Aspects of Executive Dysfunction and Racial/Ethnic Minority Status Are Associated With Unemployment Duration in Veterans With a History of Mild-to-Moderate Traumatic Brain Injury

Abstract

ObjectiveTo examine demographic, psychiatric symptom, and neuropsychological performance factors associated with duration of unemployment in Iraq/Afghanistan Veterans with a history of mild-to-moderate traumatic brain injury (TBI). DesignCross-sectional, secondary data analysis of baseline measures in a supported employment study. SettingVA medical center. ParticipantsParticipants (N=50) were veterans with a history of mild-to-moderate TBI who were unemployed, stating a goal of returning to work, and had documented impairment in at least 1 neuropsychological domain. Participants were referred from VA vocational and assessment-based clinics. InterventionsNot applicable. Main Outcome MeasuresDuration of unemployment, neuropsychological, and psychiatric symptom assessments. ResultsBivariate correlations revealed that longer duration of unemployment was associated with greater posttraumatic stress disorder (P<.10) and depressive (P<.05) symptom severity, worse executive functioning (P<.05), and racial/ethnic minority status (P<.05). A multiple linear regression analysis including these independent variables explained 26.5% of the variance in duration of unemployment. Worse executive functioning, specifically reasoning and set-shifting, and minority status were each associated with longer duration of unemployment in the context of multiple independent variables. ConclusionsOur results underscore the importance of objective assessment of cognitive functioning in job-seeking Veterans with TBI histories. It may be useful to target aspects of executive functioning in vocational rehabilitation interventions and to provide additional assistance to Veterans from racial/ethnic minority groups.