The Deployment Trauma Phenotype and Employment Status in Veterans of the Wars in Iraq and Afghanistan.
Melissa M Amick, Mark Meterko, Catherine B Fortier and 3 others
PMID 28422901WHAT IT FOUND
Veterans with mild TBI, PTSD and depression were most likely to be unemployed and not looking for work.
The study did not show this was worse than PTSD and depression alone. Mild TBI alone was least likely to be unemployed.
Key findings
01The Deployment Trauma Phenotype (mild TBI, PTSD and depression) was present in 16.4% of the final sample and had the highest adjusted risk of being unemployed and not looking for work, at 1.45 times the risk of veterans with no diagnoses.
02The adjusted risk difference between the Deployment Trauma Phenotype and the PTSD plus depression group was not statistically significant, with a risk ratio of 1.05 and a 95% confidence interval of 0.96 to 1.15.
03Veterans with mild TBI only had the lowest adjusted risk of being unemployed and not looking for work, at 0.65 times the risk of veterans with no diagnoses, and their rate of being unemployed and not looking was 8.6% versus 13.8% in the no-diagnosis group.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
The study used existing VA records and a cross-sectional design, so it cannot show that the Deployment Trauma Phenotype caused unemployment or that treating it would change employment. All participants had screened positive for possible military TBI, so the results do not represent all OEF/OIF veterans. PTSD and depression were based on clinician impressions during the Comprehensive TBI Evaluation, without a standard structured diagnostic method. The data did not include reasons for not working, such as retirement or physical injury, so unemployment and not looking for work may not reflect psychiatric disability alone. Many records were excluded, including 7,194 for non-credible symptom reporting, and the excluded non-credible group had a higher prevalence of the Deployment Trauma Phenotype. Employment status was missing for 1,058 veterans.
Declared interests
The authors reported no potential conflicts of interest. The article is listed as supported by NIH extramural and U.S. government non-PHS sources.
The easy way to misread this
Do not conclude that mild TBI alone causes unemployment or that treating mild TBI will improve employment. The mild TBI-only group had the lowest rate of being unemployed and not looking for work, and the study did not test treatment effects. Do not conclude that the Deployment Trauma Phenotype is clearly worse than PTSD plus depression, because the adjusted comparison was not statistically significant.