scholarly journals A-124 Acute Predictors of Chronic PTSD Symptoms Following TBI in U.S. Military Service Members

2020 ◽  
Vol 35 (6) ◽  
pp. 917-917
Author(s):  
Lippa S ◽  
Bailie J ◽  
Brickell T ◽  
Hungerford L ◽  
Lange R ◽  
...  
Keyword(s):  
Military Service ◽  
Injury Severity ◽  
Combat Exposure ◽  
Self Report ◽  
Service Members ◽  
Ptsd Symptoms ◽  
Post Traumatic Stress ◽  
Post Injury ◽  
Military Service Members

Abstract Objective Post-Traumatic Stress Disorder (PTSD) has been shown to be a major contributor to poor outcome after Traumatic Brain Injury (TBI). Understanding the factors that contribute to PTSD symptoms may lead to improved clinical management of PTSD and TBI. This study examines acute predictors of self-reported PTSD symptoms after TBI in military service members. Method Participants included 210 U.S. military service members (Age: M = 33.9 years, SD = 10.2) without injury (n = 86), or with history of uncomplicated mild TBI (n = 56), complicated mild, moderate, or severe TBI (n = 43), or bodily injury (n = 25) assessed at 0–8 months and ≥ 2 years post-injury. At both assessments, participants completed the PTSD Checklist (PCL-C), Neurobehavioral Symptom Inventory, Alcohol Use Disorder Checklist, Combat Exposure Scale, and TBI Quality of Life and passed symptom validity tests. Stepwise linear regression included 26 potential predictors (demographics, injury characteristics, military characteristics, and self-report measures at baseline) of PCL-C Total at follow-up. Results In this model, (F(4,188) = 68.0; p < .001; R2 = .591), baseline PCL-C (R2Δ = .52) was the main predictor of follow-up PCL-C Total, followed by Cognitive Concerns (R2Δ = .04), number of deployments (R2Δ = .01), and injury severity (R2Δ = .02). When baseline PCL-C was excluded as a predictor, somatosensory symptoms (R2Δ = .361), Emotional/Behavioral Dyscontrol (R2Δ = .067), Sleep (R2Δ = .033), Combat Exposure (R2Δ = .024), and Cognitive Concerns (R2Δ = .017) predicted follow-up PCL-C (F(5,187) = 37.7; p < .001; R2 = .502). Semipartial correlations revealed that most of the explained variance was shared among self-report predictors. Conclusion Findings suggest acute psychological distress impacts future PTSD symptomatology, whereas TBI characteristics, such as TBI severity and number of TBIs, have minimal influence.

Examining the link between prior suicidality and subsequent suicidal ideation among high-risk US military service members

2018 ◽  
Vol 49 (13) ◽  
pp. 2237-2246 ◽  
Author(s):  
Melanie A. Hom ◽  
Mary E. Duffy ◽  
Megan L. Rogers ◽  
Jetta E. Hanson ◽  
Peter M. Gutierrez ◽  
...  
Keyword(s):  
Suicidal Ideation ◽  
Military Service ◽  
Suicide Risk ◽  
Self Report ◽  
Service Members ◽  
Thwarted Belongingness ◽  
Us Military ◽  
Military Service Members ◽  
The Relationship

AbstractBackgroundResearch is needed to identify the factors that explain the link between prior and future suicidality. This study evaluated possible mediators of the relationship between: (1) the severity of prior suicidality and (2) suicidal ideation severity at 3-month follow-up among a sample of high-risk military personnel.MethodsUS military service members referred to or seeking care for suicide risk (N = 624) completed self-report psychiatric domain measures and a clinician interview assessing prior suicidality severity at baseline. Three months later, participants completed a self-report measure of suicidal ideation severity. Three separate percentile bootstrap mediation models were used to examine psychiatric factors (i.e. alcohol abuse, anxiety sensitivity, hopelessness, insomnia, posttraumatic stress symptoms, suicidal ideation, and thwarted belongingness) as parallel mediators of the relationship between prior suicidality severity (specifically, suicidal ideation, suicide attempt, and overall suicidality – i.e. ideation/attempt severity combined) at baseline and suicidal ideation severity at follow-up.ResultsHopelessness, specifically, and the total effect of all mediators, each significantly accounted for the relationship between prior suicidality severity and subsequent ideation severity across models. In the models with attempt severity and overall suicidality severity as predictors, thwarted belongingness was also a significant mediator.ConclusionsHopelessness, thwarted belongingness, and overall severity of psychiatric indices may explain the relationship between prior suicidality severity and future suicidal ideation severity among service members at elevated suicide risk. Research is needed to replicate these findings and examine other possible mediators.

Prospective study of anxiety, post-traumatic stress and depression on postural control, gait, otolith and visuospatial function in military service members with persistent post-concussive symptoms

2019 ◽  
pp. 271-287
Author(s):  
◽  
Andrew Lewandowski ◽  
Lindell K. Weaver ◽  
◽  
◽  
...  
Keyword(s):  
Brain Injury ◽  
Postural Control ◽  
Traumatic Stress ◽  
Military Service ◽  
Service Members ◽  
Post Traumatic Stress ◽  
High Anxiety ◽  
Affective Symptoms ◽  
Military Service Members ◽  
Post Traumatic

Purpose: Military service members often report both affective and vestibular complaints after mild traumatic brain injury (mTBI), but associations between symptoms and vestibular deficits can be subtle and inconsistent. Methods: From two complementary studies, one of military service members with persistent post-concussive symptoms after mTBI (NCT01611194) and the other of adult volunteers with no history of brain injury (NCT01925963), affective symptoms were compared to postural control, gait, otolith and visuospatial function. Results: The studies enrolled 71 participants with mTBI and 75 normative controls. Participants with mTBI had significantly reduced postural equilibrium on the sensory organization test (SOT), and more so in those with high anxiety or post-traumatic stress. Cervical and ocular vestibular evoked myogenic potentials (cVEMP; oVEMP) showed prolonged latencies in mTBI participants compared to controls; oVEMPs were significantly delayed in mTBI participants with high anxiety, post-traumatic stress or depression. A subset of the mTBI group had abnormal tandem gait and high anxiety. Anxiety, posttraumatic stress, and depression did not correlate with performance on the 6-Minute Walk Test, visuospatial neuropsychological measures, and the Satisfaction with Life Scale in the mTBI group. Conclusions: In this study military service members with mTBI reported affective symptoms, concurrently with vestibular-balance concerns. Worse scores on affective measures were associated with abnormal findings on measures of postural control, gait and otolith function.

scholarly journals A-116 Predicting Chronic Neurobehavioral Symptoms based on Acute Injury Characteristics and Symptoms in U.S. Military Service Members with and without history of TBI

2020 ◽  
Vol 35 (6) ◽  
pp. 909-909
Author(s):  
Lippa S ◽  
Bailie J ◽  
Brickell T ◽  
French L ◽  
Hungerford L ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Military Service ◽  
Service Members ◽  
Injury Characteristics ◽  
Military Service Members ◽  
History Of ◽  
Neurobehavioral Symptoms ◽  
Severe Tbi

Abstract Objective Recovery following traumatic brain injury (TBI) is complex. Often following mild TBI, recovery occurs within days or weeks, though this is not always the case. Following more severe TBI, some recover quickly, while many never fully recover. This study examines acute predictors of chronic neurobehavioral symptoms in U.S. military service members (Age: M = 33.9 years, SD = 10.2) without injury (n = 86), or with history of uncomplicated mild traumatic brain injury (TBI; n = 56), complicated mild, moderate, or severe TBI (mod-sev TBI; n = 43), or bodily injury (n = 25). Method Participants completed the Neurobehavioral Symptom Inventory (NSI), Posttraumatic Stress Disorder Checklist, Alcohol Use Disorder Checklist, Combat Exposure Scale, and TBI Quality of Life and passed symptom validity tests at 0–8 months and ≥ 2 years post-injury. Forward stepwise logistic regression included 26 potential predictors (demographics, injury characteristics, military characteristics, and self-report measures at baseline) of International Statistical Classification of Diseases and Related Health Problems-10 Postconcussional Syndrome (PCSy) at follow-up. Results Cognitive Concerns (Exp(B) = .896, p = .001), Sleep (Exp(B) = 1.874, p < .001), Somatosensory Symptoms (Exp(B) = 1.194, p = .012), and mod-sev TBI (Exp(B) = 2.959, p = .045) significantly predicted follow-up PCSy. When baseline NSI symptoms were removed from the model, Cognitive Concerns (Exp(B) = .902, p < .001), Post-traumatic stress (Exp(B) = 1.173, p = .001), and Resilience (Exp(B) = .950, p < .031) significantly predicted PCSy. For all included measures in both models, higher symptoms at baseline predicted increased likelihood of follow-up PCSy. Both models correctly classified 81.3% of participants. Conclusion Findings suggest patients reporting psychological distress and cognitive concerns acutely should be targeted for treatment to mitigate prolonged neurobehavioral symptoms.

scholarly journals Mental Health Outcomes Among Military Service Members After Severe Injury in Combat and TBI

2019 ◽  
Vol 185 (5-6) ◽  
pp. e711-e718 ◽  
Author(s):  
David L Chin ◽  
John E Zeber
Keyword(s):  
Mental Health ◽  
Health Outcomes ◽  
Traumatic Stress ◽  
Military Service ◽  
Mental Health Outcomes ◽  
Service Members ◽  
Post Traumatic Stress ◽  
Military Service Members ◽  
Severe Tbi ◽  
Post Traumatic

Abstract Introduction Studies examining the mental health outcomes of military personnel deployed into combat zones have focused on the risk of developing post-traumatic stress disorder conferred by mild or moderate traumatic brain injury (TBI). However, other mental health outcomes among veterans who sustained critical combat injuries have not been described. Materials and Method We examined the associations of moderate and severe TBI and combat injury with the risk for anxiety and mood disorders, adjustment reactions, schizophrenia and other psychotic disorders, cognitive disorders, and post-traumatic stress disorder. We conducted a retrospective cohort study of U.S. military service members critically injured in combat during military operations in Iraq and Afghanistan from February 1, 2002, to February 1, 2011. Health care encounters from (1) the Department of Defense (DoD) Trauma Registry (TR), (2) acute and ambulatory care in military facilities, and (3) civilian facilities are reimbursed by Tricare. Service members who sustained severe combat injury require critical care. We estimated the risk of mental health outcomes using risk-adjusted logit models for demographic and clinical factors. We explored the relationship between TBI and the total number of mental health diagnoses. Results Of the 4,980 subjects who met inclusion criteria, most injuries occurred among members of the Army (72%) or Marines (25%), with mean (SD) age of 25.5(6.1) years. The prevalence of moderate or severe TBI was 31.6% with explosion as the most common mechanism of injury (78%). We found 71% of the cohort was diagnosed with at least one poor mental health condition, and the adjusted risk conferred by TBI ranged from a modest increase for anxiety disorder (odds ratio, 1.27; 95% confidence interval [CI], 1.11–1.45) to a large increase for cognitive disorder (odds ratio, 3.24; 95% CI, 2.78–3.77). We found TBI was associated with an increased number of mental health diagnoses (incidence rate ratio, 1.52; 95% CI, 1.42–1.63). Conclusions Combat-associated TBI may have a broad effect on several mental health conditions among critically injured combat casualties. Early recognition and treatment for trauma-associated mental health are crucial to improving outcomes among service personnel as they transition to post-deployment care in the DoD, Department of Veterans Affairs, or community health systems.

scholarly journals PERIACETABULAR OSTEOTOMY IN ACTIVE DUTY U.S. MILITARY PERSONNEL: A SINGLE CENTER’S EXPERIENCE WITH A MINIMUM OF TWO YEARS FOLLOW-UP

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0014
Author(s):  
Andrew S. Murtha ◽  
Matthew R. Schmitz
Keyword(s):  
United States ◽  
Military Service ◽  
Periacetabular Osteotomy ◽  
The United States ◽  
Active Duty ◽  
Service Members ◽  
Military Service Members ◽  
Active Service ◽  
The Impact

Background: The primary focus of periacetabular osteotomy (PAO) literature has been survivorship until hip arthroplasty. This endpoint overlooks its impact on young, active patients. Hypothesis/Purpose: This study sought to assess the impact of the PAO on the careers of active duty members of the United States Armed Forces. Methods: A retrospective review identified 38 patients who underwent PAO performed by a single surgeon at an academic, military medical center from January 2014 through April 2017. Twenty-one of the patients were active duty United States military service members (16 female, 5 male) and had a minimum 28 months of post-operative follow-up at the time of review. Preoperative and postoperative duty restrictions were noted and referrals to the U.S Army and U.S. Air Force Medical Evaluation Boards (MEB) were queried. Results: The average age at surgery was 25.6 years (range, 19-40y). Preoperatively, sixteen patients (94.1%) were on duty restrictions, one had been referred to the MEB, and records were not available on three patients who separated from the military prior to review. Average follow-up was 3.4 years (range, 2.3 – 5.4y). Among the patients without a preoperative MEB referral, 85.0% remained on active duty (n = 12) or completed their military service commitment (n=5). Of the fourteen patients with temporary duty restrictions preoperatively, 35.7% (n=5) were relieved of their restrictions and returned to full duty and 50% (n=7) were retained on active service with permanent duty restrictions. Such permanent duty restrictions typically consisted of modifications to the aerobic component of the semiannual military fitness testing. Six patients (28.6%) were referred to the MEB including one who was referred prior to PAO. Of these patients, two were deemed fit to retain on active service with permanent duty restrictions, two were medically separated for non-hip conditions, and two were medically separated for a hip condition. The average Veteran Affairs (VA) disability score related to hip pathology in patients referred to MEB was 16% (range 0-40%). Conclusion: This is the first study to look at the PAO in active duty military service members. In patients with symptomatic acetabular dysplasia, PAO may provide an opportunity to relieve preoperative duty restrictions and allow for continued military service. Further study with the inclusion of patient reported outcomes are necessary assess the impact of the procedure in this active patient population.

scholarly journals ‘Master My Demons’: art therapy montage paintings by active-duty military service members with traumatic brain injury and post-traumatic stress

2018 ◽  
Vol 45 (4) ◽  
pp. 353-360 ◽  
Author(s):  
Marygrace Berberian ◽  
Melissa S Walker ◽  
Girija Kaimal
Keyword(s):  
Traumatic Brain Injury ◽  
Art Therapy ◽  
Traumatic Stress ◽  
Military Service ◽  
Active Duty ◽  
Service Members ◽  
Post Traumatic Stress ◽  
Active Duty Military ◽  
Military Service Members ◽  
Post Traumatic

This study involved a thematic analysis of montage paintings and of related clinical records of 240 active-duty military service members collected during their art therapy treatment for traumatic brain injury and underlying psychological health concerns, including post-traumatic stress, at the National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA. Congruent with other research findings, the qualitative analyses of this study suggest that the group art therapy experiences fostered improvement in interpersonal relatedness, hopefulness and gratification for the service members in treatment, aiding in externalisation, progressive exposure and construction of a trauma narrative imperative for recovery. The mixed media nature of the montage painting supported the expression of a range of postcombat symptoms. Results from this study highlighted the complexity of military culture, necessitating a broader scope of analyses for how art therapy helps service members express and communicate their challenges to care providers, peers and family as well as regulate emotion in the short and long term.

Suicidal Ideation Severity in Transgender and Cisgender Elevated-Risk Military Service Members at Baseline and Three-Month Follow-Up

2020 ◽  
Vol 8 (3) ◽  
pp. 256-264
Author(s):  
Roshni Janakiraman ◽  
Ian H. Stanley ◽  
Mary E. Duffy ◽  
Anna R. Gai ◽  
Jetta E. Hanson ◽  
...  
Keyword(s):  
Suicidal Ideation ◽  
Military Service ◽  
Elevated Risk ◽  
Service Members ◽  
Military Service Members
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