The purpose of this study is to determine what factors predict resilience among U.S. military veterans and servicemembers receiving VA inpatient rehabilitation for traumatic injuries. Resilience is defined by an adjustment trajectory of minimal distress and stable functioning following adversity. It is a surprisingly common response to potentially disturbing events such as warzone trauma, the loss of a spouse, or a life-threatening event. However, relatively little is known about resilience in the context of traumatic injury. Determining what personal qualities and situational factors predict resilience is important, as early detection of at-risk individuals can lead to targeted interventions during rehabilitation to improve resilience and thus long-term outcomes. The primary aim of this study is to determine what factors predict resilience for U.S. military veterans and personnel receiving VA inpatient rehabilitation for traumatic injuries. It is expected that several personality traits called """"""""resiliency factors"""""""" (e.g., optimism) and perceived social support will be significant predictors of resilience (Hypothesis 1). Also, it is expected that those exhibiting resilience will have more social role participation, greater satisfaction with life, and higher rates of employment than those who do not demonstrate a resilience adjustment trajectory (Hypothesis 2). One-hundred and sixty-seven Richmond VA Medical Center rehabilitation inpatients will be recruited from the VA Polytrauma Rehabilitation Center and the Spinal Cord Injury and Disorders Clinic. Veterans receiving inpatient rehabilitation will be administered baseline measures early in their hospitalization and outcome measures will be administered at discharge, 1, 3, 6, and 12 month post- baseline. Baseline variables include six resiliency factors, perceived social support, symptoms of emotional distress and health problems, social and employment activities, history and demographics, and mental disorder diagnoses. Follow-up assessment variables include symptoms of emotional distress, perceived social support, changes in health and treatment, mental disorder diagnoses, satisfaction with life, and employment. In addition, resiliency factors will be administered at 12 month follow-up to examine changes across the study period. An adjustment trajectory of resilience will be defined by a pattern of observed low or normal- range anxiety and depression and normal-to-high range positive affect during the 12 months following study enrollment. To test Hypothesis 1, bivariate and multivariate logistic regression analyses will be used to examine what factors predict resilience (vs. non-resilience). To test Hypothesis 2, simple and multivariate generalized linear model analyses will be used to examine whether resilience (vs. non- resilience trajectory) predicts greater social role participation (as measured by subscales of the Craig Handicap Assessment and Reporting Technique-Short Form [CHART-SF]), greater satisfaction with life (Satisfaction with Life Scale), and employment. A subset of participants (n = 20) will be asked to participate in a pilot study to examine the feasibility and efficiency of a telehealth approach to assess weekly changes in outcomes between 3 and 6 months post-baseline. Onset of a delayed stress response is most common during this timeframe for those receiving rehabilitation for traumatic injuries, and weekly monitoring will improve our understanding of this process. Finally, an intervention pilot study aiming to foster resilience will be developed in Years 3 and 4 of the CDA-2 funding period and conducted in Year 4 with 5-10 Richmond VAMC rehabilitation inpatients. The intervention program will be informed by the first 24-36 months of data collection and an updated literature review.

Public Health Relevance

Little is known about factors that predict resilience among traumatically injured civilians or military veterans. As a result, the study of resilience has been identified as a major gap in research on post- deployment adjustment by a joint working group of the VA-Office of Research and Development, National Institutes of Health, and U.S. Army. This study will address this gap in several ways. First, results of this study will inform the assessment and early detection of VA Polytrauma and Spinal Cord Injury rehabilitation in-patients who are at risk for poor psychological adjustment after traumatic injury. Second, it will guide the development of early interventions to foster resilience. Finally, findings will inform the practices of pre-deployment, inoculation resilience training programs such as the U.S. Army's Comprehensive Soldier Fitness program. As a result, this study has the potential to improve long-term outcomes and reduce health care costs for veterans who sustain traumatic injuries. In this resubmission, the applicant systematically addresses all the comments/critiques of the prior review and the result is greatly improved. This is a very positive example of good grantmanship in being able to take criticism and incorporate it so effectively.

National Institute of Health (NIH)
Veterans Affairs (VA)
Veterans Administration (IK2)
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VA Veterans Administration Hospital
United States
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Wilson, Sarah M; Burroughs, Thomas K; Newins, Amie R et al. (2018) The Association Between Alcohol Consumption, Lifetime Alcohol Use Disorder, and Psychiatric Distress Among Male and Female Veterans. J Stud Alcohol Drugs 79:591-600
Kimbrel, Nathan A; Garrett, Melanie E; Dennis, Michelle F et al. (2018) A genome-wide association study of suicide attempts and suicidal ideation in U.S. military veterans. Psychiatry Res 269:64-69
Calhoun, Patrick S; Wilson, Sarah M; Hertzberg, Jeffrey S et al. (2017) Validation of Veterans Affairs Electronic Medical Record Smoking Data Among Iraq- and Afghanistan-Era Veterans. J Gen Intern Med 32:1228-1234