Defense Resources Management Institute, Naval Postgraduate School, Monterey, California (Dr Amara); VA Health Services Research & Development Service Center for Healthcare Organization and Implementation Research (Ms Stolzmann and Dr Pogoda) and Women's Health Sciences Division of the National Center for PTSD (Dr Iverson), VA Boston Healthcare System, Massachusetts; Department of Psychiatry, Boston University School of Medicine, Massachusetts (Dr Iverson); and Department of Health Law, Policy & Management, Boston University School of Public Health, Massachusetts (Dr Pogoda).
J Head Trauma Rehabil. 2019 Jan/Feb;34(1):11-20. doi: 10.1097/HTR.0000000000000404.
The goal of this study was to investigate predictors of employment status in male and female post-9/11 Veterans evaluated for traumatic brain injury (TBI) in the Veterans Health Administration. Prior research suggests there are gender differences in psychosocial characteristics among this cohort.
This was a cross-sectional analysis of post-9/11 Veterans who completed a TBI evaluation between July 2009 and September 2013.
Women had lower prevalence of deployment-related TBI (65.5%) compared with men (75.3%), but the percentages of those unemployed across the TBI diagnostic categories were similar for men (38%) and women (39%). Adjusted log-binomial regression found that unemployment was significantly associated with age, education, marital status, moderate/severe TBI, suspected posttraumatic stress disorder, depression, and drug abuse/dependence, and neurobehavioral symptom severity for men, whereas for women only more severe affective and cognitive symptoms were associated with unemployment.
Although the unemployment rate was similar across gender, there was a clearer pattern of demographic and health factors, including TBI severity, that was significantly associated with employment status in men. There may be other factors contributing to the female Veteran unemployment rate, underscoring the need to investigate unique contributors to unemployment, as well as how treatment and employment services can be expanded and tailored for post-9/11 Veterans.
本研究旨在调查退伍军人事务部（Veterans Health Administration）评估的 9/11 后男性和女性创伤性脑损伤（TBI）患者的就业状况预测因素。先前的研究表明，该队列的社会心理特征存在性别差异。
这是一项对 2009 年 7 月至 2013 年 9 月期间完成 TBI 评估的 9/11 后退伍军人的横断面分析。
女性与男性相比（75.3%），与部署相关的 TBI 患病率较低（65.5%），但在 TBI 诊断类别中，男性（38%）和女性（39%）的失业比例相似。调整后的对数二项式回归发现，对于男性，失业与年龄、教育程度、婚姻状况、中度/重度 TBI、疑似创伤后应激障碍、抑郁和药物滥用/依赖以及神经行为症状严重程度显著相关，而对于女性，只有更严重的情感和认知症状与失业相关。
尽管男性和女性的失业率相似，但与就业状况显著相关的人口统计学和健康因素（包括 TBI 严重程度）模式更为清晰。可能还有其他因素导致女性退伍军人失业率高，这突显了需要调查导致失业的独特因素，以及如何扩大和调整针对 9/11 后退伍军人的治疗和就业服务。
