Differences in quality-of-life scores across injury categories by mental health status among injured U.S. military service members and veterans

Mental health outcomes following exposure to combat events during the October 7th war in Israeli reserve soldiers

BACKGROUND

The present study examines specific associations between various war events and probable posttraumatic stress disorder (PTSD) Checklist for DSM-5 [PCL-5] ≥ 33).

METHOD

This cross-sectional study included all 806 IDF reserve soldiers (96.4 % male), mean age 30.26 (SD = 6.89) who sought help from the IDF Combat Stress Reaction Unit (CSRU) between October 7th, 2023, and August 1st, 2024 (10 months), following participation in the October 7th, 2023 War.

RESULTS

A significant association emerged between probable PTSD in those who engaged in hand-to-hand combat, which was also linked with negative cognition and arousal symptom clusters. A significant correlation was found between-exposure to dead bodies or human remains and probable PTSD. Such experiences were also associated with the intrusion symptom cluster. The results indicated that being responsible for the death of an enemy combatant showed no significant relationship with probable PTSD, though it was associated only with arousal symptoms. In contrast, being responsible for the death of a noncombatant was significantly linked to probable PTSD and various PTSD symptoms, intrusion, arousal, and negative cognition symptoms.

CONCLUSION

The study highlights the need to assess various combat events in relation to PTSD symptoms and probable PTSD when conducting evaluation and treatment.

Mental and Physical Health-Related Quality of Life Following Military Polytrauma

INTRODUCTION

The long-term impact of deployment-related trauma on mental and physical health-related quality of life (HRQoL) among military personnel is not well understood. We describe the mental and physical HRQoL among military personnel following deployment-related polytrauma after their discharge from the hospital and examine factors associated with HRQoL and longitudinal trends.

MATERIALS AND METHODS

The U.S. military personnel with battlefield-related trauma enrolled in the Trauma Infectious Diseases Outcomes Study were surveyed using SF-8 Health Surveys at 1 month post-discharge (baseline) and at follow-up intervals over 2 years. Inclusion in the longitudinal analysis required baseline SF-8 plus responses during early (3 and/or 6 months) and later follow-up periods (12, 18, and/or 24 months). Associations of demographics, injury characteristics, and hospitalization with baseline SF-8 scores and longitudinal changes in SF-8 scores during follow-up were examined. Survey responses were used to calculate the Mental Component Summary score (MCS) and the Physical Component Summary score (PCS). The MCS focuses on vitality, mental health, social functioning, and daily activity limitations, whereas PCS is related to general health, bodily pain, physical functioning, and physical activity limitations. Longitudinal trends in SF-8 scores were assessed using chi-square tests by comparing the median score at each timepoint to the median 1-month (baseline) score, as well as comparing follow-up scores to the immediately prior timepoint (e.g., 6 months vs. 3 months). Associations with the 1-month baseline SF-8 scores were assessed using generalized linear regression modeling and associations with longitudinal changes in SF-8 were examined using generalized linear regression modeling with repeated measures.

RESULTS

Among 781 enrollees, lower baseline SF-8 total scores and PCS were associated with spinal and lower extremity injuries (P < .001) in the multivariate analyses, whereas lower baseline MCS was associated with head/face/neck injuries (P < .001). Higher baseline SF-8 total was associated with having an amputation (P = .009), and lower baseline SF-8 total was also associated with sustaining a traumatic brain injury (TBI; P = .042). Among 524 enrollees with longitudinal follow-up, SF-8 scores increased, driven by increased PCS and offset by small MCS decreases. Upward SF-8 total score and PCS trends were associated with time post-hospital discharge and limb amputation (any) in the multivariate analyses (P < .05), whereas downward trends were independently associated with spinal injury and developing any post-discharge infection (P ≤ .001). Patients with lower extremity injuries had lower-magnitude improvements in PCS over time compared to those without lower extremity injuries (P < .001). Upward MCS trend was associated with higher injury severity (P = .003) in the multivariate analyses, whereas downward trends were independently associated with having a TBI (P < .001), time post-hospital discharge (P < .001), and occurrence of post-discharge infections (P = .002).

CONCLUSIONS

Overall, HRQoL increased during the 2-year follow-up period, driven by PCS improvement. Increasing HRQoL was associated with time since hospital discharge and limb amputation, whereas a downward trend in HRQoL was associated with spinal injury and post-discharge infection. The longitudinal decline in MCS, driven by TBI occurrence, time since hospital discharge, and developing post-discharge infections, emphasizes the importance of longitudinal mental health care in this population.