subscales; Military to Civilian Questionnaire; and employment status. Results: Bivariate analyses revealed that veterans with every classification of TBI severity reported significantly more difficulty on social, family, and community reintegration outcomes than those with no TBI. In the fully adjusted model, veterans with unclassified and moderate/severe TBI reported significantly more difficulty with community reintegration and were less likely to be employed relative to those with no TBI; those with unclassified TBI also reported significantly more difficulty with family functioning. Veterans with mild TBI also reported significantly more difficulty with community reintegration. Conclusions: This study provides insight into long-term outcomes associated with TBI in post-9/11 veterans and suggests that exposure to TBI has a negative effect on social and family functioning, community reintegration, and return to work even after controlling for comorbidity, deployment experiences, and sociodemographic characteristics. Additional research is required to explicate what appears to be complex interactions among TBI severity, psychosocial well-being, combat exposures, and socioeconomic resources in this population.",
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AU - Pugh, Mary Jo

AU - Swan, Alicia A.

AU - Carlson, Kathleen

AU - Jaramillo, Carlos A.

AU - Eapen, Blessen C.

AU - Dillahunt-Aspillaga, Christina

AU - Amuan, Megan E.

AU - Delgado, Roxana E.

AU - McConnell, Kimberly

AU - Finley, Erin P.

AU - Grafman, Jordan H.

PY - 2017

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N2 - Objective: To examine the association between traumatic brain injury (TBI) severity; social, family, and community reintegration outcomes; and return to work status among post-9/11 veterans in Department of Veterans Affairs (VA) care. Design: Retrospective observational cohort study. Setting: Mail/online survey fielded to a national sample of veterans. Participants: Sample of post-9/11 veterans with at least 3 years of VA care stratified according to TBI severity and comorbidities who completed and returned surveys (N=2023). Interventions: Not applicable. Main Outcome Measures: Deployment Risk and Resilience Inventory-2 family functioning and social support subscales; Military to Civilian Questionnaire; and employment status. Results: Bivariate analyses revealed that veterans with every classification of TBI severity reported significantly more difficulty on social, family, and community reintegration outcomes than those with no TBI. In the fully adjusted model, veterans with unclassified and moderate/severe TBI reported significantly more difficulty with community reintegration and were less likely to be employed relative to those with no TBI; those with unclassified TBI also reported significantly more difficulty with family functioning. Veterans with mild TBI also reported significantly more difficulty with community reintegration. Conclusions: This study provides insight into long-term outcomes associated with TBI in post-9/11 veterans and suggests that exposure to TBI has a negative effect on social and family functioning, community reintegration, and return to work even after controlling for comorbidity, deployment experiences, and sociodemographic characteristics. Additional research is required to explicate what appears to be complex interactions among TBI severity, psychosocial well-being, combat exposures, and socioeconomic resources in this population.

AB - Objective: To examine the association between traumatic brain injury (TBI) severity; social, family, and community reintegration outcomes; and return to work status among post-9/11 veterans in Department of Veterans Affairs (VA) care. Design: Retrospective observational cohort study. Setting: Mail/online survey fielded to a national sample of veterans. Participants: Sample of post-9/11 veterans with at least 3 years of VA care stratified according to TBI severity and comorbidities who completed and returned surveys (N=2023). Interventions: Not applicable. Main Outcome Measures: Deployment Risk and Resilience Inventory-2 family functioning and social support subscales; Military to Civilian Questionnaire; and employment status. Results: Bivariate analyses revealed that veterans with every classification of TBI severity reported significantly more difficulty on social, family, and community reintegration outcomes than those with no TBI. In the fully adjusted model, veterans with unclassified and moderate/severe TBI reported significantly more difficulty with community reintegration and were less likely to be employed relative to those with no TBI; those with unclassified TBI also reported significantly more difficulty with family functioning. Veterans with mild TBI also reported significantly more difficulty with community reintegration. Conclusions: This study provides insight into long-term outcomes associated with TBI in post-9/11 veterans and suggests that exposure to TBI has a negative effect on social and family functioning, community reintegration, and return to work even after controlling for comorbidity, deployment experiences, and sociodemographic characteristics. Additional research is required to explicate what appears to be complex interactions among TBI severity, psychosocial well-being, combat exposures, and socioeconomic resources in this population.

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KW - Mental health

KW - Rehabilitation

KW - Stress disorders, post-traumatic

KW - Veterans

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