Psychology & Research Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA.
San Diego Joint Doctoral Program, San Diego State University/University of California, San Diego, CA, USA.
Qual Life Res. 2024 Jan;33(1):229-239. doi: 10.1007/s11136-023-03518-7. Epub 2023 Oct 19.
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).
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.
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.
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.
研究创伤性脑损伤（TBI）和脊髓损伤（SCI）双重诊断的退伍军人与无双重诊断退伍军人的临床结果和就业状况。
本横断面研究调查了参加退伍军人事务部百万退伍军人计划的全国退伍军人样本，这些退伍军人在退伍军人健康管理局的 TBI 筛查和评估计划中完成了综合 TBI 评估（CTBIE）。使用 CTBIE 数据将退伍军人分为以下 TBI/SCI 组：TBI 和 SCI 双重诊断（TBI+/SCI+）；有 TBI 病史但无 SCI（TBI+/SCI-）；无 TBI 或 SCI 病史（TBI-/SCI-；即对照组）。CTBIE 衍生的结果包括神经行为症状、合并的精神症状、疼痛和疼痛干扰以及就业状况。
卡方分析显示，TBI/SCI 组与评估的所有临床结果之间存在显著关联（所有 p 值均<.001；V 值为 0.07-0.11）。一般来说，TBI+/SCI+组和 TBI+/SCI-组报告的神经行为症状、精神症状和疼痛水平相当，但与 TBI-/SCI-组相比，症状和疼痛的发生率显著更高。所有成对比较的效应大小均较小（φ=0.01-0.11）。最后，TBI/SCI 组与就业状况之间无显著关联（p=0.170；V 值为 0.02），三组的失业率均相对较高。
无论 SCI 状况如何，有 TBI 病史的退伍军人的临床结果均比无 TBI 和 SCI 的退伍军人差。然而，三组的失业率均较高。这些发现表明，任何完成 CTBIE 的退伍军人都可能面临较差的临床和就业结果的风险。
