Linking Neurobehavioral Symptoms to Productive Activities in Post-9/11 Veterans: A Correlational Analysis Using TVMI Data.

introductionMilitary veterans are at risk for long-term neurobehavioral symptoms who may hinder participation in productive activities following their transition out of military service. This study examined the association between injury-related neurobehavioral symptoms and engagement in paid and unpaid productive activities among post-9/11 veterans. MATERIALS AND

methodsThis secondary cross-sectional analysis utilized data from the Veterans Metrics Initiative (TVMI) Study. Veterans who served in the U.S. military after September 11, 2001, and were within 90 days of separation from active duty-or from activated status in the National Guard or Reserve-were identified in Fall 2016 through records from the Department of Veterans Affairs/Department of Defense Identity Repository. Independent variables included self-reported vestibular, somatosensory, cognitive, and affective symptoms from the Defense and Veterans Brain Injury Center (DVBIC) survey. The dependent variable was engagement in productive activity, classified as: neither paid nor unpaid labor (reference), paid labor only, paid and unpaid labor, and unpaid labor only.The relationship between neurobehavioral symptoms and productive activity status was assessed using multinomial logistic regression. In Model 1, we adjusted for pre-military traumatic brain injury (TBI) history, probable deployment TBI status, and demographic characteristics. Model 2 added a positive screen for possible post-traumatic stress disorder (PTSD). Results are presented as relative risk ratios (RR), which represent the ratio of the probability of an outcome occurring in an exposed group to the probability of it occurring in a reference group.

resultsAmong 8,945 veterans (mean age = 35.7 years), 37.0% engaged in paid labor only, 21.4% in both paid and unpaid labor, 27.0% in unpaid labor only, and 14.6% in neither. Symptom prevalence was somatosensory (18.0%), affective (16.9%), cognitive (11.5%), and vestibular (7.2%). In Model 1, vestibular symptoms were linked to lower likelihood of engaging in paid labor only (RR = 0.54, 95% CI [0.40-0.74], P < .001) and both paid and unpaid labor (RR = 0.69, 95% CI [0.49-0.96], P = .027). Cognitive symptoms were also associated with a lower likelihood of paid labor only (RR = 0.67, 95% CI [0.49-0.91], P = .011). In Model 2 (adjusting for demographics and probable PTSD), vestibular symptoms remained significant (RR = 0.59, 95% CI [0.43-0.81], P = .001), although cognitive symptoms were no longer associated. Post-traumatic stress disorder emerged as a strong predictor with veterans screening positive being 53% less likely to engage in paid labor only (RR = 0.47, 95% CI [0.39-0.56], P < .001) and 37% less likely to engage in both paid and unpaid labor (RR = 0.63, 95% CI [0.52-0.76], P < .001).

conclusionsVestibular and cognitive symptoms were related to less engagement in productive activities post-service for Veterans, with an emphasis on activities that included paid employment. Participation may improve with the treatment of neurobehavioral symptoms.