影响军事相关多发伤合并创伤性脑损伤后脑震荡和创伤后应激症状报告的因素。
Factors influencing postconcussion and posttraumatic stress symptom reporting following military-related concurrent polytrauma and traumatic brain injury.
机构信息
Defense and Veterans Brain Injury Center, Bethesda, MD, USA Walter Reed National Military Medical Center, Bethesda, MD, USA University of British Columbia, Vancouver, BC, Canada Center for Neuroscience and Regenerative Medicine, Bethesda, MD, USA
Defense and Veterans Brain Injury Center, Bethesda, MD, USA Walter Reed National Military Medical Center, Bethesda, MD, USA Uniformed Services University of the Health Sciences, Bethesda, MD, USA Center for Neuroscience and Regenerative Medicine, Bethesda, MD, USA.
出版信息
Arch Clin Neuropsychol. 2014 Jun;29(4):329-47. doi: 10.1093/arclin/acu013. Epub 2014 Apr 9.
The purpose of this study was to identify factors that are predictive of, or associated with, high endorsement of postconcussion and posttraumatic stress symptoms following military-related traumatic brain injury (TBI). Participants were 1,600 U.S. service members (age: M = 27.1, SD = 7.1; 95.4% male) who had sustained a mild-to-moderate TBI and who had been evaluated by the Defense and Veterans Brain Injury Center at one of six military medical centers. Twenty-two factors were examined that included demographic, injury circumstances/severity, treatment/evaluation, and psychological/physical variables. Four factors were statistically and meaningfully associated with clinically elevated postconcussion symptoms: (i) low bodily injury severity, (ii) posttraumatic stress, (iii) depression, and (iv) military operation where wounded (p < .001, 43.2% variance). The combination of depression and posttraumatic stress symptoms accounted for the vast majority of unique variance (41.5%) and were strongly associated with, and predictive of, clinically elevated postconcussion symptoms [range: odds ratios (OR) = 4.24-7.75; relative risk (RR) = 2.28-2.51]. Five factors were statistically and meaningfully associated with clinically elevated posttraumatic stress symptoms: (i) low bodily injury severity, (ii) depression, (iii) a longer time from injury to evaluation, (iv) military operation where wounded, and (v) current auditory deficits (p < .001; 65.6% variance accounted for). Depression alone accounted for the vast majority of unique variance (60.0%) and was strongly associated with, and predictive of, clinically elevated posttraumatic stress symptoms (OR = 38.78; RR = 4.63). There was a very clear, strong, and clinically meaningful association between depression, posttraumatic stress, and postconcussion symptoms in this sample. Brain injury severity, however, was not associated with symptom reporting following TBI.
这项研究的目的是确定与军事相关的创伤性脑损伤（TBI）后出现的脑震荡后和创伤后应激症状高度相关或与之相关的因素。参与者是 1600 名美国军人（年龄：M=27.1，SD=7.1；95.4%为男性），他们遭受了轻度至中度 TBI，并在六家军事医疗中心之一的国防和退伍军人脑损伤中心接受了评估。研究检查了 22 个因素，包括人口统计学、受伤情况/严重程度、治疗/评估以及心理/身体变量。有四个因素与临床显著的脑震荡后症状具有统计学意义和实际意义相关：（i）身体损伤严重程度低，（ii）创伤后应激，（iii）抑郁，以及（iv）军事行动中受伤（p<.001，占 43.2%的方差）。抑郁和创伤后应激症状的组合占绝大多数的独特方差（41.5%），与临床显著的脑震荡后症状强烈相关，并具有预测性[范围：比值比（OR）=4.24-7.75；相对风险（RR）=2.28-2.51]。有五个因素与临床显著的创伤后应激症状具有统计学意义和实际意义相关：（i）身体损伤严重程度低，（ii）抑郁，（iii）从受伤到评估的时间较长，（iv）军事行动中受伤，以及（v）当前听觉缺陷（p<.001；占 65.6%的方差）。单独的抑郁占绝大多数的独特方差（60.0%），与临床显著的创伤后应激症状强烈相关，并具有预测性（OR=38.78；RR=4.63）。在这个样本中，抑郁、创伤后应激和脑震荡后症状之间存在非常明显、强烈且具有临床意义的关联。然而，脑损伤严重程度与 TBI 后的症状报告无关。
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