Health Services Research & Development

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2017 HSR&D/QUERI National Conference Abstract

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1060 — Predicting Employment Status in OEF/OIF/OND Veterans Three Years after Evaluation for Traumatic Brain Injury

Lead/Presenter: Terri Pogoda, COIN - Bedford/Boston
All Authors: Pogoda TK (VA Boston Healthcare System, CHOIR; Boston University School of Public Health) Iverson KM (VA Boston Healthcare System, National Center for PTSD, CHOIR; Boston University School of Medicine ) Charns MP (VA Boston Healthcare System, CHOIR; Boston University School of Public Health) Stolzmann KL (VA Boston Healthcare System, CHOIR) Suri P (VA Puget Sound Healthcare System, ERIC; University of Washington) Gormley KE (VA Boston Healthcare System, CHOIR) Krengel MH (VA Boston Healthcare System; Boston University Department of Neurology) Sayer NA (Minneapolis VA Healthcare System, CCDOR; the University of Minnesota)

Objectives:
Workforce participation is a key indicator of readjustment to civilian life for Veterans. Yet, OEF/OIF/OND Veterans, especially those with traumatic brain injury (TBI) history, have difficulty obtaining employment after military separation. We examined contributors to long-term employment status in Veterans evaluated for TBI in VHA.

Methods:
We reviewed Comprehensive TBI Evaluation (CTBIE) administrative data and conducted a three-year follow-up survey. Demographic, military, and health data were collected at both time points. The main outcome was self-reported employment status at follow-up. Individuals were categorized as employed (full-time or part-time)/students, unemployed/looking for work, and unemployed/not looking for work. Analyses included chi-square and multinomial logistic regression that adjusted for potential confounders. Adjusted odds ratios (aOR) and 95% confidence intervals are presented.

Results:
The sample included 2,568 OEF/OIF/OND Veterans who completed a CTBIE and a follow-up survey 3.1(SD = 1.3) years post-CTBIE. At the CTBIE, approximately 60% of Veterans self-identified as being employed/students, followed by 22% being unemployed/looking for work, and 18% unemployed/not looking for work. At follow-up, the prevalence of being employed/student was similar (58.8%) to the time of CTBIE, whereas being unemployed/looking for work decreased (9.4%), and being unemployed/not looking for work increased (31.8%), p < 0.0001. Compared to those who were employed/students, predictors of being unemployed/not looking for work at follow-up included: being unemployed/not looking for work (aOR = 10.4, 7.3-14.9) or unemployed/looking for work (aOR = 2.9, 2.1-4.0) at time of CTBIE; having moderate/severe (aOR = 3.2, 2.0-5.1) or mild TBI (aOR = 1.7, 1.2-2.5) history (compared to no TBI); PTSD documented in medical records (aOR = 2.4, 2.3-4.9); and self-reported post-deployment homelessness history (aOR = 1.9, 1.4-2.6).

Implications:
The prevalence of being unemployed/not looking for work nearly doubled during a three-year period. Veterans with TBI, PTSD, and homelessness history are at elevated risk of being unemployed/not looking for work.

Impacts:
For those with significant risk factors for future unemployment, it may be clinically indicated to offer referrals for vocational rehabilitation. Such health and psychosocial services, and vocational rehabilitation in particular, may improve employment outcomes among OEF/OIF/OND Veterans with TBI.