Related Experiment Video
Updated: Sep 11, 2025
Author Spotlight: Developing Precise and Clinically Relevant Models for Studying Secondary Degeneration in Traumatic Optic Neuropathy
Published on: November 29, 2024
Impact of Probable Deployment Traumatic Brain Injury on Post-9/11 Veteran's Productive Activity Participation After
Kelsee M Stromberg1, Erin D Bouldin, Dawne Vogt
1Author Affiliations: Department of Internal Medicine, Division of Epidemiology, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah (Drs Stromberg, Bouldin, Vanneman, Pugh); Veterans Affairs Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, Utah (Drs Stromberg, Bouldin, Pugh); Department of Economics, University of Utah, Salt Lake City, Utah (Dr Maloney); Department of Population Health Sciences, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, Utah (Dr Vanneman); Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts (Dr Vogt); Division of Psychiatry, Boston University Chobanian & Avedisian School Medicine, Boston, Massachusetts (Dr Vogt); Mental Health and Behavioral Sciences Services, James A. Haley Veterans' Hospital, Tampa, Florida (Dr Miles) and Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, Florida (Dr Miles).
Objective:
To assess the impact of probable deployment traumatic brain injury (TBI) history on post-9/11 US veterans' participation in productive activities-including employment, caregiving, volunteering, and education-after military service.
Methods:
This secondary cross-sectional analysis of the Veterans Metrics Initiative (TVMI) study examined productive activities among 8946 veterans who transitioned from service in 2016 and completed the TVMI survey. Associations between probable deployment TBI and activity engagement were analyzed using bivariate analysis and multinomial logistic regression. Probable deployment TBI, the independent variable, was defined as a head injury with loss or alteration of consciousness. The dependent variable was engagement in productive activities, categorized as neither paid nor unpaid labor (reference), paid labor only, paid and unpaid labor, and unpaid labor only. Covariates included demographic characteristics, self-reported premilitary TBI, and a positive screen for probable post-traumatic stress disorder (PTSD) identified using the PC-PTSD-5 screening tool.
Results:
Veterans with probable deployment TBI were significantly less likely to engage in paid labor only (risk ratio [RR] = 0.66, 95% confidence interval [CI]: 0.55-0.79, P < .001) or paid and unpaid labor (RR = 0.79, 95% CI: 0.65-0.96, P = .023) compared to those without TBI. Conversely, they were more likely to engage in unpaid labor only (RR = 1.23, 95% CI: 1.02-1.48, P = .024). These associations remained after adjusting for covariates described above.
Conclusions:
Productive activity engagement differed between veterans with and without probable deployment TBI. Veterans with probable deployment TBI were less likely to participate in paid labor and more likely to engage in unpaid or no labor. Additional support may be needed to facilitate their transition into the civilian workforce.
