Research Letter: Traumatic Brain Injury Among Veterans Accessing VA Justice-Related Services
Ryan Holliday, Alexandra A. Smith, Adam R. Kinney, Jeri E. Forster, Nazanin H. Bahraini, Lindsey L. Monteith, Lisa A. Brenner
Abstract
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.