There is a well-established relationship between commonly occurring mental health disorders, such as post-traumatic stress disorder, depression, and alcohol use disorders, and poor functional outcomes. However, less is known about long-term functional trajectories among returning Veterans and specific factors that predict who will follow better or worse courses of readjustment. Building upon the successful foundation of our currently RR&D-funded MERIT award, this second submission of our renewal application proposes to continue following the existing carefully-characterized cohort of 300 Veterans who served as part of Operations Enduring and Iraqi Freedom and New Dawn (OEF/OIF/OND) for an additional 2-year period. The sample size will also be expanded to include 500 Veterans.
The Specific Aims are to identify clinically relevant, modifiable psychosocial factors that: 1) prospectively predict improvements in long-term functioning and community reintegration over time; (2) predict membership in latent class trajectories of functioning; and (3) predict transitions between classes of functional trajectories. Veterans will complete state-of-the-art diagnostic interviews and self-report questionnaires at baseline and 24-months. Follow-up questionnaires will be mailed at 6-, 12-, and 18-months. Multiple domains of functioning will be evaluated, including occupational, family, social, and physical functioning, as well as community reintegration. The long-term objective of this programmatic line of research is to improve functional outcomes and quality of life of returning OEF/OIF/OND Veterans. In keeping with the VHA's goal of operationalizing principles of recovery and rehabilitation in treatment planning, this research wil provide a platform of empirical data to help guide refinement and further development of meaningful treatment programs to assist OEF/OIF/OND Veterans with optimal post-war readjustment over time. Upon completing the study, data from this project will inform allocation of VA resources and targets for clinical interventions that have the highest probability of ensuring that Veterans recover following deployments to warzones.

Public Health Relevance

Meaningful functional recovery is often an elusive goal, and like many hard-to-achieve goals, it is of the utmost importance in OEF/OIF/OND Veterans. Functional recovery must be evaluated to enhance knowledge regarding long-term readjustment processes in Veterans returning from the warzone. Although most Veterans are resilient, concerning rates of PTSD, depression, and alcohol misuse have been found, with resulting poor functioning in work, family, and community reintegration. We plan to follow an existing cohort of returning Veterans for an additional two-year period to determine who is most likely to follow improved or worsened long-term functional trajectories. This valuable information will guide the development of early intervention and treatment programs to foster optimal post-war readjustment.

National Institute of Health (NIH)
Veterans Affairs (VA)
Non-HHS Research Projects (I01)
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Psychological Health & Social Reintegration (RRD4)
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Olin Teague Veterans Center
United States
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Kimbrel, Nathan A; Wilson, Laura C; Mitchell, John T et al. (2017) ADHD and nonsuicidal self-injury in male veterans with and without PTSD. Psychiatry Res 252:161-163
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Kimbrel, Nathan A; Gratz, Kim L; Tull, Matthew T et al. (2015) Non-suicidal self-injury as a predictor of active and passive suicidal ideation among Iraq/Afghanistan war veterans. Psychiatry Res 227:360-2

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