Garber Bryan G, Rusu Corneliu, Zamorski Mark A
BMC Psychiatry. 2014 Nov 20;14:325. doi: 10.1186/s12888-014-0325-5.
Up to 20% of US military personnel deployed to Iraq or Afghanistan experience mild traumatic brain injury (mTBI) while deployed; up to one-third will experience persistent post-concussive symptoms (PCS). The objective of this study was to examine the epidemiology of deployment-related mTBI and its relationship to PCS and mental health problems (MHPs) in Canadian Armed Forces (CAF) personnel.
Participants were 16153 personnel who underwent post-deployment screening (median =136 days after return) following deployment in support of the mission in Afghanistan from 2009 - 2012. The screening questionnaire assessed mTBI and other injuries while deployed, using the Brief Traumatic Brain Injury Screening Tool. Current MHPs and PCS were assessed using items from the Patient Health Questionnaire, the Patient Checklist for PTSD, and the Cognitive Failures Questionnaire. Log-binomial regression explored the association of mTBI, other injuries, and MHPs with PCS, using the presence of 3 or more of 7 PCS as the outcome. Results are expressed as adjusted prevalence ratios (PR).
mTBI while deployed was reported in 843 respondents (5.2%). Less severe forms of mTBI (associated only with having been dazed or confused or having "seen stars") predominated. Blast was reported as a mechanism of injury in half of those with mTBI. Multiple PCS were present in 21% of those with less severe forms of mTBI and in 27% of those with more severe forms of mTBI (i.e., mTBI associated with loss of consciousness or post-traumatic amnesia). After adjustment for confounding, mTBI had no statistically significant association with PCS relative to non-TBI injury. In contrast, MHPs had a strong association with reporting 3 or more PCS (adjusted prevalence ratio (PR) =7.77).
Deployment-related mTBI prevalence was lower than in many US reports; most of those who had had mTBI were free of multiple PCS. PCS was strongly associated with MHPs but not with mTBI. Careful assessment of MHPs is essential in personnel with a history of combat-related mTBI and PCS.
部署到伊拉克或阿富汗的美国军事人员中，高达20%在部署期间经历轻度创伤性脑损伤（mTBI）；高达三分之一的人会出现持续性脑震荡后症状（PCS）。本研究的目的是调查加拿大武装部队（CAF）人员中与部署相关的mTBI的流行病学及其与PCS和心理健康问题（MHP）的关系。
参与者为16153名在2009年至2012年支持阿富汗任务的部署后接受筛查（返回后中位数为136天）的人员。筛查问卷使用简易创伤性脑损伤筛查工具评估部署期间的mTBI和其他损伤。使用患者健康问卷、创伤后应激障碍患者清单和认知失误问卷中的项目评估当前的MHP和PCS。对数二项回归以7项PCS中出现3项或更多项为结局，探讨mTBI、其他损伤和MHP与PCS的关联。结果以调整后的患病率比（PR）表示。
843名受访者（5.2%）报告在部署期间发生mTBI。较轻形式的mTBI（仅与头晕、困惑或“眼前冒金星有关”）占主导。在有mTBI的人中，一半报告爆炸为损伤机制。在较轻形式的mTBI患者中，21%出现多种PCS，在较严重形式的mTBI患者中（即与意识丧失或创伤后遗忘相关的mTBI），这一比例为27%。在对混杂因素进行调整后，相对于非TBI损伤，mTBI与PCS无统计学显著关联。相比之下，MHP与报告3项或更多项PCS有很强的关联（调整后的患病率比（PR）=7.77）。
与部署相关的mTBI患病率低于许多美国报告中的数据；大多数有mTBI的人没有多种PCS。PCS与MHP密切相关，但与mTBI无关。对有与战斗相关的mTBI和PCS病史的人员进行仔细的MHP评估至关重要。
