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Risk Factors for Suicide-Related Behavior among OEF/OIF Veterans with “Polytrauma Clinical Triad”
The co-occurrence of PTSD, TBI, and chronic pain is known as the “Polytrauma Clinical Triad” (PCT). This study examined the association of these conditions, independently and in interaction with other conditions, with the risk of suicide-related behavior (SRB) among OEF/OIF Veterans. Findings showed that the PCT was a moderate predictor of suicide-related behavior, but did not appear to increase risk for SRB above that associated with PTSD, depression, or substance abuse alone. Moreover, PTSD comorbid with either depression or substance abuse significantly increased risk for suicidal ideation. Veterans with a diagnosis of bipolar disorder, anxiety, substance abuse, schizophrenia, depression, or PTSD were significantly more likely to be diagnosed with all three categories of SRB. Female Veterans were less likely than male Veterans to exhibit suicidal ideation, which contradicts prior research and may suggest that females are less comfortable reporting ideation within VA. Risk for SRB was highest in the 18-25 year old age group.
Date: July 17, 2014
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Prevalence of “Polytrauma Triad” among Iraq and Afghanistan War Veterans
This study sought to determine the prevalence of TBI, PTSD, and pain among Veterans from the OEF/OIF/OND wars, who received VA healthcare. Findings showed that large and increasing numbers of OEF/OIF/OND Veterans accessed the VA healthcare system over the three-year study period. Of these Veterans, about 10% were diagnosed with TBI, 30% with PTSD, and 40% with pain. Approximately 6% had all three diagnoses — or the polytrauma triad. Overall, while the absolute number of OEF/OIF/OND Veterans increased by more than 40% from FY09 through FY11, the relative proportion of Veterans diagnosed with TBI, and the high rate of comorbid PTSD and pain in this population have remained stable.
Date: January 1, 2014
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Low Rates of VA Vocational Service Use among OEF/OIF Veterans with Mental Health Conditions
This study assessed nationwide patterns of supported employment and vocational service use among OEF/OIF Veterans with the top four mental health conditions: PTSD, depression, substance use disorder, or traumatic brain injury (TBI). Findings showed that of the Veterans with mental health diagnoses included in this study, only 8% had a vocational services encounter during the study period, with 2% of these receiving evidence-based supported employment. Moreover, retention was low, with most Veterans attending just one to two appointments. Veterans with TBI – and those with more mental health conditions overall – were more likely to access vocational services. Among Veterans whose employment was tracked, 51% with at least one supported employment encounter worked competitively, compared to 21% of those who did not receive supported employment. Thus, supported employment was effective when it was provided. Results indicate that recovery-oriented, evidence-based, supported employment is the best way to assist unemployed Veterans with mental health conditions to achieve competitive employment. However, resources are limited for Veterans without psychosis and those who are not homeless. Given that OEF/OIF Veterans with TBI are more likely to need vocational services, the authors suggest supported employment could be effectively integrated into VA polytrauma clinics.
Date: August 1, 2013
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Some VA Polytrauma Team Members Caring for Veterans with Traumatic Brain Injury at Risk for Job Burnout
This study sought to examine the extent of job burnout among VA polytrauma team members engaged in the diagnosis and treatment of traumatic brain injury – and to identify their coping strategies for dealing with job-related stress. Findings showed that VA polytrauma team members experienced moderate levels of emotional exhaustion, low levels of depersonalization, and high levels of personal accomplishment. However, 24% of participants in this study reported high levels of emotional exhaustion, which may be a precursor to job burnout. Polytrauma team members who reported caring for Veterans with TBI >50% of their time experienced higher levels of emotional exhaustion than those who spent <50% of their time caring for Veterans with TBI. Coping strategies included: connecting with others (e.g., relating to family, friends, and coworkers); promoting a healthy lifestyle (e.g., healthy diet, exercise); pursuing outside interests (e.g., hobbies); managing the work environment (e.g., staying organized); and maintaining positive thinking. No significant differences in participant characteristics for any of the subscales that were measured (emotional exhaustion, depersonalization, and personal accomplishment) were found for age category, race, years in practice, years at VA, primary role, or percent of time providing direct care.
Date: March 1, 2013
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Significant Financial Burden for Caregivers of Veterans with Polytrauma and Traumatic Brain Injury
This study (conducted prior to the implementation of stipends from the Caregivers and Veterans Omnibus Health Services Act) evaluated the prevalence of financial strain as measured by asset depletion and/or debt accumulation, and labor force exit among caregivers of Veterans with polytrauma and traumatic brain injury (TBI). Findings showed that financial strain is common for caregivers: 62% reported depleted assets and/or accumulated debt, and 41% reported leaving the labor force. The latter finding stands in sharp contrast to studies in other populations internationally, where between 2% to 27% of caregivers left the labor force. If a severely injured Veteran needed intensive help with activities of daily living, the primary caregiver faced 4.6 higher odds of leaving the labor force, and used $27,576 more assets and/or debt to help care for the Veteran compared to caregivers of Veterans needing little or no help. Male caregivers, those providing care since the time of injury, and those providing care to Veterans with high-intensity needs and with the lowest overall functioning at time of discharge experienced significantly higher amounts of asset depletion and/or debt accumulation compared to female caregivers, caregivers relatively new to their role, and those providing care to higher functioning Veterans with low-intensity care needs. Spouses did not face higher financial strain compared to parents; financial strain was no higher for caregivers of those injured in Iraq, Afghanistan or the Middle East compared to those injured in the U.S., and the timing of injury was not associated with greater financial strain.
Date: February 1, 2013
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Post-deployment Health Outcomes Associated with Multiple Deployment-Related Factors
This study examined the unique contributions of various deployment-related exposures and injuries to current post-deployment physical, psychological, and general health outcomes in National Guard members. Findings showed that various deployment-related experiences increased the risk for post-deployment adverse mental and physical health outcomes, individually and in combination. Most adverse outcomes had associations with multiple deployment-related factors. Deployment-related mild traumatic brain injury (TBI) was associated with post-deployment depression, anxiety, PTSD, and post-concussive symptoms such as headaches and dizziness. Combat exposures with and without physical injury were associated not only with PTSD, but also with numerous post-concussive and non-post-concussive symptoms (e.g., chest pain, indigestion). Associations between blast exposure and abdominal pain, pain on deep breathing, shortness of breath, hearing loss, and tinnitus suggested residual barotrauma. The experience of seeing others wounded or killed, or experiencing the death of a buddy or leader, was associated with indigestion and headaches, but not with depression, anxiety, or PTSD. Findings indicate that an integrated interdisciplinary healthcare approach would be beneficial for Veterans with multiple deployment-related health issues. Such a system of care is currently being used within the VA Polytrauma programs.
Date: November 1, 2012
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Prevalence and Risk Factors for Non-Fatal Injuries among Veterans with TBI – Post-Discharge from VA Polytrauma Care
This study examined the prevalence of, and potential risk factors for, non-fatal injuries among Veterans with TBI after discharge from VA inpatient polytrauma rehabilitation programs. Caregivers reported that nearly one-third (32%) of Veterans discharged from VA Polytrauma Rehabilitation Centers had incurred subsequent, medically treated injuries; most were associated with falls (49%) and motor vehicles (37%). Factors associated with Veterans’ increased odds of subsequent injury included poor or fair general health and requiring assistance with activities of daily living or instrumental activities of daily living. A number of caregiver-reported ongoing symptoms/health problems among Veterans (e.g., depression, vision loss, hearing loss) were also associated with greater injury odds. Moreover, the odds of subsequent injury increased as the number of reported symptoms/comorbid health problems increased. Compared to male Veterans, the small proportion of female Veterans (n=23) had approximately four and a half times the odds of sustaining subsequent injury. Caregivers who reported their own health as poor or fair were more likely to report subsequent injuries for Veterans compared to caregivers who reported their own health as excellent, very good, or good. Caregivers with higher than average or average depressive or anxiety symptoms, or lower than average physical functioning scores, also were more likely to report injuries among Veterans compared to caregivers without these symptoms.
Date: January 1, 2012
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Profile of Caregivers and Care Provided for OEF/OIF Veterans Following Acute Rehabilitation for TBI and Polytrauma
The Family and Caregiver Experience Study (FACES) sought to describe the care and support needs of OEF/OIF Veterans with moderate to severe polytrauma after they received acute rehabilitation – and to describe the providers of that care. Findings showed that a significant portion of caregivers provide time-consuming, unpaid care for Veterans, years after injury. Policymakers may need to target additional resources to meet the long-term needs of caregivers who may not be eligible for support mandated by the Caregivers and Veterans Omnibus Health Services Act of 2010.
Date: August 25, 2011
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Low Follow-Up Rates for Positive TBI Screens
This retrospective study evaluated VA’s TBI screening program in terms of predictors of screening and positive-screen follow-up. Findings show that almost 90% of Iraq and Afghanistan war Veterans in this study were offered TBI screening, and 17% screened positive; 52% of those screening positive had subsequent appointments in a TBI/polytrauma specialty clinic during the 18-month study period. Of 1,185 patients evaluated in a TBI/polytrauma clinic following a positive screen, 55% were given a TBI diagnosis, and of 92 patients not evaluated in a TBI/polytrauma clinic following a positive screen, 8.5% were given a TBI diagnosis. Screening likelihood increased with time since implementation of the TBI screening program and was greater at the first clinic encounter. There was considerable variation by facility; for example, Veterans seen in a VAMC were more likely to be screened than those seen in a CBOC. Screening was particularly likely to occur during TBI/polytrauma and primary care clinic appointments. Younger, male, Army Veterans without psychiatric diagnoses were more likely to be screened compared with women Veterans, Iraq/Afghanistan Veterans from other branches of the military, and those who were at least 40 years old.
Date: February 11, 2011
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Special Issue of Pain Medicine Highlights VA Research on Pain among OEF/OIF Veterans
This publication is in follow-up to a Pain Research Summit held in September 2007 by VA’s Rehabilitation R&D Service and VA/HSR&D’s Polytrauma and Blast-Related Injury Quality Enhancement Research Initiative (PT/BRI-QUERI). This Special Issue begins with four articles that build on the growing epidemiological literature on the prevalence and correlates of pain among OEF/OIF Veterans, and considers the evidence for the assessment and management of pain in this population. The Issue also includes several original articles that provide a sample of the relatively large and growing body of research on pain, including research that focuses on the most prevalent and challenging of pain conditions observed among OEF/OIF Veterans, such as neuropathic pain, chronic widespread pain, musculoskeletal/joint pain, and pain secondary to spinal cord injury.
Date: October 1, 2009
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