{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T11:20:19Z","timestamp":1785151219744,"version":"3.55.0"},"reference-count":47,"publisher":"Elsevier BV","issue":"1","license":[{"start":{"date-parts":[[2023,1,3]],"date-time":"2023-01-03T00:00:00Z","timestamp":1672704000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,1,3]],"date-time":"2023-01-03T00:00:00Z","timestamp":1672704000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100000738","name":"U.S. Department of Veterans Affairs","doi-asserted-by":"publisher","award":["IK2 CX001952"],"award-info":[{"award-number":["IK2 CX001952"]}],"id":[{"id":"10.13039\/100000738","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Military Med Res"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Examining the health outcomes of veterans who have completed the United States Veterans Health Administration\u2019s (VHA\u2019s) Traumatic Brain Injury (TBI) Screening and Evaluation Program may aid in the refinement and improvement of clinical care initiatives within the VHA. This study compared self-reported physical functioning, cardiometabolic health conditions, and health care utilization patterns in Million Veteran Program enrollees with TBI Screening and Evaluation Program data (collected between 2007 and 2019), with the goal of enhancing understanding of potentially modifiable health conditions in this population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In this observational cohort study, veterans (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200916,452) were grouped based on the diagnostic outcome of the TBI Screening and Evaluation Program: 1) negative TBI screen (Screen\n                      <jats:sup>\u2013<\/jats:sup>\n                      ); 2) positive TBI screen but no confirmed TBI diagnosis [Screen\n                      <jats:sup>+<\/jats:sup>\n                      \/ Comprehensive TBI Evaluation (CTBIE)\n                      <jats:sup>\u2013<\/jats:sup>\n                      ]; or 3) positive TBI screen and confirmed TBI diagnosis (Screen\n                      <jats:sup>+<\/jats:sup>\n                      \/CTBIE\n                      <jats:sup>+<\/jats:sup>\n                      ). Chi-square tests and analysis of covariance were used to explore group differences in physical functioning, cardiometabolic health conditions, and health care utilization patterns, and logistic regressions were used to examine predictors of Screen\n                      <jats:sup>+\/\u2013<\/jats:sup>\n                      and CTBIE\n                      <jats:sup>+\/\u2013<\/jats:sup>\n                      group status.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The results showed that veterans in the Screen\n                      <jats:sup>+<\/jats:sup>\n                      \/CTBIE\n                      <jats:sup>\u2013<\/jats:sup>\n                      and Screen\n                      <jats:sup>+<\/jats:sup>\n                      \/CTBIE\n                      <jats:sup>+<\/jats:sup>\n                      groups generally reported poorer levels of physical functioning (\n                      <jats:italic>P\u2019s<\/jats:italic>\n                      \u2009&lt;\u20090.001,\n                      <jats:italic>n<\/jats:italic>\n                      <jats:sub>\n                        <jats:italic>p<\/jats:italic>\n                      <\/jats:sub>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090.02 to 0.03), higher rates of cardiometabolic health conditions (\n                      <jats:italic>P\u2019s<\/jats:italic>\n                      \u2009&lt;\u20090.001,\n                      <jats:italic>\u03c6<\/jats:italic>\n                      \u2009=\u20090.14 to 0.52), and increased health care utilization (\n                      <jats:italic>P\u2019s<\/jats:italic>\n                      \u2009&lt;\u20090.001,\n                      <jats:italic>\u03c6<\/jats:italic>\n                      \u2009=\u20090.14 to\u2009&gt;\u20090.5) compared with the Screen\n                      <jats:sup>\u2013<\/jats:sup>\n                      group; however, health outcomes were generally comparable between the Screen\n                      <jats:sup>+<\/jats:sup>\n                      \/CTBIE\n                      <jats:sup>\u2013<\/jats:sup>\n                      and Screen\n                      <jats:sup>+<\/jats:sup>\n                      \/CTBIE\n                      <jats:sup>+<\/jats:sup>\n                      groups. Follow-up analyses confirmed that while physical functioning, hypertension, stroke, healthcare utilization, and prescription medication use reliably distinguished between the Screen\n                      <jats:sup>\u2013<\/jats:sup>\n                      and Screen\n                      <jats:sup>+<\/jats:sup>\n                      groups (\n                      <jats:italic>P\u2019s<\/jats:italic>\n                      \u2009&lt;\u20090.02,\n                      <jats:italic>OR\u2019s<\/jats:italic>\n                      \u20090.78 to 3.38), only physical functioning distinguished between the Screen\n                      <jats:sup>+<\/jats:sup>\n                      \/CTBIE\n                      <jats:sup>\u2013<\/jats:sup>\n                      and Screen\n                      <jats:sup>+<\/jats:sup>\n                      \/CTBIE\n                      <jats:sup>+<\/jats:sup>\n                      groups (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001,\n                      <jats:italic>OR<\/jats:italic>\n                      \u20090.99\n                      <jats:italic>)<\/jats:italic>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The findings suggest that veterans who screen positive for TBI, regardless of whether they are ultimately diagnosed with TBI, are at greater risk for negative health outcomes, signifying that these veterans represent a vulnerable group that may benefit from increased clinical care and prevention efforts.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s40779-022-00435-7","type":"journal-article","created":{"date-parts":[[2023,1,3]],"date-time":"2023-01-03T12:08:41Z","timestamp":1672747721000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Self-reported physical functioning, cardiometabolic health conditions, and health care utilization patterns in Million Veteran Program enrollees with Traumatic Brain Injury Screening and Evaluation Program data"],"prefix":"10.1016","volume":"10","author":[{"given":"Alexandra L.","family":"Clark","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Makenna B.","family":"McGill","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin D.","family":"Ozturk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David M.","family":"Schnyer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Chanfreau-Coffinier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5683-4168","authenticated-orcid":false,"given":"Victoria C.","family":"Merritt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the VA Million Veteran Program","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","published-online":{"date-parts":[[2023,1,3]]},"reference":[{"issue":"1","key":"435_CR1","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1002\/jts.21979","volume":"28","author":"SM Lippa","year":"2015","unstructured":"Lippa SM, Fonda JR, Fortier CB, Amick MA, Kenna A, Milberg WP, et al. Deployment-related psychiatric and behavioral conditions and their association with functional disability in OEF\/OIF\/OND Veterans. J Trauma Stress. 2015;28(1):25\u201333.","journal-title":"J Trauma Stress"},{"issue":"11","key":"435_CR2","doi-asserted-by":"publisher","first-page":"853","DOI":"10.1089\/neu.2013.3283","volume":"32","author":"JA Haagsma","year":"2015","unstructured":"Haagsma JA, Scholten AC, Andriessen TMJC, Vos PE, Van Beeck EF, Polinder S. Impact of depression and post-traumatic stress disorder on functional outcome and health-related quality of life of patients with mild traumatic brain injury. J Neurotraum. 2015;32(11):853\u201362.","journal-title":"J Neurotraum"},{"issue":"4","key":"435_CR3","doi-asserted-by":"publisher","first-page":"342","DOI":"10.1097\/MLR.0b013e318245a558","volume":"50","author":"BC Taylor","year":"2012","unstructured":"Taylor BC, Hagel EM, Carlson KF, Cifu DX, Cutting A, Bidelspach DE, et al. Prevalence and costs of co-occurring traumatic brain injury with and without psychiatric disturbance and pain among Afghanistan and Iraq War Veteran VA users. Med Care. 2012;50(4):342\u20136.","journal-title":"Med Care"},{"issue":"9","key":"435_CR4","doi-asserted-by":"publisher","first-page":"1200","DOI":"10.1007\/s11606-012-2061-1","volume":"27","author":"JF Spelman","year":"2012","unstructured":"Spelman JF, Hunt SC, Seal KH, Burgo-Black AL. Post deployment care for returning combat Veterans. J Gen Intern Med. 2012;27(9):1200\u20139.","journal-title":"J Gen Intern Med"},{"issue":"3\u20134","key":"435_CR5","doi-asserted-by":"publisher","first-page":"e1645","DOI":"10.7205\/MILMED-D-16-00221","volume":"182","author":"JL Williams","year":"2017","unstructured":"Williams JL, McDevitt-Murphy ME, Murphy JG, Crouse EM. Postconcussive symptoms, PTSD, and medical disease burden in treatment-seeking OEF\/OIF\/OND Veterans. Mil Med. 2017;182(3\u20134):e1645\u201350.","journal-title":"Mil Med"},{"issue":"2","key":"435_CR6","doi-asserted-by":"publisher","first-page":"172","DOI":"10.1097\/MLR.0000000000000059","volume":"52","author":"MJ Pugh","year":"2014","unstructured":"Pugh MJ, Finley EP, Copeland LA, Wang CP, Noel PH, Amuan ME, et al. Complex comorbidity clusters in OEF\/OIF Veterans: the polytrauma clinical triad and beyond. Med Care. 2014;52(2):172\u201381.","journal-title":"Med Care"},{"issue":"1","key":"435_CR7","doi-asserted-by":"publisher","first-page":"E16","DOI":"10.1097\/HTR.0000000000000227","volume":"32","author":"SM Kehle-Forbes","year":"2017","unstructured":"Kehle-Forbes SM, Campbell EH, Taylor BC, Scholten J, Sayer N. Does co-occurring traumatic brain injury affect VHA outpatient health service utilization and associated costs among Veterans with posttraumatic stress disorder? An examination based on VHA administrative data. J Head Trauma Rehab. 2017;32(1):E16-23.","journal-title":"J Head Trauma Rehab"},{"issue":"2","key":"435_CR8","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1682\/JRRD.2014.12.0301","volume":"53","author":"KH Seal","year":"2016","unstructured":"Seal KH, Bertenthal D, Samuelson K, Maguen S, Kumar S, Vasterling JJ. Association between mild traumatic brain injury and mental health problems and self-reported cognitive dysfunction in Iraq and Afghanistan Veterans. J Rehabil Res Dev. 2016;53(2):185\u201398.","journal-title":"J Rehabil Res Dev"},{"issue":"1","key":"435_CR9","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1002\/jts.20483","volume":"23","author":"KF Carlson","year":"2010","unstructured":"Carlson KF, Nelson D, Orazem RJ, Nugent S, Cifu DX, Sayer NA. Psychiatric diagnoses among Iraq and Afghanistan War Veterans screened for deployment-related traumatic brain injury. J Trauma Stress. 2010;23(1):17\u201324.","journal-title":"J Trauma Stress"},{"key":"435_CR10","unstructured":"VHA. Screening and evaluation of possible traumatic brain injury in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) Veterans. 2007. https:\/\/www.va.gov\/optometry\/docs\/vha_directive_2007-013_screening_possible_tbi.pdf. Accessed 27 Jan 2022."},{"key":"435_CR11","unstructured":"VHA. Screening and evaluation of possible traumatic brain injury in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) Veterans. 2010. https:\/\/www.va.gov\/optometry\/docs\/vha_directive_2010-012_screening_and_evaluation_of_possible_tbi_in_oef-oif_veterans.pdf. Accessed 17 Jan 2022."},{"key":"435_CR12","unstructured":"The Management of Concussion\/mTBI Working Group. VA\/DoD clinical practice guidelines for the management of concussion\/mild traumatic brain injury (mTBI): guideline summary. 2016. https:\/\/www.va.gov\/covidtraining\/docs\/mTBICPGFullCPG50821816.pdf. Accessed 17 Jan 2022."},{"key":"435_CR13","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1016\/j.jpsychires.2022.04.019","volume":"151","author":"SJ Fink","year":"2022","unstructured":"Fink SJ, Davey DK, Sakamoto MS, Chanfreau-Coffinier C, Clark AL, Delano-Wood L, et al. Subjective cognitive and psychiatric well-being in U.S. Military Veterans screened for deployment-related traumatic brain injury: a Million Veteran Program Study. J Psychiat Res. 2022;151:144\u20139.","journal-title":"J Psychiat Res."},{"issue":"4 Suppl","key":"435_CR14","doi-asserted-by":"publisher","first-page":"S210","DOI":"10.1016\/j.whi.2011.04.019","volume":"21","author":"KM Iverson","year":"2011","unstructured":"Iverson KM, Hendricks AM, Kimerling R, Krengel M, Meterko M, Stolzmann KL, et al. Psychiatric diagnoses and neurobehavioral symptom severity among OEF\/OIF VA patients with deployment-related traumatic brain injury: a gender comparison. Women\u2019s Health Issues. 2011;21(4 Suppl):S210\u20137.","journal-title":"Women\u2019s Health Issues"},{"issue":"7","key":"435_CR15","doi-asserted-by":"publisher","first-page":"971","DOI":"10.1682\/JRRD.2011.06.0099","volume":"49","author":"TK Pogoda","year":"2012","unstructured":"Pogoda TK, Hendricks AM, Iverson KM, Stolzmann KL, Krengel MH, Baker E, et al. Multisensory impairment reported by veterans with and without mild traumatic brain injury history. J Rehabil Res Dev. 2012;49(7):971.","journal-title":"J Rehabil Res Dev"},{"issue":"3","key":"435_CR16","doi-asserted-by":"publisher","first-page":"191","DOI":"10.1097\/HTR.0000000000000092","volume":"31","author":"TK Pogoda","year":"2016","unstructured":"Pogoda TK, Stolzmann KL, Iverson KM, Baker E, Krengel M, Lew HL, et al. Associations between traumatic brain injury, suspected psychiatric conditions, and unemployment in Operation Enduring Freedom\/Operation Iraqi Freedom Veterans. J Head Trauma Rehab. 2016;31(3):191\u2013203.","journal-title":"J Head Trauma Rehab"},{"issue":"10","key":"435_CR17","doi-asserted-by":"publisher","first-page":"1177","DOI":"10.3109\/02699052.2012.661914","volume":"26","author":"JD Scholten","year":"2012","unstructured":"Scholten JD, Sayer NA, Vanderploeg RD, Bidelspach DE, Cifu DX. Analysis of US Veterans Health Administration comprehensive evaluations for traumatic brain injury in Operation Enduring Freedom and Operation Iraqi Freedom Veterans. Brain Inj. 2012;26(10):1177\u201384.","journal-title":"Brain Inj"},{"key":"435_CR18","doi-asserted-by":"publisher","first-page":"230","DOI":"10.1016\/j.jpsychires.2021.12.032","volume":"145","author":"ED Ozturk","year":"2022","unstructured":"Ozturk ED, Chanfreau-Coffinier C, Sakamoto MS, Delano-Wood L, Merritt VC. Characterization of Million Veteran Program (MVP) enrollees with Comprehensive Traumatic Brain Injury Evaluation (CTBIE) data: an analysis of neurobehavioral symptoms. J Psychiat Res. 2022;145:230\u201342.","journal-title":"J Psychiat Res"},{"issue":"3","key":"435_CR19","doi-asserted-by":"publisher","first-page":"E18","DOI":"10.1097\/HTR.0000000000000449","volume":"34","author":"DR Sullivan","year":"2019","unstructured":"Sullivan DR. A cerebrovascular hypothesis of neurodegeneration in mTBI. J Head Trauma Rehab. 2019;34(3):E18-27.","journal-title":"J Head Trauma Rehab"},{"key":"435_CR20","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1016\/j.ebiom.2018.01.021","volume":"28","author":"J Ramos-Cejudo","year":"2018","unstructured":"Ramos-Cejudo J, Wisniewski T, Marmar C, Zetterberg H, Blennow K, de Leon MJ, et al. Traumatic brain injury and Alzheimer\u2019s disease: the cerebrovascular link. EBioMedicine. 2018;28:21\u201330.","journal-title":"EBioMedicine"},{"issue":"10","key":"435_CR21","doi-asserted-by":"publisher","first-page":"1246","DOI":"10.1001\/jamaneurol.2017.1658","volume":"74","author":"RF Gottesman","year":"2017","unstructured":"Gottesman RF, Albert MS, Alonso A, Coker LH, Coresh J, Davis SM, et al. Associations between midlife vascular risk factors and 25-year incident dementia in the Atherosclerosis Risk in Communities (ARIC) cohort. JAMA Neurol. 2017;74(10):1246\u201354.","journal-title":"JAMA Neurol"},{"issue":"3","key":"435_CR22","doi-asserted-by":"publisher","first-page":"531","DOI":"10.3233\/JAD-2012-120802","volume":"32","author":"AM Tolppanen","year":"2012","unstructured":"Tolppanen AM, Solomon A, Soininen H, Kivipelto M. Midlife vascular risk factors and Alzheimer\u2019s disease: Evidence from epidemiological studies. J Alzheimers Dis. 2012;32(3):531\u201340.","journal-title":"J Alzheimers Dis"},{"key":"435_CR23","doi-asserted-by":"publisher","first-page":"214","DOI":"10.1016\/j.jclinepi.2015.09.016","volume":"70","author":"JM Gaziano","year":"2016","unstructured":"Gaziano JM, Concato J, Brophy M, Fiore L, Pyarajan S, Breeling J, et al. Million Veteran Program: a mega-biobank to study genetic influences on health and disease. J Clin Epidemiol. 2016;70:214\u201323.","journal-title":"J Clin Epidemiol"},{"issue":"7","key":"435_CR24","doi-asserted-by":"publisher","first-page":"1203","DOI":"10.1377\/hlthaff.2014.0054","volume":"33","author":"SD Fihn","year":"2014","unstructured":"Fihn SD, Francis J, Clancy C, Nielson C, Nelson K, Rumsfeld J, et al. Insights from advanced analytics at the Veterans Health Administration. Health Affair. 2014;33(7):1203\u201311.","journal-title":"Health Affair"},{"issue":"3","key":"435_CR25","doi-asserted-by":"publisher","first-page":"204","DOI":"10.1097\/HTR.0000000000000168","volume":"31","author":"HG Belanger","year":"2016","unstructured":"Belanger HG, Vanderploeg RD, Sayer N. Screening for remote history of mild traumatic brain injury in VHA: a critical literature review. J Head Trauma Rehab. 2016;31(3):204\u201314.","journal-title":"J Head Trauma Rehab"},{"issue":"6","key":"435_CR26","first-page":"1","volume":"46","author":"Management of Concussion\/mTBI Working Group","year":"2009","unstructured":"Management of Concussion\/mTBI Working Group. VA\/DoD clinical practice guideline for management of concussion\/mild traumatic brain injury. J Rehabil Res Dev. 2009;46(6):1\u201368.","journal-title":"J Rehabil Res Dev"},{"issue":"7","key":"435_CR27","doi-asserted-by":"publisher","first-page":"1234","DOI":"10.1016\/j.apmr.2012.03.003","volume":"93","author":"HG Belanger","year":"2012","unstructured":"Belanger HG, Vanderploeg RD, Soble JR, Richardson M, Groer S. Validity of the Veterans Health Administration\u2019s traumatic brain injury screen. Arch Phys Med Rehab. 2012;93(7):1234\u20139.","journal-title":"Arch Phys Med Rehab"},{"issue":"6","key":"435_CR28","doi-asserted-by":"publisher","first-page":"439","DOI":"10.1097\/HTR.0b013e3182005de3","volume":"26","author":"KT Donnelly","year":"2011","unstructured":"Donnelly KT, Donnelly JP, Dunnam M, Warner GC, Kittleson CJ, Constance JE, et al. Reliability, sensitivity, and specificity of the VA traumatic brain injury screening tool. J Head Trauma Rehab. 2011;26(6):439\u201353.","journal-title":"J Head Trauma Rehab"},{"issue":"1","key":"435_CR29","doi-asserted-by":"publisher","first-page":"E1","DOI":"10.1097\/HTR.0000000000000008","volume":"30","author":"CB Fortier","year":"2015","unstructured":"Fortier CB, Amick MM, Kenna A, Milberg WP, McGlinchey RE. Correspondence of the Boston Assessment of Traumatic Brain Injury-Lifetime (BAT-L) clinical interview and the VA TBI screen. J Head Trauma Rehab. 2015;30(1):E1-7.","journal-title":"J Head Trauma Rehab"},{"issue":"7","key":"435_CR30","doi-asserted-by":"publisher","first-page":"1370","DOI":"10.1016\/j.apmr.2017.11.017","volume":"99","author":"TLB Pape","year":"2018","unstructured":"Pape TLB, Smith B, Babcock-Parziale J, Evans CT, Herrold AA, Phipps Maieritsch K, et al. Diagnostic accuracy of the veteran affairs\u2019 traumatic brain injury screen. Arch Phys Med Rehab. 2018;99(7):1370\u201382.","journal-title":"Arch Phys Med Rehab"},{"issue":"5","key":"435_CR31","doi-asserted-by":"publisher","first-page":"E51","DOI":"10.1097\/HTR.0000000000000361","volume":"33","author":"L Radigan","year":"2018","unstructured":"Radigan L, McGlinchey RE, Milberg WP, Fortier CB. Correspondence of the Boston Assessment of Traumatic Brain Injury-Lifetime (BAT-L) and the VA comprehensive TBI evaluation (CTBIE). J Head Trauma Rehab. 2018;33(5):E51\u20135.","journal-title":"J Head Trauma Rehab"},{"issue":"2","key":"435_CR32","doi-asserted-by":"publisher","first-page":"98","DOI":"10.4103\/jhrr.jhrr_10_18","volume":"5","author":"XMT Nguyen","year":"2018","unstructured":"Nguyen XMT, Quaden RM, Song RJ, Ho YL, Honerlaw J, Whitbourne S, et al. Baseline characterization and annual trends of body mass index for a mega-biobank cohort of US Veterans 2011\u20132017. J Health Res Rev Dev Ctries. 2018;5(2):98\u2013107.","journal-title":"J Health Res Rev Dev Ctries"},{"issue":"Suppl 1","key":"435_CR33","doi-asserted-by":"publisher","first-page":"S56","DOI":"10.1016\/j.whi.2019.04.012","volume":"29","author":"KM Harrington","year":"2019","unstructured":"Harrington KM, Nguyen XMT, Song RJ, Hannagan K, Quaden R, Gagnon DR, et al. Gender differences in demographic and health characteristics of the Million Veteran Program cohort. Women\u2019s Health Issues. 2019;29(Suppl 1):S56-66.","journal-title":"Women\u2019s Health Issues"},{"issue":"4","key":"435_CR34","doi-asserted-by":"publisher","first-page":"e0266381","DOI":"10.1371\/journal.pone.0266381","volume":"17","author":"SB Whitbourne","year":"2022","unstructured":"Whitbourne SB, Nguyen XMT, Song RJ, Lord E, Lyden M, Harrington KM, et al. Million Veteran Program\u2019s response to COVID-19: survey development and preliminary findings. PLoS One. 2022;17(4):e0266381.","journal-title":"PLoS ONE"},{"issue":"2","key":"435_CR35","doi-asserted-by":"publisher","first-page":"182","DOI":"10.1097\/00004479-200604000-00011","volume":"29","author":"LE Kazis","year":"2006","unstructured":"Kazis LE, Miller DR, Skinner KM, Lee A, Ren XS, Clark JA, et al. Applications of methodologies of the Veterans Health Study in the VA healthcare system: conclusions and summary. J Ambul Care Manag. 2006;29(2):182\u20138.","journal-title":"J Ambul Care Manag"},{"key":"435_CR36","unstructured":"Iqbal SU, Rogers W, Selim A, Qian S, Lee A, Ren XS, et al. The Veterans RAND 12 Item Health Survey (VR-12): What it is and how it is used. 2007. https:\/\/www.bu.edu\/sph\/files\/2015\/01\/veterans_rand_12_item_health_survey_vr-12_2007.pdf. Accessed 27 Jan 2022."},{"issue":"3","key":"435_CR37","doi-asserted-by":"publisher","first-page":"218","DOI":"10.1037\/a0019236","volume":"2","author":"K Possemato","year":"2010","unstructured":"Possemato K, Wade M, Andersen J, Ouimette P. The impact of PTSD, depression, and substance use disorders on disease burden and health care utilization among OEF\/OIF Veterans. Psychol Trauma US. 2010;2(3):218\u201323.","journal-title":"Psychol Trauma US"},{"issue":"5","key":"435_CR38","doi-asserted-by":"publisher","first-page":"489","DOI":"10.1001\/jama.2009.1084","volume":"302","author":"BE Cohen","year":"2009","unstructured":"Cohen BE, Marmar C, Ren L, Bertenthal D, Seal KH. Association of cardiovascular risk factors with mental health diagnoses in Iraq and Afghanistan War Veterans using VA health care. J Am Med Assoc. 2009;302(5):489\u201392.","journal-title":"J Am Med Assoc"},{"issue":"6","key":"435_CR39","doi-asserted-by":"publisher","first-page":"697","DOI":"10.1682\/JRRD.2009.01.0006","volume":"46","author":"HL Lew","year":"2009","unstructured":"Lew HL, Otis JD, Tun C, Kerns RD, Clark ME, Cifu DX. Prevalence of chronic pain, posttraumatic stress disorder, and persistent postconcussive symptoms in OIF\/OEF veterans: polytrauma clinical triad. J Rehabil Res Dev. 2009;46(6):697\u2013702.","journal-title":"J Rehabil Res Dev"},{"issue":"2","key":"435_CR40","doi-asserted-by":"publisher","first-page":"E30","DOI":"10.1097\/HTR.0000000000000308","volume":"33","author":"MM Amick","year":"2018","unstructured":"Amick MM, Meterko M, Fortier CB, Fonda JR, Milberg WP, McGlinchey RE. The deployment trauma phenotype and employment status in Veterans of the wars in Iraq and Afghanistan. J Head Trauma Rehab. 2018;33(2):E30-40.","journal-title":"J Head Trauma Rehab"},{"issue":"3","key":"435_CR41","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1097\/HTR.0b013e31828b50db","volume":"28","author":"RD Vanderploeg","year":"2013","unstructured":"Vanderploeg RD, Belanger HG. Screening for a remote history of mild traumatic brain injury: when a good idea is bad. J Head Trauma Rehabil. 2013;28(3):211\u20138.","journal-title":"J Head Trauma Rehabil"},{"issue":"1\u20134","key":"435_CR42","first-page":"127","volume":"5","author":"CH Lin","year":"2018","unstructured":"Lin CH, Cheng HM, Chuang SY, Chen CH. Vascular aging and cognitive dysfunction: silent midlife crisis in the brain. Pulse. 2018;5(1\u20134):127\u201332.","journal-title":"Pulse"},{"issue":"2","key":"435_CR43","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1016\/j.jpsychores.2006.09.003","volume":"62","author":"L Frostholm","year":"2007","unstructured":"Frostholm L, Oernboel E, Christensen KS, Toft T, Olesen F, Weinman J, Fink P. Do illness perceptions predict health outcomes in primary care patients? A 2-year follow-up study. J Psychosom Res. 2007;62(2):129\u201338.","journal-title":"J Psychosom Res"},{"issue":"5","key":"435_CR44","doi-asserted-by":"publisher","first-page":"453","DOI":"10.1056\/NEJMoa072972","volume":"358","author":"CW Hoge","year":"2008","unstructured":"Hoge CW, McGurk D, Thomas JL, Cox AL, Engel CC, Castro CA. Mild traumatic brain injury in US soldiers returning from Iraq. New Engl J Med. 2008;358(5):453\u201363.","journal-title":"New Engl J Med"},{"issue":"1","key":"435_CR45","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1097\/HTR.0b013e3181957032","volume":"24","author":"HG Belanger","year":"2009","unstructured":"Belanger HG, Uomoto JM, Vanderploeg RD. The Veterans Health Administration system of care for mild traumatic brain injury: costs, benefits, and controversies. J Head Trauma Rehab. 2009;24(1):4\u201313.","journal-title":"J Head Trauma Rehab"},{"key":"435_CR46","doi-asserted-by":"publisher","first-page":"873","DOI":"10.3389\/fneur.2018.00873","volume":"9","author":"AL Clark","year":"2018","unstructured":"Clark AL, Merritt VC, Bigler ED, Bangen KJ, Werhane M, Sorg SF, Bondi MW, Schiehser DM, Delano-Wood L. Blast-exposed veterans with mild traumatic brain injury show greater frontal cortical thinning and poorer executive functioning. Front Neurol. 2018;9:873.","journal-title":"Front Neurol"},{"issue":"3","key":"435_CR47","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1080\/23279095.2019.1630627","volume":"28","author":"FJ Haran","year":"2021","unstructured":"Haran FJ, Handy JD, Servatius RJ, Rhea CK, Tsao JW. Acute neurocognitive deficits in active duty service members following subconcussive blast exposure. Appl Neuropsychol Adult. 2021;28(3):297\u2013309.","journal-title":"Appl Neuropsychol Adult"}],"container-title":["Military Medical Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40779-022-00435-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s40779-022-00435-7\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40779-022-00435-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T20:52:49Z","timestamp":1772830369000},"score":1,"resource":{"primary":{"URL":"https:\/\/mmrjournal.biomedcentral.com\/articles\/10.1186\/s40779-022-00435-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,3]]},"references-count":47,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,12]]}},"alternative-id":["435"],"URL":"https:\/\/doi.org\/10.1186\/s40779-022-00435-7","relation":{},"ISSN":["2054-9369"],"issn-type":[{"value":"2054-9369","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,3]]},"assertion":[{"value":"6 April 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 November 2022","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 January 2023","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"MVP was originally approved by the VA\u2019s Central Institutional Review Board (IRB) in 2010 and is actively recruiting and enrolling veteran participants. All veterans provided written informed consent prior to participation. IRB approval for the present study (conducted under project \u2018MVP026\u2019) was obtained in 2019.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"2"}}