An Examination of Racial/Ethnic Differences on the Neurobehavioral Symptom Inventory Among Veterans Completing the Comprehensive Traumatic Brain Injury Evaluation: A Veterans Affairs Million Veteran Program Study

McKenna S Sakamoto; Karen L Hanson; Catherine Chanfreau-Coffinier; Mark H C Lai; Cristina A F Román; Alexandra L Clark; María J Marquine; Lisa Delano-Wood; Victoria C Merritt; VA Million Veteran Program

doi:10.1093/arclin/acad005

An Examination of Racial/Ethnic Differences on the Neurobehavioral Symptom Inventory Among Veterans Completing the Comprehensive Traumatic Brain Injury Evaluation: A Veterans Affairs Million Veteran Program Study

Arch Clin Neuropsychol. 2023 Aug 24;38(6):929-943. doi: 10.1093/arclin/acad005.

Authors

Affiliations

¹ Research & Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA.
² Department of Psychiatry, University of California San Diego, La Jolla, CA, USA.
³ VA Informatics and Computing Infrastructure (VINCI), VA Salt Lake City Health Care System, Salt Lake City, UT, USA.
⁴ Department of Psychology, University of Southern California, Los Angeles, CA, USA.
⁵ Kessler Foundation, West Orange, NJ, USA.
⁶ Department of Psychology, The University of Texas at Austin, Austin, TX, USA.
⁷ Department of Medicine, University of California San Diego, La Jolla, CA, USA.
⁸ Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, USA.

Abstract

Objective: The purpose of this study was to explore racial/ethnic differences in neurobehavioral symptom reporting and symptom validity testing among military veterans with a history of traumatic brain injury (TBI).

Method: Participants of this observational cross-sectional study (N = 9,646) were post-deployed Iraq-/Afghanistan-era veterans enrolled in the VA's Million Veteran Program with a clinician-confirmed history of TBI on the Comprehensive TBI Evaluation (CTBIE). Racial/ethnic groups included White, Black, Hispanic, Asian, Multiracial, Another Race, American Indian or Alaska Native, and Native Hawaiian or Other Pacific Islander. Dependent variables included neurobehavioral symptom domains and symptom validity assessed via the Neurobehavioral Symptom Inventory (NSI) and Validity-10, respectively.

Results: Chi-square analyses showed significant racial/ethnic group differences for vestibular, somatic/sensory, and affective symptoms as well as for all Validity-10 cutoff scores examined (≥33, ≥27, ≥26, >22, ≥22, ≥13, and ≥7). Follow-up analyses compared all racial/ethnic groups to one another, adjusting for sociodemographic- and injury-related characteristics. These analyses revealed that the affective symptom domain and the Validity-10 cutoff of ≥13 revealed the greatest number of racial/ethnic differences.

Conclusions: Results showed significant racial/ethnic group differences on neurobehavioral symptom domains and symptom validity testing among veterans who completed the CTBIE. An enhanced understanding of how symptoms vary by race/ethnicity is vital so that clinical care can be appropriately tailored to the unique needs of all veterans. Results highlight the importance of establishing measurement invariance of the NSI across race/ethnicity and underscore the need for ongoing research to determine the most appropriate Validity-10 cutoff score(s) to use across racially/ethnically diverse veterans.

Keywords: Assessment; Head injury; Symptom validity testing; Traumatic brain injury.

Published by Oxford University Press 2023.

Publication types

Observational Study

MeSH terms

Brain Injuries, Traumatic* / complications
Ethnicity
Hispanic or Latino
Humans
Neuropsychological Tests
Veterans* / psychology

Abstract

Publication types

MeSH terms

Grants and funding