Holliday Ryan, Smith Alexandra A, Kinney Adam R, Forster Jeri E, Bahraini Nazanin, Monteith Lindsey L, Brenner Lisa A
Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Aurora, Colorado (Drs Holliday, Kinney, Forster, Bahraini, Monteith, and Brenner and Ms Smith); Department of Psychiatry (Drs Holliday and Monteith), Department of Physical Medicine and Rehabilitation (Dr Forster), Departments of Physical Medicine and Rehabilitation, Psychiatry (Drs Bahraini), Departments of Physical Medicine and Rehabilitation, Psychiatry, and Neurology (Dr Brenner), University of Colorado Anschutz Medical Campus, Aurora; and VA National Center on Homelessness Among Veterans, Washington, District of Columbia (Dr Holliday).
J Head Trauma Rehabil. 2023;38(2):184-190. doi: 10.1097/HTR.0000000000000822. Epub 2023 Jan 24.
Risk for traumatic brain injury (TBI) within both the Veteran population and among individuals with a history of criminal justice involvement is notably high. Despite this, research examining TBI among Veterans with a history of criminal justice involvement (ie, justice-involved Veterans) remains limited. The sequelae of TBI can impact justice-involved Veterans' engagement in Department of Veterans Affairs (VA) justice-related services (ie, Veterans Justice Outreach and Health Care for Re-entry Veterans), thus potentially increasing risk for recidivism and impacting psychosocial functioning. As such, further understanding of TBI risk among justice-involved Veterans has the potential to inform the need for tailored screening and interventional efforts within VA justice-related service settings. We sought to better understand relative risk for TBI diagnosis among male and female Veteran recipients and nonrecipients of VA justice-related services.
Electronic medical record data for Veterans accessing VA services from 2005 to 2018.
1517 447 (12.48% justice-involved) male and 126 237 (8.89% justice-involved) female Veterans.
A cross-sectional examination of national VA electronic medical record data. Sex-stratified analyses were conducted to examine relative risk of TBI diagnosis based on use of VA justice-related services.
Documented TBI diagnosis was the main outcome. Covariates included VA service use, age, race, and ethnicity.
Both male and female Veterans using VA justice-related services were more likely to have a documented TBI diagnosis in their electronic VA medical record. Associations were attenuated, yet maintained significance, in all adjusted and sensitivity models.
Given potential risk for TBI, enhancing and tailoring care for justice-involved Veterans may be critical to facilitating rehabilitation and reducing recidivism. Examination of existing services within justice-related settings and methods of augmenting care is an important next step.
退伍军人以及有刑事司法介入史的人群中，创伤性脑损伤（TBI）的风险显著较高。尽管如此，针对有刑事司法介入史的退伍军人（即涉及司法的退伍军人）的TBI研究仍然有限。TBI的后遗症会影响涉及司法的退伍军人参与退伍军人事务部（VA）与司法相关的服务（即退伍军人司法外展服务和退伍军人重新融入社会的医疗保健服务），从而可能增加再犯风险并影响心理社会功能。因此，进一步了解涉及司法的退伍军人中的TBI风险，有可能为VA与司法相关的服务环境中量身定制筛查和干预措施的需求提供信息。我们试图更好地了解VA与司法相关服务的男性和女性退伍军人接受者与非接受者中TBI诊断的相对风险。
2005年至2018年期间访问VA服务的退伍军人的电子病历数据。
1517447名男性退伍军人（12.48%涉及司法）和126237名女性退伍军人（8.89%涉及司法）。
对国家VA电子病历数据进行横断面检查。进行了性别分层分析，以检查基于使用VA与司法相关服务的TBI诊断的相对风险。
记录在案的TBI诊断是主要结果。协变量包括VA服务使用情况、年龄、种族和民族。
使用VA与司法相关服务的男性和女性退伍军人在其电子VA病历中更有可能有记录在案的TBI诊断。在所有调整和敏感性模型中，关联减弱但仍具有显著性。
鉴于TBI的潜在风险，加强并为涉及司法的退伍军人量身定制护理对于促进康复和减少再犯可能至关重要。检查与司法相关环境中的现有服务以及加强护理的方法是重要的下一步。
