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Evaluation of clinical outcomes and employment status in veterans with dual diagnosis of traumatic brain injury and spinal cord injury

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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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Data Availability

The data underlying this publication are accessible to researchers with Million Veteran Program (MVP) data access. MVP is currently only accessible to researchers who have a funded MVP project, either through a VA Merit Award or a VA Career Development Award. See https://www.research.va.gov/funding/Guidance-MVP-Data-Access-Merit-Award.pdf for more details.

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Acknowledgements

The authors sincerely thank the Veterans who volunteered to participate in the Million Veteran Program. This research is based on data from the Million Veteran Program, Office of Research and Development, Veterans Health Administration, and was supported by award # IK2 CX001952. This publication does not represent the views of the Department of Veteran Affairs or the United States Government.

Funding

This work was supported by a Career Development Award awarded to Victoria C. Merritt from the VA Clinical Science Research & Development Service (IK2 CX001952).

Author information

Authors and Affiliations

  1. Psychology & Research Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA

    Jillian M. R. Clark, Erin D. Ozturk & Victoria C. Merritt

  2. San Diego Joint Doctoral Program, San Diego State University/University of California, San Diego, CA, USA

    Erin D. Ozturk

  3. VA Informatics and Computing Infrastructure (VINCI), VA Salt Lake City Health Care System, Salt Lake City, UT, USA

    Catherine Chanfreau-Coffinier

  4. Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, CA, USA

    Victoria C. Merritt

  5. Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, USA

    Victoria C. Merritt

  6. VA San Diego Healthcare System (151B), 3350 La Jolla Village Drive, San Diego, CA, 92161, USA

    Victoria C. Merritt

Authors
  1. Jillian M. R. Clark
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  2. Erin D. Ozturk
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  3. Catherine Chanfreau-Coffinier
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  4. Victoria C. Merritt
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the VA Million Veteran Program

Contributions

All authors contributed to the study conception and design. Data curation and cleaning were performed by CC-C, and data analysis was performed by VM, in consultation with JC. The first draft of the manuscript was written by JC and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Victoria C. Merritt.

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The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of the VA Central IRB.

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Informed consent was obtained from all individual participants included in the study.

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Clark, J.M.R., Ozturk, E.D., Chanfreau-Coffinier, C. et al. Evaluation of clinical outcomes and employment status in veterans with dual diagnosis of traumatic brain injury and spinal cord injury. Qual Life Res 33, 229–239 (2024). https://doi.org/10.1007/s11136-023-03518-7

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