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Objective: This study compared rates of suicide attempt (SA) and suicidal ideation (SI) during the first 5 years after traumatic brain injury (TBI) among veterans and service members (V/SMs) in the Veterans Affairs (VA) and the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) Model Systems National Databases to each other and to non-veterans (non-Vs) in the NIDILRR database. Setting: Twenty-one NIDILRR and 5 VA TBI Model Systems (TBIMS) inpatient rehabilitation facilities in the United States. Participants: Participants with TBI were discharged from rehabilitation alive, had a known military status recorded (either non-V or history of military service), and successful 1-, 2-, and/or 5-year follow-up interviews completed between 2009 and 2021. The year 1 cohort included 8737 unique participants (8347 with SA data and 3987 with SI data); the year 2 (7628 participants) and year 5 (4837 participants) cohorts both had similar demographic characteristics to the year 1 cohort. Design: Longitudinal design with data collected across TBIMS centers at 1, 2, and 5 years post-injury. Main Outcomes and Measures: History of SA in past year and SI in past 2 weeks assessed by the Patient Health Questionnaire-9 (PHQ-9). Patient demographics, injury characteristics, and rehabilitation outcomes were also assessed. Results: Full sample rates of SA were 1.9%, 1.5%, and 1.6%, and rates of SI were 9.6%, 10.1%, and 8.7% (respectively at years 1, 2, and 5). There were significant differences among groups based on demographic, injury-related, mental/behavioral health, and functional outcome variables. Characteristics predicting SA/SI related to mental health history, substance use, younger age, lower functional independence, and greater levels of disability. Conclusions: Compared with participants with TBI in the NIDILRR system, higher rates of SI among V/SMs with TBI in the VA system appear associated with risk factors observed within this group, including mental/behavioral health characteristics and overall levels of disability. [ABSTRACT FROM AUTHOR]

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The present study aimed to describe the personality and psychopathology dimensions reported by veterans seeking organ transplantation, as well as to identify those dimensions associated with subsequent presurgical recommendations and transplant outcomes. Data were collected from 245 veterans undergoing a pretransplant psychological evaluation that included the MMPI-2-RF. Three treatment recommendations resulting from these evaluations, three recommendation adherence variables, and two transplant outcomes were extracted from electronic medical records. The sample's MMPI-2-RF scale scores were compared to the normative sample and two other presurgical samples and contrasted across subgroups defined by organ transplanted. Point-biserial correlations and logistic regression analyses examined associations between MMPI-2-RF scale scores and the eight measured outcomes. Results indicated that over-reporting, internalizing tendencies, negative emotionality, and a lack of positive emotions were uniquely predictive of mental health treatment recommendation, whereas somatic over-reporting, externalizing tendencies, and disinhibition were predictive of substance use treatment recommendation. Veterans who reported higher levels of activation were less likely to initiate mental health treatment. Finally, veterans with greater somatic preoccupation were less likely to be listed for organ transplant. More suspicious and mistrustful veterans were less likely to receive the transplant. These findings offer support for the role of the MMPI-2-RF in veteran pretransplant evaluations. [ABSTRACT FROM AUTHOR]

Objective: The construct of participation after traumatic brain injury (TBI) can be difficult to operationalize. Psychometric network analysis offers an empirical approach to visualizing and quantifying the associations between activities that comprise participation, elucidating the relations among the construct's components without assuming the presence of a latent common cause and generating a model to inform future measurement methods. The current research applied psychometric network analysis to the Participation Assessment with Recombined Tools-Objective (PART-O) within a sample of service members and veterans (SM/Vs) with a history of TBI at 1 and 2 years (T1 and T2) postinjury. Participants: Participants (N = 663) were SM/Vs with a history of TBI who completed comprehensive inpatient rehabilitation services at a Department of Veterans Affairs (VA) Polytrauma Rehabilitation Center (PRC). Setting: Five VA PRCs. Design: Cross-sectional, retrospective analysis of data from the VA TBI Model Systems study. Main Measures: PART-O. Results: Network analysis demonstrated that the PART-O structure was generally consistent over time, but some differences emerged. The greatest difference observed was the association between "spending time with friends" and "giving emotional support" to others. This association was more than twice as strong at T2 as at T1. The "out of the house" item was most central, as demonstrated by dense connections within its own subscale (Out and About) and items in other subscales (ie, Social Relations and Productivity).When examining items connecting the 3 subscales, the items related to giving emotional support, internet use, and getting out of the house emerged as the strongest connectors at T1, and the internet was the strongest connector at T2. Conclusion: Providing emotional support to others is associated with greater participation across multiple domains and is an important indicator of recovery. Being out and about, internet use, and engagement in productive activities such as school and work shared strong associations with Social Relations. Network analysis permits visual conceptualization of the dynamic constructs that comprise participation and has the potential to inform approaches to measurement and treatment. [ABSTRACT FROM AUTHOR]

• Those with more severe traumatic brain injury described more barriers to accessing care. • Ease of communication with providers was the most common facilitator. • Distance from facilities was the most common barrier. • Tailored approaches for those with greater disability are needed to improve access. To compare barriers and facilitators to accessing health care services among service members and veterans (SMVs) by traumatic brain injury (TBI) severity groups. Qualitative descriptive study guided by an access to health care services conceptual framework. Five Veterans Affairs (VA) polytrauma rehabilitation centers. SMVs (N=55, including 10 caregivers as proxies) ≥2 years post-TBI recruited from the VA TBI Model Systems and grouped by TBI severity (mild/moderate, severe). Barriers and facilitators accessing care. The main facilitators included ease of communicating with providers to help SMVs identify and utilize appropriate health care, family advocates who promoted engagement in health care, ability to use government and community facilities, and online resources or equipment. Distance to services was uniformly identified as a main barrier for both patient groups. However, facilitators and barriers to health care access differed by TBI severity. SMVs with severe TBI highlighted the role of nonprofit organizations in promoting health care engagement and the availability of VA specialty residential programs in meeting health care needs. Having unrecognized health care needs in chronic stages and communication difficulties with providers were more commonplace for those with greater TBI severity and affected quality of care. Those with mild/moderate TBI highlighted challenges associated with paying for services in the community and scheduling of services. Barriers and facilitators exist across multiple dimensions of a health care access framework and vary by TBI severity. Results suggest possible mechanistic links between health care access and SMV health outcomes. Findings support current policy and practice efforts to facilitate health care access for SMVs with TBI but highlight the need for tailored approaches for those with greater disability. [ABSTRACT FROM AUTHOR]

To describe the development of the Rehabilitation Needs Survey (RNS) for persons in the chronic phase of traumatic brain injury (TBI) recovery. RNS items were generated following a literature review (January – March 2015) on the topic of rehabilitation needs and revised via consensus from an expert panel of TBI clinicians and researchers. The RNS was added to the VA TBI Model Systems longitudinal study; data collection occurred between 2015–2019. Needs were classified as current (if endorsed) or absent; if current, needs were classified as unmet if no help was received. Need frequency and association with rehabilitation outcomes were presented. Eight studies examined rehabilitation needs and formed the initial item pool of 42 needs. This was reduced to form the 21-item RNS which was administered at year 1 (n = 260) and year 2 (n = 297) post-TBI. Number of needs endorsed was 8–9, and number of unmet needs was 1–2, on average. Number of needs was correlated with functional status, neurobehavioral symptoms, and mental health symptoms (p < 0.05) suggesting support for convergent validity of the RNS. The RNS is a new measure of rehabilitation needs following TBI. Further investigation into its psychometrics and clinical utility is recommended. Veterans and Service Members with traumatic brain injury across the severity spectrum have ongoing rehabilitation needs during the chronic phase of recovery. The Rehabilitation Needs Survey is a standardized measure of rehabilitation needs following traumatic brain injury. Identification of unmet rehabilitation needs is important for raising awareness of service gaps and providing justification for resource allocation. [ABSTRACT FROM AUTHOR]