Division of Psychiatry and Neuroscience, Walter Reed Army Institute of Research, U.S. Army Medical Research and Materiel Command, Silver Spring, Maryland 20910, USA.
Psychosom Med. 2012 Apr;74(3):249-57. doi: 10.1097/PSY.0b013e318244c604. Epub 2012 Feb 24.
Several studies have examined the relationship between concussion/mild traumatic brain injury (mTBI), posttraumatic stress disorder (PTSD), depression, and postdeployment symptoms. These studies indicate that the multiple factors involved in postdeployment symptoms are not accounted for in the screening processes of the Department of Defense/Veteran's Affairs months after concussion injuries. This study examined the associations of single and multiple deployment-related mTBIs on postdeployment health.
A total of 1502 U.S. Army soldiers were administered anonymous surveys 4 to 6 months after returning from deployment to Iraq or Afghanistan assessing history of deployment-related concussions, current PTSD, depression, and presence of postdeployment physical and neurocognitive symptoms.
Of these soldiers, 17% reported an mTBI during their previous deployment. Of these, 59% reported having more than one. After adjustment for PTSD, depression, and other factors, loss of consciousness was significantly associated with three postconcussive symptoms, including headaches (odds ratio [OR] = 1.5, 95% confidence interval [CI] = 1.1-2.3). However, these symptoms were more strongly associated with PTSD and depression than with a history of mTBI. Multiple mTBIs with loss of consciousness increased the risk of headache (OR = 4.0, 95% CI = 2.4-6.8) compared with a single occurrence, although depression (OR = 4.2, 95% CI = 2.6-6.8) remained as strong a predictor.
These data indicate that current screening tools for mTBI being used by the Department of Defense/Veteran's Affairs do not optimally distinguish persistent postdeployment symptoms attributed to mTBI from other causes such as PTSD and depression. Accumulating evidence strongly supports the need for multidisciplinary collaborative care models of treatment in primary care to collectively address the full spectrum of postwar physical and neurocognitive health concerns.
多项研究考察了脑震荡/轻度创伤性脑损伤（mTBI）、创伤后应激障碍（PTSD）、抑郁和部署后症状之间的关系。这些研究表明，在脑震荡损伤后数月，国防部/退伍军人事务部的筛查过程并未考虑到与部署后症状相关的多个因素。本研究探讨了单次和多次与部署相关的 mTBI 对部署后健康的影响。
共有 1502 名美国陆军士兵在从伊拉克或阿富汗部署返回后 4 至 6 个月接受了匿名调查，评估了与部署相关的脑震荡史、当前 PTSD、抑郁和部署后身体和神经认知症状的存在情况。
这些士兵中，17%报告在之前的部署中患有 mTBI。其中，59%的人报告有多次。在调整 PTSD、抑郁和其他因素后，意识丧失与三种脑震荡后症状显著相关，包括头痛（优势比[OR] = 1.5，95%置信区间[CI] = 1.1-2.3）。然而，与 mTBI 病史相比，这些症状与 PTSD 和抑郁的相关性更强。多次伴有意识丧失的 mTBI 会增加头痛的风险（OR = 4.0，95% CI = 2.4-6.8），尽管抑郁（OR = 4.2，95% CI = 2.6-6.8）仍是一个强有力的预测因素。
这些数据表明，国防部/退伍军人事务部目前用于 mTBI 的筛查工具不能最佳地区分归因于 mTBI 的持续部署后症状与 PTSD 和抑郁等其他原因。越来越多的证据强烈支持在初级保健中采用多学科协作治疗模式来共同解决战后身体和神经认知健康的全部问题。
