{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T18:01:56Z","timestamp":1773252116675,"version":"3.50.1"},"reference-count":44,"publisher":"Oxford University Press (OUP)","issue":"3-4","license":[{"start":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T00:00:00Z","timestamp":1761177600000},"content-version":"vor","delay-in-days":14,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Services at the University of Utah"},{"name":"Translational Research: Implementation, Analysis and Design"},{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["UM1TR004409"],"award-info":[{"award-number":["UM1TR004409"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Health Services Research & Development"},{"name":"Research Career Scientist","award":["RCS 17-297"],"award-info":[{"award-number":["RCS 17-297"]}]},{"DOI":"10.13039\/100003896","name":"Henry M. Jackson Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100003896","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Military veterans are at risk for long-term neurobehavioral symptoms who may hinder participation in productive activities following their transition out of military service. This study examined the association between injury-related neurobehavioral symptoms and engagement in paid and unpaid productive activities among post-9\/11 veterans.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>This secondary cross-sectional analysis utilized data from the Veterans Metrics Initiative (TVMI) Study. Veterans who served in the U.S. military after September 11, 2001, and were within 90 days of separation from active duty\u2014or from activated status in the National Guard or Reserve\u2014were identified in Fall 2016 through records from the Department of Veterans Affairs\/Department of Defense Identity Repository. Independent variables included self-reported vestibular, somatosensory, cognitive, and affective symptoms from the Defense and Veterans Brain Injury Center (DVBIC) survey. The dependent variable was engagement in productive activity, classified as: neither paid nor unpaid labor (reference), paid labor only, paid and unpaid labor, and unpaid labor only.<\/jats:p>\n                    <jats:p>The relationship between neurobehavioral symptoms and productive activity status was assessed using multinomial logistic regression. In Model 1, we adjusted for pre-military traumatic brain injury (TBI) history, probable deployment TBI status, and demographic characteristics. Model 2 added a positive screen for possible post-traumatic stress disorder (PTSD). Results are presented as relative risk ratios (RR), which represent the ratio of the probability of an outcome occurring in an exposed group to the probability of it occurring in a reference group.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 8,945 veterans (mean age\u2009=\u200935.7 years), 37.0% engaged in paid labor only, 21.4% in both paid and unpaid labor, 27.0% in unpaid labor only, and 14.6% in neither. Symptom prevalence was somatosensory (18.0%), affective (16.9%), cognitive (11.5%), and vestibular (7.2%). In Model 1, vestibular symptoms were linked to lower likelihood of engaging in paid labor only (RR\u2009=\u20090.54, 95% CI [0.40-0.74], P\u2009&amp;lt;\u2009.001) and both paid and unpaid labor (RR\u2009=\u20090.69, 95% CI [0.49-0.96], P\u2009=\u2009.027). Cognitive symptoms were also associated with a lower likelihood of paid labor only (RR\u2009=\u20090.67, 95% CI [0.49-0.91], P\u2009=\u2009.011). In Model 2 (adjusting for demographics and probable PTSD), vestibular symptoms remained significant (RR\u2009=\u20090.59, 95% CI [0.43-0.81], P\u2009=\u2009.001), although cognitive symptoms were no longer associated. Post-traumatic stress disorder emerged as a strong predictor with veterans screening positive being 53% less likely to engage in paid labor only (RR\u2009=\u20090.47, 95% CI [0.39-0.56], P\u2009&amp;lt;\u2009.001) and 37% less likely to engage in both paid and unpaid labor (RR\u2009=\u20090.63, 95% CI [0.52-0.76], P\u2009&amp;lt;\u2009.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Vestibular and cognitive symptoms were related to less engagement in productive activities post-service for Veterans, with an emphasis on activities that included paid employment. Participation may improve with the treatment of neurobehavioral symptoms.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/milmed\/usaf462","type":"journal-article","created":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T11:29:13Z","timestamp":1757417353000},"page":"e737-e745","source":"Crossref","is-referenced-by-count":0,"title":["Linking Neurobehavioral Symptoms to Productive Activities in Post-9\/11 Veterans: A Correlational Analysis Using TVMI Data"],"prefix":"10.1093","volume":"191","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5266-7374","authenticated-orcid":false,"given":"Kelsee M","family":"Stromberg","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Division of Epidemiology, Spencer Fox Eccles School of Medicine, University of Utah , 295 Chipeta Way , Salt Lake City, UT 84108,","place":["United States"]},{"name":"Veterans Affairs Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System , 30 N 1900 E , Salt Lake City, UT 84132,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erin D","family":"Bouldin","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Epidemiology, Spencer Fox Eccles School of Medicine, University of Utah , 295 Chipeta Way , Salt Lake City, UT 84108,","place":["United States"]},{"name":"Veterans Affairs Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System , 30 N 1900 E , Salt Lake City, UT 84132,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6636-1034","authenticated-orcid":false,"given":"Dawne","family":"Vogt","sequence":"additional","affiliation":[{"name":"VA Boston Health Care System , 150 South Huntington Avenue , Boston, MA 02130,","place":["United States"]},{"name":"Division of Psychiatry, Boston University Chobanian & Avedisian School Medicine , 72 East Concord Street , Boston, MA 02118,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shannon R","family":"Miles","sequence":"additional","affiliation":[{"name":"Mental Health and Behavioral Sciences Services, James A. Haley Veterans\u2019 Hospital , 13000 Bruce B. Downs Boulevard Tampa , FL 33612-4745,","place":["United States"]},{"name":"Department of Neurosurgery, Brain and Spine, Morsani College of Medicine, University of South Florida, Tampa, Florida , 2 Tampa General Circle, STC 7th Floor , Tampa, FL 33606,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Megan E","family":"Vanneman","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Epidemiology, Spencer Fox Eccles School of Medicine, University of Utah , 295 Chipeta Way , Salt Lake City, UT 84108,","place":["United States"]},{"name":"Veterans Affairs Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System , 30 N 1900 E , Salt Lake City, UT 84132,","place":["United States"]},{"name":"Department of Population Health Sciences, University of Utah Spencer Fox Eccles School of Medicine , Salt Lake City, 295 Chipeta Way , Salt Lake City, Utah 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