INS NYC 2024 Program

Custom Content	Poster Session 03 Program Schedule 02/15/2024 09:30 am - 10:40 am Room: Shubert Complex (Posters 1-60) Poster Session 03: Neurotrauma \| Neurovascular Final Abstract #6 Poster Symposium: Invisible Injuries: Screening, Assessment, and Rehabilitation of Traumatic Brain Injury in Vulnerable Populations — Abstract 5 Neuropsychological Performance and Functional Outcomes in Unstably Housed Veterans with Mental Health Conditions Ilyssa Silverman, SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, United States Amber Keller, SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, United States Jacqueline Maye, Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, United States Tara Austin, Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, United States Jessica Zakrzewski, University of California, San Diego - Department of Psychiatry, San Diego, United States Jillian Clark, Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, United States Amy Jak, Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, United States Elizabeth Twamley, Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, United States Category: Concussion/Mild TBI (Adult) Keyword 1: cognitive functioning Keyword 2: everyday functioning Keyword 3: traumatic brain injury Objective: Homelessness in returning Veterans is a longstanding public health issue of national importance. Impaired functioning – including dysfunction in communication, mobility, work performance, personal relationships, and community integration – can be a significant barrier to sustaining income and housing and to accessing, navigating, and engaging in rehabilitation services. Accordingly, improvements in these domains of functioning may play a role in reducing homelessness. This study probed the relationship between cognition and functioning in the presence of other complex psychiatric and medical factors (e.g., depression, anxiety, PTSD, sleep disturbance, pain, post-concussive symptoms) in a transdiagnostic sample of unstably housed Veterans with mental health conditions. Our goal was to better understand correlates of functioning in this population to identify treatment targets for cognitive rehabilitation. Participants and Methods: 89 post-9/11 Veterans who were experiencing or at-risk for homelessness and receiving residential psychiatric rehabilitation completed baseline assessments as part of a randomized controlled trial. We used an expanded MATRICS Consensus Cognitive Battery (MCCB) to measure neuropsychological performance, World Health Organization Disability Assessment Schedule (WHODAS 2.0) domain scores to measure functional outcomes, and a variety of self-report measures to assess psychiatric and medical symptoms. We examined bivariate correlations among these variables and entered significant bivariate correlates into hierarchical multiple regression analyses to predict variance in WHODAS domains. Block 1 of these analyses included psychiatric and medical symptom scores significantly correlated with each WHODAS domain, and block 2 included bivariate-significant neuropsychological variables (MCCB domain scores). Results: Participants were mostly male (98%), White/Non-Hispanic (63%), and on average, were age 37 with 14 years of education. Most (69%) had no employment in the past 6 months and 53% lived in their car, in public, or in a shelter for at least one week in the past 6 months. Participants had clinically significant depressive, PTSD, and insomnia symptoms; 90% had a history of TBI; 90% reported pain. After controlling for psychiatric and medical symptoms, MCCB Attention/Vigilance accounted for 4% of the variance in WHODAS Cognition (p=.030); MCCB Reasoning/Problem Solving accounted for 7% of the variance in WHODAS Getting Along (p=.002); and MCCB Visual Learning accounted for 19% of the variance in WHODAS Participation in community activities (p<.001). Conclusions: Neuropsychological test performance was significantly associated with functional outcomes in our sample of unstably housed Veterans with mental health conditions, even after controlling for clinically significant medical and psychiatric symptoms. Cognitive rehabilitation targeting attention, learning, and executive functioning may improve functioning in this vulnerable population.

Custom Content

02/15/2024
09:30 am - 10:40 am
Room: Shubert Complex (Posters 1-60)

Poster Session 03: Neurotrauma | Neurovascular

Final Abstract #6

Poster Symposium: Invisible Injuries: Screening, Assessment, and Rehabilitation of Traumatic Brain Injury in Vulnerable Populations — Abstract 5

Neuropsychological Performance and Functional Outcomes in Unstably Housed Veterans with Mental Health Conditions

Ilyssa Silverman, SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, United States
Amber Keller, SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, United States
Jacqueline Maye, Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, United States
Tara Austin, Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, United States
Jessica Zakrzewski, University of California, San Diego - Department of Psychiatry, San Diego, United States
Jillian Clark, Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, United States
Amy Jak, Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, United States
Elizabeth Twamley, Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, United States

Category: Concussion/Mild TBI (Adult)

Keyword 1: cognitive functioning
Keyword 2: everyday functioning
Keyword 3: traumatic brain injury

Objective:

Homelessness in returning Veterans is a longstanding public health issue of national importance. Impaired functioning – including dysfunction in communication, mobility, work performance, personal relationships, and community integration – can be a significant barrier to sustaining income and housing and to accessing, navigating, and engaging in rehabilitation services. Accordingly, improvements in these domains of functioning may play a role in reducing homelessness. This study probed the relationship between cognition and functioning in the presence of other complex psychiatric and medical factors (e.g., depression, anxiety, PTSD, sleep disturbance, pain, post-concussive symptoms) in a transdiagnostic sample of unstably housed Veterans with mental health conditions. Our goal was to better understand correlates of functioning in this population to identify treatment targets for cognitive rehabilitation.

Participants and Methods:

89 post-9/11 Veterans who were experiencing or at-risk for homelessness and receiving residential psychiatric rehabilitation completed baseline assessments as part of a randomized controlled trial. We used an expanded MATRICS Consensus Cognitive Battery (MCCB) to measure neuropsychological performance, World Health Organization Disability Assessment Schedule (WHODAS 2.0) domain scores to measure functional outcomes, and a variety of self-report measures to assess psychiatric and medical symptoms. We examined bivariate correlations among these variables and entered significant bivariate correlates into hierarchical multiple regression analyses to predict variance in WHODAS domains. Block 1 of these analyses included psychiatric and medical symptom scores significantly correlated with each WHODAS domain, and block 2 included bivariate-significant neuropsychological variables (MCCB domain scores).

Results:

Participants were mostly male (98%), White/Non-Hispanic (63%), and on average, were age 37 with 14 years of education. Most (69%) had no employment in the past 6 months and 53% lived in their car, in public, or in a shelter for at least one week in the past 6 months. Participants had clinically significant depressive, PTSD, and insomnia symptoms; 90% had a history of TBI; 90% reported pain. After controlling for psychiatric and medical symptoms, MCCB Attention/Vigilance accounted for 4% of the variance in WHODAS Cognition (p=.030); MCCB Reasoning/Problem Solving accounted for 7% of the variance in WHODAS Getting Along (p=.002); and MCCB Visual Learning accounted for 19% of the variance in WHODAS Participation in community activities (p<.001).

Conclusions:

Neuropsychological test performance was significantly associated with functional outcomes in our sample of unstably housed Veterans with mental health conditions, even after controlling for clinically significant medical and psychiatric symptoms. Cognitive rehabilitation targeting attention, learning, and executive functioning may improve functioning in this vulnerable population.