Depressive Symptomatology Mediates Associations With Community Reintegration in Veterans With TBI

The purpose of this scoping review was to evaluate the current literature related to vocational outcomes among US service members and veterans with traumatic brain injury (TBI). Methods: Seven research databases (Ovid MEDLINE, PsycINFO, EMBASE, CINAHL Plus, Cochrane Library, Scopus, and SPORTDiscus) were queried for human studies between the database inception and February, 2020. We included studies that focused on US service members and veterans who sustained a TBI and their vocational outcomes. Conference abstracts, systematic reviews, literature reviews, editorials, consensus reports, commentaries, dissertations, and qualitative studies were excluded. Two rounds of independent reviews were performed. Details of study design, intervention, and vocational outcomes were recorded. Results: The search yielded 5667 articles; 48 articles met inclusion criteria. Forty-three studies were observational (90%), and 5 were randomized controlled trials. A majority of interventions were in the outpatient setting (71%). Interventions related to return to work and duty utilized physical therapy and occupational therapy to address cognitive skills and functional deficits and provide supportive employment. Conclusion: Community reintegration research among service members and veterans with brain injuries is underdeveloped. Because of heterogeneity of severity and smaller sample sizes, no consensus was reached on interventions that improve vocational outcomes. Evidence thus far suggests that future studies should incorporate an interdisciplinary team approach beyond physical therapy and occupational therapy, longer-term outcomes, and sample subgroups.

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“…RTW is addressed in 36 of the articles identified 26,28–62. Overall, the articles reported RTW ranging from 94% to 17%.…”

Section: Resultsmentioning

confidence: 98%

Vocational Outcomes of Service Members and Veterans After Traumatic Brain Injury: A Scoping Review

Nguyen

Hackman²,

Truitt³

2021

Journal of Head Trauma Rehabilitation

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“…Active military service members are regularly exposed to high‐stress environments and blast/blunt head impact exposures, placing them at increased risk for acute and chronic maladaptive mental health, cognitive and physiological outcomes (Hoge et al., 2006; Hurley et al., 2006; Kazis et al., 2004; Kimbrel et al., 2016; Moriarty et al., 2016). Both chronic stress and blast exposure have been linked to decreased neurological and psychophysiological health, such as cerebrovascular reactivity, cardiovascular health and symptoms relating to stress, anxiety and mood disorders (Len & Neary, 2011; Walker et al., 2017).…”

Section: Introductionmentioning

confidence: 99%

The relationship between resilience and neurophysiological stress in Special Operations Forces combat service members

Barczak‐Scarboro

Roby

Kiefer

et al. 2021

Eur J of Neuroscience

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“…Depression has also been shown to mediate effects of other predictors on important outcomes in TBI, as mentioned earlier, mediating effects of both physical functioning and PTSD on community reintegration (CR) (defined as the extent to which the individual participates in activities with family, friends, and community) ( 58 ). Depression also mediates effects of insomnia on suicide risk among military veterans with or without TBI ( 59 ). In other (non-TBI) clinical populations, depression has been shown to mediate effects of severity, pain, or other predictors on rehabilitation outcomes such as functioning, quality of life, and community integration ( 60 – 63 ).…”

Section: Introductionmentioning

confidence: 99%

Employment Status Among U.S. Military Veterans With Traumatic Brain Injury: Mediation Analyses and the Goal of Tertiary Prevention

2019

Self Cite

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For most individuals with traumatic brain injury (TBI), the ability to work is crucial to financial and psychological well-being. TBI produces a wide range of cognitive, physical, emotional, and interpersonal impairments that may undermine the ability to work. Employment is therefore a primary goal of TBI rehabilitation and has been the focus of extensive research. Although this literature has identified predictors of employment outcomes, few studies have examined the mechanisms that underlie these associations. Mediation analysis can identify these mechanisms, provide a more nuanced view of how predictors jointly affect rehabilitation outcomes, and identify predictors that, if treatable conditions, could be useful targets for tertiary prevention. Such efforts are aimed at reducing long-term impairments, disability, or suffering resulting from the injury. The study sample comprised 83 U.S. military veterans with TBI who had participated in a larger rehabilitation study and were interviewed in their homes. Bivariate tests revealed significant associations of employment with pain, cognitive functioning, self-rated health, depressive symptoms and physical functioning; the latter variable was operationalized in two ways—using the Patient Competency Rating Scale and the SF–36V physical functioning subscales. Because these physical functioning measures were highly intercorrelated (r = 0.69, p < 0.0001), separate regression models were conducted. In the hierarchical binary logistic regression models, predictors were entered in order of modifiability, with comorbidities (pain) entered in block 1, physical health/functioning sequelae in block 2, and depressive symptoms in block 3. In the regression using the SF-36V measure of physical functioning, pain's effect was mediated by the physical functioning/health predictors, with only physical functioning emerging as significant, but this effect was itself mediated by depressive symptoms. In the regression using the PCRS physical-function measure, only depressive symptoms emerged as a mediator of other effects. Findings underscore the central role of depression in the employment status of veterans with TBI, suggesting that negative effects of other problems/limitations could be mitigated by more effective treatment of depression. Thus, for many with chronic TBI who live with vocational limitations, outcomes may improve with lower depression. Findings argue for the wider use of mediation approaches in TBI research as a means of identifying targets for tertiary prevention of poor outcomes.

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Depressive Symptomatology Mediates Associations With Community Reintegration in Veterans With TBI

Cited by 4 publications

References 68 publications

Vocational Outcomes of Service Members and Veterans After Traumatic Brain Injury: A Scoping Review

Vocational Outcomes of Service Members and Veterans After Traumatic Brain Injury: A Scoping Review

The relationship between resilience and neurophysiological stress in Special Operations Forces combat service members

Employment Status Among U.S. Military Veterans With Traumatic Brain Injury: Mediation Analyses and the Goal of Tertiary Prevention

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