Examining the Role of Behavioral Health Factors on Inpatient Traumatic Brain Injury Rehabilitation Outcomes Among Service Members and Veterans.

OBJECTIVE: To examine the association between behavioral health factors, specifically pretreatment alcohol and tobacco use, and traumatic brain injury (TBI)-related outcomes in the Intensive Evaluation and Treatment Program (IETP). DESIGN: Retrospective longitudinal cohort design. SETTING: The intervention and data collection were conducted at 5 Veterans Health Administration (VHA) sites (Florida, Texas, California, Minnesota, and Virginia). PARTICIPANTS: Behavioral health and TBI-related outcome data were collected from N=205 veteran and active-duty service member participants with mild-to-moderate TBI. INTERVENTIONS: The VHA IETP delivered interdisciplinary rehabilitation to veterans and service members with a history of mild-to-moderate TBI and related conditions, including posttraumatic stress disorder (PTSD), pain, impaired function, and adverse neurobehavioral symptoms. MAIN OUTCOME MEASURES: The exploratory outcome measures included the Neurobehavioral Symptom Inventory, the PTSD Checklist for DSM-5, the Patient Reported Outcomes Measurement Information System Pain Interference scale, and the Mayo-Portland Adaptability Inventory. Pretreatment tobacco and alcohol use behaviors were extracted from patient medical records. Multiple linear regression models were fitted to the data to test our hypotheses. RESULTS: Alcohol use was not shown to be associated with changes in any of the outcomes; however, tobacco use was associated with attenuated improvement in PTSD symptoms (p=.03). CONCLUSIONS: This study suggests that pretreatment tobacco use may lessen the effects of long-term PTSD rehabilitation among patients with TBI.