1
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Lester PB, Harms PD, DeSimone JA. Taken to the extreme: Transformational leadership, psychological capital, and follower health outcomes in extreme contexts. MILITARY PSYCHOLOGY 2024; 36:137-147. [PMID: 38377249 PMCID: PMC10880496 DOI: 10.1080/08995605.2022.2147361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 11/09/2022] [Indexed: 12/13/2022]
Abstract
The purpose of this study is to examine the boundary conditions of transformational leadership, follower psychological capital, and their effects on follower mental health outcomes. Specifically, we utilize archival, multi-wave data from a military sample to examine whether the negative relationship between transformational leadership and adverse follower stress outcomes increases as the context shifts from a relatively safe environment to one in which follower lives are at risk. Additionally, psychological capital, a constellation of personal psychological resources, is also assessed to account for individual buffers against extreme stressors. Findings from the current study suggest that the negative relationship between transformational leadership and follower stress increases significantly when the context shifts to a high-risk, mortality-salient environment.
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Affiliation(s)
- Paul B. Lester
- Graduate School of Defense Management, Naval Postgraduate School, Monterey, California, USA
| | - Peter D. Harms
- Culverhouse College of Business, University of Alabama, USA
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2
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Kocheril PA, Moore SC, Lenz KD, Mukundan H, Lilley LM. Progress Toward a Multiomic Understanding of Traumatic Brain Injury: A Review. Biomark Insights 2022; 17:11772719221105145. [PMID: 35719705 PMCID: PMC9201320 DOI: 10.1177/11772719221105145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 05/17/2022] [Indexed: 12/11/2022] Open
Abstract
Traumatic brain injury (TBI) is not a single disease state but describes an array
of conditions associated with insult or injury to the brain. While some
individuals with TBI recover within a few days or months, others present with
persistent symptoms that can cause disability, neuropsychological trauma, and
even death. Understanding, diagnosing, and treating TBI is extremely complex for
many reasons, including the variable biomechanics of head impact, differences in
severity and location of injury, and individual patient characteristics. Because
of these confounding factors, the development of reliable diagnostics and
targeted treatments for brain injury remains elusive. We argue that the
development of effective diagnostic and therapeutic strategies for TBI requires
a deep understanding of human neurophysiology at the molecular level and that
the framework of multiomics may provide some effective solutions for the
diagnosis and treatment of this challenging condition. To this end, we present
here a comprehensive review of TBI biomarker candidates from across the
multiomic disciplines and compare them with known signatures associated with
other neuropsychological conditions, including Alzheimer’s disease and
Parkinson’s disease. We believe that this integrated view will facilitate a
deeper understanding of the pathophysiology of TBI and its potential links to
other neurological diseases.
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Affiliation(s)
- Philip A Kocheril
- Physical Chemistry and Applied Spectroscopy Group, Chemistry Division, Los Alamos National Laboratory, Los Alamos, NM, USA
| | - Shepard C Moore
- Physical Chemistry and Applied Spectroscopy Group, Chemistry Division, Los Alamos National Laboratory, Los Alamos, NM, USA
| | - Kiersten D Lenz
- Physical Chemistry and Applied Spectroscopy Group, Chemistry Division, Los Alamos National Laboratory, Los Alamos, NM, USA
| | - Harshini Mukundan
- Physical Chemistry and Applied Spectroscopy Group, Chemistry Division, Los Alamos National Laboratory, Los Alamos, NM, USA
| | - Laura M Lilley
- Physical Chemistry and Applied Spectroscopy Group, Chemistry Division, Los Alamos National Laboratory, Los Alamos, NM, USA
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3
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Whitworth JW, Hayes SM, Andrews RJ, Fonda JR, Beck BM, Hanlon LB, Fortier CB, Milberg WP, McGlinchey RE. Cardiorespiratory Fitness Is Associated With Better Cardiometabolic Health and Lower PTSD Severity in Post-9/11 Veterans. Mil Med 2021; 185:e592-e596. [PMID: 32060558 DOI: 10.1093/milmed/usaa005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 12/13/2019] [Accepted: 01/07/2020] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Post-traumatic stress disorder (PTSD) is associated with an increased risk of cardiovascular and metabolic diseases and physical inactivity. Cardiorespiratory fitness (CRF), which is modifiable by physical activity, is a strong independent predictor of cardiometabolic health. However, the relationship between CRF and cardiometabolic health in veterans with PTSD is unknown. Thus, this study aimed to explore the cross-sectional relationships among CRF, indices of cardiometabolic health (ie, HbA1c, blood lipids, blood pressure, waist-hip ratio, and body mass index), and PTSD severity in veterans with PTSD. MATERIALS AND METHODS This study was approved by the local Institutional Review Board. All participants were informed of the study risks and provided consent prior to participation. Participants (n = 13) completed a cardiopulmonary exercise test, a fasting blood draw, and the Clinician Administered PTSD Scale. Correlations between CRF and cardiometabolic health were examined with Spearman's rank correlations, and differences in PTSD symptom severity were explored as a function of CRF (ie, low-to-moderate vs. high CRF), using multiple linear regression. RESULTS Peak oxygen uptake ($\dot{\mathrm{V}}$O2peak) was correlated with high-density lipoproteins rho = 0.60, P = 0.04 and diastolic blood pressure rho = -0.56, P = 0.05. Ventilatory threshold was correlated with HbA1c rho = -0.61, P = 0.03 and diastolic blood pressure rho = -0.56, P = 0.05. Higher CRF was associated with lower total PTSD severity standardized β = -0.84, P = 0.01, adjusted R2 = 0.47, total Cluster C symptoms (avoidance/numbing) β = -0.71, P = 0.02, adjusted R2 = 0.49, and total Cluster D symptoms (hyperarousal) β = -0.89, P = 0.01, adjusted R2 = 0.41, while adjusting for age and smoking status. CONCLUSIONS These preliminary findings suggest that CRF and by proxy physical activity may be important factors in understanding the increased risk of cardiovascular and metabolic disease associated with PTSD.
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Affiliation(s)
- James W Whitworth
- National Center for PTSD, Boston, MA.,Translational Research Center for Traumatic Brain Injury and Stress Disorders, and Geriatric Research, Education and Clinical Center, Department of Veterans Affairs Boston Healthcare System, 150 S. Huntington Ave, Boston, MA.,Boston University School of Medicine, Boston, MA
| | - Scott M Hayes
- Department of Psychology, The Ohio State University, Columbus, OH.,Chronic Brain Injury Initiative, The Ohio State University, Columbus, OH
| | - Ryan J Andrews
- Massachusetts General Hospital Institute of Health Professions, Boston, MA
| | - Jennifer R Fonda
- Translational Research Center for Traumatic Brain Injury and Stress Disorders, and Geriatric Research, Education and Clinical Center, Department of Veterans Affairs Boston Healthcare System, 150 S. Huntington Ave, Boston, MA.,Boston University School of Medicine, Boston, MA.,Harvard Medical School, Boston, MA
| | - Brigitta M Beck
- Translational Research Center for Traumatic Brain Injury and Stress Disorders, and Geriatric Research, Education and Clinical Center, Department of Veterans Affairs Boston Healthcare System, 150 S. Huntington Ave, Boston, MA
| | - Lilly B Hanlon
- Translational Research Center for Traumatic Brain Injury and Stress Disorders, and Geriatric Research, Education and Clinical Center, Department of Veterans Affairs Boston Healthcare System, 150 S. Huntington Ave, Boston, MA
| | - Catherine B Fortier
- Translational Research Center for Traumatic Brain Injury and Stress Disorders, and Geriatric Research, Education and Clinical Center, Department of Veterans Affairs Boston Healthcare System, 150 S. Huntington Ave, Boston, MA.,Harvard Medical School, Boston, MA
| | - William P Milberg
- Translational Research Center for Traumatic Brain Injury and Stress Disorders, and Geriatric Research, Education and Clinical Center, Department of Veterans Affairs Boston Healthcare System, 150 S. Huntington Ave, Boston, MA.,Harvard Medical School, Boston, MA
| | - Regina E McGlinchey
- Translational Research Center for Traumatic Brain Injury and Stress Disorders, and Geriatric Research, Education and Clinical Center, Department of Veterans Affairs Boston Healthcare System, 150 S. Huntington Ave, Boston, MA.,Harvard Medical School, Boston, MA
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4
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Strack JE, Torres VA, Pennington ML, Cardenas MN, Dupree J, Meyer EC, Dolan S, Kruse MI, Synett SJ, Kimbrel NA, Gulliver SB. Psychological distress and line-of-duty head injuries in firefighters. Occup Med (Lond) 2021; 71:99-104. [PMID: 33598694 DOI: 10.1093/occmed/kqab013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Head injuries are common injury in the fire service; however, very little data exist on the risks this may pose to the development of post-traumatic stress disorder (PTSD) and depression in this high-risk population. AIMS Our study aimed to compare levels of PTSD and depression symptoms in firefighters with a line-of-duty head injury, non-line-of-duty head injury and no head injury. METHODS In this cross-sectional study, we assessed current PTSD and depression symptoms as well as retrospective head injuries. RESULTS Seventy-six per cent of the total sample reported at least one head injury in their lifetime. Depression symptoms were significantly more severe among firefighters with a line-of-duty head injury compared to those with no head injury, but not compared to those who sustained a non-line-of-duty head injury. Depression symptoms did not differ between firefighters with a non-line-of-duty head injury and those with no head injury. PTSD symptoms were significantly more severe among firefighters with a line-of-duty head injury compared to both firefighters with no head injury and those with a non-line-of-duty head injury. CONCLUSIONS We found that firefighters who reported at least one line-of-duty head injury had significantly higher levels of PTSD and depression symptoms than firefighters who reported no head injuries. Our findings also suggest head injuries sustained outside of fire service could have less of an impact on the firefighter's PTSD symptom severity than head injuries that occur as a direct result of their job.
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Affiliation(s)
- J E Strack
- Warriors Research Institute, Baylor Scott & White Health, Waco, TX, USA
| | - V A Torres
- University of Mississippi, University Park, Mississippi, USA
| | - M L Pennington
- Warriors Research Institute, Baylor Scott & White Health, Waco, TX, USA
| | - M N Cardenas
- Warriors Research Institute, Baylor Scott & White Health, Waco, TX, USA
| | - J Dupree
- Warriors Research Institute, Baylor Scott & White Health, Waco, TX, USA
| | - E C Meyer
- Warriors Research Institute, Baylor Scott & White Health, Waco, TX, USA.,Department of Psychiatry and Behavioral Science, Texas A&M University Health Science Center, Temple, TX, USA.,Department of Psychology and Neuroscience, Baylor University, Waco, TX, USA
| | - S Dolan
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, USA
| | - M I Kruse
- Austin Fire Department and Austin-Travis County Emergency Medical Services, Austin, TX, USA
| | - S J Synett
- Rocky Mountain Mental Illness Research, Education, and Clinical Center, U.S. Department of Veterans Affairs, Denver, CO, USA
| | - N A Kimbrel
- Durham Veteran Affairs Medical Center, Durham, NC, USA.,VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA.,Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - S B Gulliver
- Warriors Research Institute, Baylor Scott & White Health, Waco, TX, USA.,Department of Psychiatry and Behavioral Science, Texas A&M University Health Science Center, Temple, TX, USA
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5
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Ragsdale KA, Sprang Jones KR, Nichols A, Watkins LE, Penna S, Rauch SA, Rothbaum BO. Clinical Effectiveness of an Intensive Outpatient Program for Integrated Treatment of Posttraumatic Stress Disorder and Mild Traumatic Brain Injury. COGNITIVE AND BEHAVIORAL PRACTICE 2020. [DOI: 10.1016/j.cbpra.2020.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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6
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Weppner J, Linsenmeyer M, Ide W. Military Blast-Related Traumatic Brain Injury. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2019. [DOI: 10.1007/s40141-019-00241-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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7
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Hoge CW, Wolf J, Williamson D. Astroglial scarring after blast exposure: unproven causality. Lancet Neurol 2019; 16:26. [PMID: 27979348 DOI: 10.1016/s1474-4422(16)30342-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 11/10/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Charles W Hoge
- Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA.
| | - Jonathan Wolf
- National Intrepid Center for Excellence, Bethesda, MD, USA
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8
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Differences in Posttraumatic Stress Disorder, Depression, and Attribution of Symptoms in Service Members With Combat Versus Noncombat Mild Traumatic Brain Injury. J Head Trauma Rehabil 2019; 35:37-45. [PMID: 31033746 DOI: 10.1097/htr.0000000000000486] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study compares combat-related mild traumatic brain injury (mTBI) to non-combat-related mTBI in rates of posttraumatic stress disorder (PTSD) and depression after injury, severity of postconcussive symptoms (PCSs), and attribution of those symptoms to mTBI versus PTSD. PARTICIPANTS A total of 371 active duty service members (SMs) with documented history of mTBI, divided into combat and non-combat-related cohorts. DESIGN Retrospective cohort study. MAIN MEASURES Diagnoses of PTSD and depression based on medical record review and self-report. PCSs measured using Neurobehavioral Symptom Index. Attribution of symptoms based on a rating scale asking how much mTBI, PTSD, depression, deployment, or readjustment stress contributed to current symptoms. RESULTS Prevalence of PTSD was significantly higher after a combat-related mTBI, compared with a noncombat mTBI (P = .001). Prevalence of depression did not differ between the 2 groups. PCSs were high in both combat and noncombat mTBIs, with no statistical difference between groups. SMs with PTSD reported higher PCS, regardless of combat status. SMs without PTSD attributed symptoms mainly to mTBI, whereas SMs with PTSD, regardless of combat status, were much more likely to attribute symptoms to PTSD, depression, and deployment/readjustment stress. CONCLUSIONS This research contributes to our understanding of the complex interplay between mTBI and PTSD in both combat and noncombat injuries within the military population and the importance of addressing both simultaneously.
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9
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Glotfelty EJ, Delgado TE, Tovar-y-Romo LB, Luo Y, Hoffer BJ, Olson L, Karlsson TE, Mattson MP, Harvey BK, Tweedie D, Li Y, Greig NH. Incretin Mimetics as Rational Candidates for the Treatment of Traumatic Brain Injury. ACS Pharmacol Transl Sci 2019; 2:66-91. [PMID: 31396586 PMCID: PMC6687335 DOI: 10.1021/acsptsci.9b00003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Indexed: 12/17/2022]
Abstract
Traumatic brain injury (TBI) is becoming an increasing public health issue. With an annually estimated 1.7 million TBIs in the United States (U.S) and nearly 70 million worldwide, the injury, isolated or compounded with others, is a major cause of short- and long-term disability and mortality. This, along with no specific treatment, has made exploration of TBI therapies a priority of the health system. Age and sex differences create a spectrum of vulnerability to TBI, with highest prevalence among younger and older populations. Increased public interest in the long-term effects and prevention of TBI have recently reached peaks, with media attention bringing heightened awareness to sport and war related head injuries. Along with short-term issues, TBI can increase the likelihood for development of long-term neurodegenerative disorders. A growing body of literature supports the use of glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic peptide (GIP), and glucagon (Gcg) receptor (R) agonists, along with unimolecular combinations of these therapies, for their potent neurotrophic/neuroprotective activities across a variety of cellular and animal models of chronic neurodegenerative diseases (Alzheimer's and Parkinson's diseases) and acute cerebrovascular disorders (stroke). Mild or moderate TBI shares many of the hallmarks of these conditions; recent work provides evidence that use of these compounds is an effective strategy for its treatment. Safety and efficacy of many incretin-based therapies (GLP-1 and GIP) have been demonstrated in humans for the treatment of type 2 diabetes mellitus (T2DM), making these compounds ideal for rapid evaluation in clinical trials of mild and moderate TBI.
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Affiliation(s)
- Elliot J. Glotfelty
- Translational
Gerontology Branch, and Laboratory of Neurosciences, Intramural
Research Program, National Institute on
Aging, National Institutes of Health, Baltimore, Maryland 21224, United States
- Department
of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Thomas E. Delgado
- Translational
Gerontology Branch, and Laboratory of Neurosciences, Intramural
Research Program, National Institute on
Aging, National Institutes of Health, Baltimore, Maryland 21224, United States
| | - Luis B. Tovar-y-Romo
- Division
of Neuroscience, Institute of Cellular Physiology, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Yu Luo
- Department
of Molecular Genetics, University of Cincinnati, Cincinnati, Ohio 45221, United States
| | - Barry J. Hoffer
- Department
of Neurosurgery, Case Western Reserve University
School of Medicine, Cleveland, Ohio 44106, United States
| | - Lars Olson
- Department
of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | | | - Mark P. Mattson
- Translational
Gerontology Branch, and Laboratory of Neurosciences, Intramural
Research Program, National Institute on
Aging, National Institutes of Health, Baltimore, Maryland 21224, United States
| | - Brandon K. Harvey
- Molecular
Mechanisms of Cellular Stress and Inflammation Unit, Integrative Neuroscience
Department, National Institute on Drug Abuse,
National Institutes of Health, Baltimore, Maryland 21224, United States
| | - David Tweedie
- Translational
Gerontology Branch, and Laboratory of Neurosciences, Intramural
Research Program, National Institute on
Aging, National Institutes of Health, Baltimore, Maryland 21224, United States
| | - Yazhou Li
- Translational
Gerontology Branch, and Laboratory of Neurosciences, Intramural
Research Program, National Institute on
Aging, National Institutes of Health, Baltimore, Maryland 21224, United States
| | - Nigel H. Greig
- Translational
Gerontology Branch, and Laboratory of Neurosciences, Intramural
Research Program, National Institute on
Aging, National Institutes of Health, Baltimore, Maryland 21224, United States
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10
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Epstein EL, Martindale SL, Va Mid-Atlantic Mirecc Workgroup, Miskey HM. Posttraumatic stress disorder and traumatic brain Injury: Sex differences in veterans. Psychiatry Res 2019; 274:105-111. [PMID: 30784779 DOI: 10.1016/j.psychres.2019.01.097] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 01/17/2019] [Accepted: 01/18/2019] [Indexed: 12/13/2022]
Abstract
Around half of Iraq and Afghanistan war veterans with traumatic brain injury (TBI) have co-occurring posttraumatic stress disorder (PTSD). Research on the differences between male and female veterans with co-occurring PTSD/TBI is sparse. This study evaluated behavioral health differences between sexes with these conditions. Veterans (N = 1577) completed a structured psychiatric interview, TBI interview, and self-report interviews assessing sleep quality, alcohol use, substance use, pain, depression symptoms, PTSD symptoms, and combat exposure. Groups depended on the presence/absence of a lifetime PTSD diagnosis and history of TBI. Among veterans with PTSD and TBI, males and females were equally likely to meet criteria for current PTSD, and in the PTSD only group, male veterans were more likely to have current PTSD. Male veterans with PTSD were also more likely to meet criteria for lifetime alcohol and substance use disorders (AUD and SUD), and mild TBI. Although TBI severity did not differ between sexes in the TBI only group, female veterans were more likely to have a moderate/severe TBI among veterans with co-occurring PTSD. Female veterans without PTSD and TBI were more likely to have major depressive disorder (MDD). Significant sex differences were found for AUD, MDD, current PTSD, and TBI severity.
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Affiliation(s)
- Erica L Epstein
- Salisbury VA Health Care System, 1601 Brenner Ave, Salisbury, NC 28144, USA; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), 508 Fulton St, Durham, NC 27705, USA; Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
| | - Sarah L Martindale
- Salisbury VA Health Care System, 1601 Brenner Ave, Salisbury, NC 28144, USA; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), 508 Fulton St, Durham, NC 27705, USA; Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
| | | | - Holly M Miskey
- Salisbury VA Health Care System, 1601 Brenner Ave, Salisbury, NC 28144, USA; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), 508 Fulton St, Durham, NC 27705, USA; Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
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11
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Ryan-Gonzalez C, Kimbrel NA, Meyer EC, Gordon EM, DeBeer BB, Gulliver SB, Elliott TR, Morissette SB. Differences in Post-Traumatic Stress Disorder Symptoms among Post-9/11 Veterans with Blast- and Non-Blast Mild Traumatic Brain Injury. J Neurotrauma 2019; 36:1584-1590. [PMID: 30511882 DOI: 10.1089/neu.2017.5590] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The relationship between traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) has been difficult to disentangle, in part due to the commonality of incidents that can cause both conditions, as well as high rates of comorbidity between the two conditions. Inconsistent findings may be related to different study characteristics and types of mild TBI (mTBI) sustained (e.g., blast, non-blast). The objective of this study was to determine the association of blast- versus non-blast-related TBIs with long-term PTSD symptoms after controlling for demographic variables and trauma exposure. The sample included 230 post-9/11 veterans who experienced a blast-related mTBI (n = 29), non-blast mTBI (n = 74), combined blast and non-blast mTBI (n = 40), or no TBI (n = 87). As hypothesized, a between-groups analysis of covariance (ANCOVA) revealed that, after controlling for demographics, combat exposure, and prior trauma, PTSD symptoms among individuals with blast-related mTBI and combined blast and non-blast mTBI were significantly higher compared with non-blast-related mTBI and no TBI. These data suggest that blast-related mTBI is associated with more severe long-term PTSD symptoms.
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Affiliation(s)
- Clark Ryan-Gonzalez
- 1 Department of Psychology, The University of Texas at San Antonio, San Antonio, Texas
| | - Nathan A Kimbrel
- 2 Department of Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center, and Duke University Medical Center, Durham, North Carolina
| | - Eric C Meyer
- 3 Department of Veterans Affairs VISN 17 Center of Excellence for Research on Returning War Veterans, Central Texas Veterans Healthcare System, Texas A&M University Health Science Center, and Warriors Research Institute at Baylor Scott & White Health, Waco, Texas
| | - Evan M Gordon
- 4 Department of Veterans Affairs VISN 17 Center of Excellence for Research on Returning War Veterans, Central Texas Veterans Healthcare System, and University of Texas at Dallas, Dallas, Texas
| | - Bryann B DeBeer
- 5 Department of Veterans Affairs VISN 17 Center of Excellence for Research on Returning War Veterans, Central Texas Veterans Healthcare System, and Texas A&M University Health Science Center, College Station, Texas
| | - Suzy Bird Gulliver
- 6 Warriors Research Institute at Baylor Scott & White Health and Texas A&M University Health Science Center, College Station, Texas
| | - Timothy R Elliott
- 7 Department of Psychology, Texas A&M University, College Station, Texas
| | - Sandra B Morissette
- 1 Department of Psychology, The University of Texas at San Antonio, San Antonio, Texas
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12
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Porter KE, Stein MB, Martis B, Avallone KM, McSweeney LB, Smith ER, Simon NM, Gargan S, Liberzon I, Hoge CW, Rauch SAM. Postconcussive symptoms (PCS) following combat-related traumatic brain injury (TBI) in Veterans with posttraumatic stress disorder (PTSD): Influence of TBI, PTSD, and depression on symptoms measured by the Neurobehavioral Symptom Inventory (NSI). J Psychiatr Res 2018; 102:8-13. [PMID: 29554536 DOI: 10.1016/j.jpsychires.2018.03.004] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 02/05/2018] [Accepted: 03/09/2018] [Indexed: 11/28/2022]
Abstract
Mild traumatic brain injury (mTBI) is commonly reported in recent combat Veterans. While the majority resolve, some Veterans develop postconcussive symptoms (PCS). Previous research suggests these symptoms are not specific to head injury and are often associated with psychiatric symptoms. The current study examines the relative contributions of posttraumatic stress, depressive symptoms, and TBI on postconcussive symptoms, and explores whether the relationship remains after controlling for symptom overlap. Two hundred eighteen combat Veterans from Operation Iraqi Freedom (OIF), Operation Enduring Freedom (OEF), and Operation New Dawn (OND) provided the data for this study as part of a baseline evaluation for inclusion into larger treatment study for posttraumatic stress disorder (PTSD). Participants completed the Brief Traumatic Brain Injury Screen (BTBIS), Neurobehavioral Symptom Inventory (NSI), PTSD Checklist-Stressor Version (PCL-S), Beck Depression Inventory-II (BDI-II). Significant differences in NSI total score between individuals with and without history of TBI were not found. A series of regression analyses demonstrated that Depression and PTSD were significant predictors of NSI score even after removal of NSI symptoms that overlap with PTSD or depression. TBI status was also a significant predictor of PCS in most models, but its relative contribution was much smaller than that of depression and PTSD. Within PTSD symptoms, hyperarousal cluster was a significant predictor of NSI scores. Findings demonstrate that depression and PTSD are related to PCS beyond similarities in construct. Further, within a primarily PTSD treatment-seeking population, these psychiatric symptoms appear to be a stronger contributor than TBI.
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Affiliation(s)
- Katherine E Porter
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; University of Michigan, Ann Arbor, MI, USA.
| | - Murray B Stein
- University of California San Diego, La Jolla, CA, USA; VA San Diego Healthcare System, San Diego, CA, USA
| | - Brian Martis
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; University of Michigan, Ann Arbor, MI, USA
| | - Kimberly M Avallone
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; University of Michigan, Ann Arbor, MI, USA
| | - Lauren B McSweeney
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; Emory University School of Medicine, Atlanta, GA, USA
| | - Erin R Smith
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; University of Michigan, Ann Arbor, MI, USA
| | - Naomi M Simon
- Massachusetts General Hospital, Boston, MA, USA; New York University School of Medicine, New York, NY, USA
| | | | - Israel Liberzon
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; University of Michigan, Ann Arbor, MI, USA
| | - Charles W Hoge
- Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Sheila A M Rauch
- Emory University School of Medicine, Atlanta, GA, USA; Atlanta VA Medical Center, Atlanta, GA, USA
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13
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Dismuke-Greer CE, Nolen TL, Nowak K, Hirsch S, Pogoda TK, Agyemang AA, Carlson KF, Belanger HG, Kenney K, Troyanskaya M, Walker WC. Understanding the impact of mild traumatic brain injury on veteran service-connected disability: results from Chronic Effects of Neurotrauma Consortium. Brain Inj 2018; 32:1178-1187. [PMID: 29889561 DOI: 10.1080/02699052.2018.1482428] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
OBJECTIVES Disability evaluation is complex. The association between mild traumatic brain injury (mTBI) history and VA service-connected disability (SCD) ratings can have implications for disability processes in the civilian population. We examined the association of VA SCD ratings with lifetime mTBI exposure in three models: any mTBI, total mTBI number, and blast-related mTBI. METHODS Participants were 492 Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn veterans from four US VA Medical Centers enrolled in the Chronic Effects of Neurotrauma Consortium study between January 2015 and August 2016. Analyses entailed standard covariate-adjusted linear regression models, accounting for demographic, military, and health-related confounders and covariates. RESULTS Unadjusted and adjusted results indicated lifetime mTBI was significantly associated with increased SCD, with the largest effect observed for blast-related mTBI. Every unit increase in mTBI was associated with an increase in 3.6 points of percent SCD. However, hazardous alcohol use was associated with lower SCD. CONCLUSIONS mTBI, especially blast related, is associated with higher VA SCD ratings, with each additional mTBI increasing percent SCD. The association of hazardous alcohol use with SCD should be investigated as it may impact veteran health services access and health outcomes. These findings have implications for civilian disability processes.
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Affiliation(s)
- Clara Elizabeth Dismuke-Greer
- a Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson VA Medical Center, and Department of Medicine , Medical University of South Carolina , Charleston , SC , USA.,b Research Service , Ralph H. Johnson VAMC , Charleston , SC, USA
| | | | | | | | - Terri K Pogoda
- d Center for Healthcare Organization and Implementation Research , VA Boston Healthcare System, and Boston University School of Public Health , Boston , MA , USA
| | - Amma A Agyemang
- e Department of Physical Medicine and Rehabilitation , Virginia Commonwealth University , Richmond , VA, USA
| | - Kathleen F Carlson
- f HSR&D Center of Innovation, VA Portland Health Care System, and OHSU-PSU School of Public Health , Oregon Health and Science University , Portland , OR, USA
| | - Heather G Belanger
- g HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans' Hospital (VH), and Department of Psychiatry and Behavioral Neurosciences , University of South Florida , Tampa , FL, USA
| | - Kimbra Kenney
- h Uniformed Services University of the Health Sciences , Bethesda , MD, USA
| | - Maya Troyanskaya
- i Michael E. DeBakey VA Medical Center and Department of Physical Medicine and Rehabilitation , Baylor College of Medicine , Houston , TX, USA
| | - William C Walker
- e Department of Physical Medicine and Rehabilitation , Virginia Commonwealth University , Richmond , VA, USA.,j Hunter Holmes McGuire VA Medical Center
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Behavioral and Health Outcomes Associated With Deployment and Nondeployment Acquisition of Traumatic Brain Injury in Iraq and Afghanistan Veterans. Arch Phys Med Rehabil 2018; 99:2485-2495. [PMID: 29859179 DOI: 10.1016/j.apmr.2018.04.029] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Revised: 04/24/2018] [Accepted: 04/27/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To characterize behavioral and health outcomes in veterans with traumatic brain injury (TBI) acquired in nondeployment and deployment settings. DESIGN Cross-sectional assessment evaluating TBI acquired during and outside of deployment, mental and behavioral health symptoms, and diagnoses. SETTING Veterans Affairs Medical Centers. PARTICIPANTS Iraq and Afghanistan veterans who were deployed to a warzone (N=1399). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Comprehensive lifetime TBI interview, Structured Clinical Interview for DSM-IV Disorders, Combat Exposure Scale, and behavioral and health measures. RESULTS There was a main effect of deployment TBI on depressive symptoms, posttraumatic stress symptoms, poor sleep quality, substance use, and pain. Veterans with deployment TBI were also more likely to have a diagnosis of bipolar, major depressive, alcohol use, and posttraumatic stress disorders than those who did not have a deployment TBI. CONCLUSIONS TBIs acquired during deployment are associated with different behavioral and health outcomes than TBI acquired in nondeployment environments. The presence of TBI during deployment is associated with poorer behavioral outcomes, as well as a greater lifetime prevalence of behavioral and health problems in contrast to veterans without deployment TBI. These results indicate that problems may persist chronically after a deployment TBI and should be considered when providing care for veterans. Veterans with deployment TBI may require treatment alterations to improve engagement and outcomes.
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15
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Completion of Multidisciplinary Treatment for Persistent Postconcussive Symptoms Is Associated With Reduced Symptom Burden. J Head Trauma Rehabil 2017; 32:1-15. [DOI: 10.1097/htr.0000000000000202] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Tate DF, Wade BSC, Velez CS, Drennon AM, Bolzenius J, Gutman BA, Thompson PM, Lewis JD, Wilde EA, Bigler ED, Shenton ME, Ritter JL, York GE. Volumetric and shape analyses of subcortical structures in United States service members with mild traumatic brain injury. J Neurol 2016; 263:2065-79. [PMID: 27435967 PMCID: PMC5564450 DOI: 10.1007/s00415-016-8236-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 07/07/2016] [Accepted: 07/08/2016] [Indexed: 10/21/2022]
Abstract
Mild traumatic brain injury (mTBI) is a significant health concern. The majority who sustain mTBI recover, although ~20 % continue to experience symptoms that can interfere with quality of life. Accordingly, there is a critical need to improve diagnosis, prognostic accuracy, and monitoring (recovery trajectory over time) of mTBI. Volumetric magnetic resonance imaging (MRI) has been successfully utilized to examine TBI. One promising improvement over standard volumetric approaches is to analyze high-dimensional shape characteristics of brain structures. In this study, subcortical shape and volume in 76 Service Members with mTBI was compared to 59 Service Members with orthopedic injury (OI) and 17 with post-traumatic stress disorder (PTSD) only. FreeSurfer was used to quantify structures from T1-weighted 3 T MRI data. Radial distance (RD) and Jacobian determinant (JD) were defined vertex-wise on parametric mesh-representations of subcortical structures. Linear regression was used to model associations between morphometry (volume and shape), TBI status, and time since injury (TSI) correcting for age, sex, intracranial volume, and level of education. Volumetric data was not significantly different between the groups. JD was significantly increased in the accumbens and caudate and significantly reduced in the thalamus of mTBI participants. Additional significant associations were noted between RD of the amygdala and TSI. Positive trend-level associations between TSI and the amygdala and accumbens were observed, while a negative association was observed for third ventricle. Our findings may aid in the initial diagnosis of mTBI, provide biological targets for functional examination, and elucidate regions that may continue remodeling after injury.
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Affiliation(s)
- David F Tate
- Missouri Institute of Mental Health, University of Missouri, St. Louis, 4633 World Parkway Circle, Berkeley, MO, 63134-3115, USA.
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA.
| | - Benjamin S C Wade
- Imaging Genetics Center, University of Southern California, Marina del Rey, CA, USA
| | - Carmen S Velez
- Missouri Institute of Mental Health, University of Missouri, St. Louis, 4633 World Parkway Circle, Berkeley, MO, 63134-3115, USA
| | - Ann Marie Drennon
- Defense and Veterans Brain Injury Centers, San Antonio Military Medical Center, San Antonio, TX, USA
| | - Jacob Bolzenius
- Missouri Institute of Mental Health, University of Missouri, St. Louis, 4633 World Parkway Circle, Berkeley, MO, 63134-3115, USA
| | - Boris A Gutman
- Imaging Genetics Center, University of Southern California, Marina del Rey, CA, USA
| | - Paul M Thompson
- Imaging Genetics Center, University of Southern California, Marina del Rey, CA, USA
| | - Jeffrey D Lewis
- Department of Neurology, Uniformed Services University of the Health Sciences School of Medicine, Bethesda, MD, USA
| | - Elisabeth A Wilde
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
- Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Erin D Bigler
- Departments of Psychology and Neuroscience, Brigham Young University, Provo, UT, USA
| | - Martha E Shenton
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Brockton Division, VA Boston Healthcare System, Brockton, MA, USA
| | - John L Ritter
- Department of Radiology, Brooke Army Medical Center, San Antonio, TX, USA
| | - Gerald E York
- Alaska Radiology Associates, TBI Imaging and Research, Anchorage, AK, USA
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Sheng T, Fairchild JK, Kong JY, Kinoshita LM, Cheng JJ, Yesavage JA, Helmer DA, Reinhard MJ, Ashford JW, Adamson MM. The influence of physical and mental health symptoms on Veterans’ functional health status. ACTA ACUST UNITED AC 2016; 53:781-796. [DOI: 10.1682/jrrd.2015.07.0146] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 03/30/2016] [Indexed: 11/05/2022]
Affiliation(s)
- Tong Sheng
- War Related Illness and Injury Study Center, VA Palo Alto Health Care System, Palo Alto, CA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - J. Kaci Fairchild
- War Related Illness and Injury Study Center, VA Palo Alto Health Care System, Palo Alto, CA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | | | - Lisa M. Kinoshita
- War Related Illness and Injury Study Center, VA Palo Alto Health Care System, Palo Alto, CA
| | - Jauhtai J. Cheng
- War Related Illness and Injury Study Center, VA Palo Alto Health Care System, Palo Alto, CA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - Jerome A. Yesavage
- War Related Illness and Injury Study Center, VA Palo Alto Health Care System, Palo Alto, CA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - Drew A. Helmer
- War Related Illness and Injury Study Center, VA New Jersey Health Care System, East Orange, NJ
| | - Matthew J. Reinhard
- War Related Illness and Injury Study Center, VA Medical Center, Washington DC
| | - J. Wesson Ashford
- War Related Illness and Injury Study Center, VA Palo Alto Health Care System, Palo Alto, CA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - Maheen M. Adamson
- War Related Illness and Injury Study Center, VA Palo Alto Health Care System, Palo Alto, CA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
- Defense and Veterans Brain Injury Center, VA Palo Alto Health Care System, Palo Alto, CA
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Huang M, Risling M, Baker DG. The role of biomarkers and MEG-based imaging markers in the diagnosis of post-traumatic stress disorder and blast-induced mild traumatic brain injury. Psychoneuroendocrinology 2016; 63:398-409. [PMID: 25769625 DOI: 10.1016/j.psyneuen.2015.02.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 02/13/2015] [Accepted: 02/15/2015] [Indexed: 12/23/2022]
Abstract
BACKGROUND Pervasive use of improvised explosive devices (IEDs), rocket-propelled grenades, and land mines in the recent conflicts in Iraq and Afghanistan has brought traumatic brain injury (TBI) and its impact on health outcomes into public awareness. Blast injuries have been deemed signature wounds of these wars. War-related TBI is not new, having become prevalent during WWI and remaining medically relevant in WWII and beyond. Medicine's past attempts to accurately diagnose and disentangle the pathophysiology of war-related TBI parallels current lines of inquiry and highlights limitations in methodology and attribution of symptom etiology, be it organic, psychological, or behavioral. New approaches and biomarkers are needed. PRECLINICAL Serological biomarkers and biomarkers of injury obtained with imaging techniques represent cornerstones in the translation between experimental data and clinical observations. Experimental models for blast related TBI and PTSD can generate critical data on injury threshold, for example for white matter injury from acceleration. Carefully verified and validated models can be evaluated with gene expression arrays and proteomics to identify new candidates for serological biomarkers. Such models can also be analyzed with diffusion MRI and microscopy in order to identify criteria for detection of diffuse white matter injuries, such as DAI (diffuse axonal injury). The experimental models can also be analyzed with focus on injury outcome in brain stem regions, such as locus coeruleus or nucleus raphe magnus that can be involved in response to anxiety changes. CLINICAL Mild (and some moderate) TBI can be difficult to diagnose because the injuries are often not detectable on conventional MRI or CT. There is accumulating evidence that injured brain tissues in TBI patients generate abnormal low-frequency magnetic activity (ALFMA, peaked at 1-4Hz) that can be measured and localized by magnetoencephalography (MEG). MEG imaging detects TBI abnormalities at the rates of 87% for the mild TBI, group (blast-induced plus non-blast causes) and 100% for the moderate group. Among the mild TBI patients, the rates of abnormalities are 96% and 77% for the blast and non-blast TBI groups, respectively. There is emerging evidence based on fMRI and MEG studies showing hyper-activity in the amygdala and hypo-activity in pre-frontal cortex in individuals with PTSD. MEG signal may serve as a sensitive imaging marker for mTBI, distinguishable from abnormalities generated in association with PTSD. More work is needed to fully describe physiological mechanisms of post-concussive symptoms.
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Affiliation(s)
- Mingxiong Huang
- Radiology Services, VA San Diego Healthcare System, San Diego, CA, USA; Research Services, VA San Diego Healthcare System, San Diego, CA, USA; Department of Radiology, University of California, San Diego, CA, USA.
| | - Mårten Risling
- Karolinska Institutet, Department of Neuroscience, Stockholm, Sweden
| | - Dewleen G Baker
- Veterans Affairs Center for Excellence in Stress and Mental Health (CESAMH), San Diego, CA, USA; University of California San Diego, Department of Psychiatry, La Jolla, USA
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Stein MB, Kessler RC, Heeringa SG, Jain S, Campbell-Sills L, Colpe LJ, Fullerton CS, Nock MK, Sampson NA, Schoenbaum M, Sun X, Thomas ML, Ursano RJ. Prospective longitudinal evaluation of the effect of deployment-acquired traumatic brain injury on posttraumatic stress and related disorders: results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). Am J Psychiatry 2015; 172:1101-11. [PMID: 26337036 PMCID: PMC5125442 DOI: 10.1176/appi.ajp.2015.14121572] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Traumatic brain injury (TBI) is increasingly recognized as a risk factor for deleterious mental health and functional outcomes. The purpose of this study was to examine the strength and specificity of the association between deployment-acquired TBI and subsequent posttraumatic stress and related disorders among U.S. Army personnel. METHOD A prospective, longitudinal survey of soldiers in three Brigade Combat Teams was conducted 1-2 months prior to an average 10-month deployment to Afghanistan (T0), upon redeployment to the United States (T1), approximately 3 months later (T2), and approximately 9 months later (T3). Outcomes of interest were 30-day prevalence postdeployment of posttraumatic stress disorder (PTSD), major depressive episode, generalized anxiety disorder, and suicidality, as well as presence and severity of postdeployment PTSD symptoms. RESULTS Complete information was available for 4,645 soldiers. Approximately one in five soldiers reported exposure to mild (18.0%) or more-than-mild (1.2%) TBI(s) during the index deployment. Even after adjusting for other risk factors (e.g., predeployment mental health status, severity of deployment stress, prior TBI history), deployment-acquired TBI was associated with elevated adjusted odds of PTSD and generalized anxiety disorder at T2 and T3 and of major depressive episode at T2. Suicidality risk at T2 appeared similarly elevated, but this association did not reach statistical significance. CONCLUSIONS The findings highlight the importance of surveillance efforts to identify soldiers who have sustained TBIs and are therefore at risk for an array of postdeployment adverse mental health outcomes, including but not limited to PTSD. The mechanism(s) accounting for these associations need to be elucidated to inform development of effective preventive and early intervention programs.
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Fitch T, Villanueva G, Quadir MM, Sagiraju HKR, Alamgir H. The prevalence and risk factors of Post-Traumatic Stress Disorder among workers injured in Rana Plaza building collapse in Bangladesh. Am J Ind Med 2015; 58:756-63. [PMID: 25964138 DOI: 10.1002/ajim.22471] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2015] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Prevalence and risk factors of PTSD among injured garment workers who survived a major factory collapse. METHODS Survivors receiving treatment or rehabilitation care at one year post event were surveyed, which included Post Traumatic Stress Disorder Checklist Specific version. RESULTS The respondents consisted of 181 people with a mean age of 27.8 years and a majority had less than high school education (91.2%). Multivariable logistic regression found that the odds of having PTSD was higher among married (OR: 3.2 [95% CI: 1.3-8.0]), those who used to work more than 70 hr/week (OR: 2.4 [1.1-5.3]), workers who used to hold higher job positions (OR: 2.6 [1.2-5.6]) or who had a concussion injury (OR: 3.7 [1.4-9.8]). Among the respondents, 83.4% remained unemployed, and only 57.3% (63 people) reported receiving a quarter or less of what they were promised as compensation. CONCLUSIONS Probable PTSD was prevalent among surviving workers of the Rana Plaza building collapse in Bangladesh.
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Affiliation(s)
- Taylor Fitch
- University of Texas; School of Public Health; San Antonio Campus; San Antonio Texas
- School of Medicine; University of Texas Health Science Center at San Antonio
| | - Gabriela Villanueva
- University of Texas; School of Public Health; San Antonio Campus; San Antonio Texas
- School of Medicine; University of Texas Health Science Center at San Antonio
| | | | - Hari K. R. Sagiraju
- University of Texas; School of Public Health; San Antonio Campus; San Antonio Texas
| | - Hasanat Alamgir
- University of Texas; School of Public Health; San Antonio Campus; San Antonio Texas
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