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Research Letter: Traumatic Brain Injury Among Veterans Accessing VA Justice-Related Services
Ryan Holliday1, Alexandra A Smith, Adam R Kinney
1Rocky 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).
Objective:
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.
Setting:
Electronic medical record data for Veterans accessing VA services from 2005 to 2018.
Participants:
1517 447 (12.48% justice-involved) male and 126 237 (8.89% justice-involved) female Veterans.
Design:
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.
Main Measures:
Documented TBI diagnosis was the main outcome. Covariates included VA service use, age, race, and ethnicity.
Results:
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.
Conclusions:
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.
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