Citation

Amick MM, Meterko M, Fortier CB, Fonda JR, Milberg WP, McGlinchey RE. J. Head Trauma Rehabil. 2018; 33(2): E30-E40.

Affiliation

Translational Research Center for TBI and Stress Disorders and Geriatric Research, Education and Clinical Center (Drs Amick, Fortier, Fonda, Milberg, and McGlinchey) and HSR&D Center for Healthcare Organization and Implementation Research (Dr Meterko), VA Boston Healthcare System, Massachusetts; Department of Psychiatry, Boston University Medical School, Massachusetts (Dr Amick); Department of Health Law, Policy and Management (Dr Meterko) and Department of Epidemiology (Dr Fonda), Boston University School of Public Health, Massachusetts; and Department of Psychiatry, Harvard Medical School, Boston, Massachusetts (Drs Fortier, Milberg, and McGlinchey).

Copyright

(Copyright © 2018, Lippincott Williams and Wilkins)

DOI

10.1097/HTR.0000000000000308

PMID

28422901

Abstract

OBJECTIVES: To determine the prevalence of comorbid mild traumatic brain injury (mTBI), posttraumatic stress disorder (PTSD), and depression, termed the deployment trauma phenotype (DTP), and its constituent diagnoses' impact on unemployment status in a national cohort of veterans. SETTING: Retrospective analysis of the comprehensive TBI evaluation, a Veterans Affairs-wide protocol for assessing TBI, employment status, and psychiatric impressions. PARTICIPANTS: The final data set consisted of 48 821 veterans.

MAIN OUTCOMES AND MEASURES: Frequency of mTBI, PTSD, and depression in isolation and combinations and their association with unemployment status.

RESULTS: Age- and education-adjusted risk ratios (RRs) showed that the mTBI-only group was the least likely to be unemployed, RR = 0.65 (0.59-0.71). By contrast, the greatest likelihood of unemployment was associated with membership in the DTP group, RR = 1.45 (1.36-1.56), and the comorbid PTSD and depression group, RR = 1.39 (1.27-1.52). Furthermore, the DTP was nearly 3 times more prevalent (16.4%) in this sample compared with comorbid PTSD and depression (5.7%), indicating that the DTP conveys risk for unemployment to a significantly greater number of individuals.

CONCLUSIONS AND RELEVANCE: The comorbid and interactive conditions of PTSD, depression, and mTBI, rather than mTBI in isolation, were linked to significant risk for unemployment in this veteran cohort. These findings suggest that multifaceted assessments and interventions to improve postdeployment reintegration are needed.

Language: en