Medical and social criteria for predicting the employment of disabled people due to military trauma

Background. Employment and occupation are important areas of social policy in the system of rehabilitation of the disabled people. Servicemen of working age are an active and able-bodied part of the population, however, when a disability is established, they develop problems associated with social maladaptation.

Aim. Development of criteria for assessing the social and labor prognosis of disabled military service due to “military injury”.

Material and methods. A cross-sectional study by the method of random non-repetitive selection was carried out. From a population of 1,618 disabled due to “military injury” who were re-examined at the Bureau of Medical and Social Expertise of the Republic of Dagestan in the period 2014–2019, a sample of military personnel with a disability due to the consequences of a military injury (n=90) was formed and divided into two groups. The criterion for dividing into groups was the motivation for labor activity. The first group included 28 disabled people who worked after their disability was established and were characterized by positive motivation to work. The second group included 62 disabled people who were not working at the time of the survey and were characterized by negative and indefinite motivation to work. Disabled people of both groups were subjected to a questionnaire survey based on the original questionnaire “Medical-expert indicators of the vital activity of disabled military service due to “military injury”, characterizing the state of life and the needs of disabled people due to military injury” developed by us. A comparative statistical analysis of the selected groups on a set of social and hygienic indicators of military personnel with disabilities due to “military injury” was carried out by testing statistical hypotheses using nonparametric Pearson’s χ2 test and Fisher’s exact test. The ranking of the studied indicators according to the degree of their influence on the result of employment was performed using the algorithm of classification trees. A set of 7 features that are most closely related to the result of employment were identified, which were used to calculate the indicator of social and labor forecast. The calculated threshold value of the indicator of social and labor prognosis made it possible to discriminate military personnel with disabilities due to “military injury” into two groups associated with high and low employment opportunities.

Results. The length of stay on disability from 1 to 4 years characterized more than half of working disabled people and only a quarter of non-working people (64.3 and 22.6%, respectively; χ2=14.64; p <0.001); 21.4% of working disabled people and 2 times more (45.2%) non-working people (χ2=4.62; p=0.032) were on disability from 5 to 10 years. In the working group, the overwhelming majority (92.9%) had clear ideas about the need for work to restore their health, which could not be said about the disabled from the group of non-working disabled (27.4%; χ2=33.1; р <0.001). A significant association of motivation to work with the age structure of disabled people due to military trauma has been established. The youngest age category (18–39 years) in 67.9% of cases was characteristic of disabled people with positive motivation to work, while in groups with uncertain and negative motivation it was statistically significantly less common — 26.7 and 6.5% (p=0.0017 and p <0.001, respectively). A relationship between the motivation to work and the assessment of one’s own labor opportunities was established: 67.9% with a positive attitude to work were characterized by adequate self-assessment, which distinguished this group from the other two (p <0.001). Significant differences in the structure of the severity of their psychoorganic syndrome were revealed. A pronounced degree of psychoorganic syndrome was determined in every fourth disabled person with negative motivation to work (25.0%), while in disabled people with positive and indefinite motivation it was absent (p <0.01).

Conclusion. The most priority indicators involved in the formation of a social and labor forecast were the duration of disability, motivation to work, age, the severity of the psychoorganic syndrome, self-assessment of professional abilities, timely career guidance and information work with disabled people, limiting the ability to self-service.