Miller Shannon C, Whitehead Casserly R, Otte Clifford N, Wells Timothy S, Webb Timothy S, Gore Russell K, Maynard Charles
Veterans Affairs Medical Center, Cincinnati, Ohio, USA Addiction Sciences Division, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, Ohio, USA Vulnerability Analysis Branch, Air Force Research Laboratory, Wright-Patterson AFB, Ohio, USA.
Infoscitex Corporation, Dayton, Ohio, USA.
Occup Environ Med. 2015 Aug;72(8):560-6. doi: 10.1136/oemed-2014-102646. Epub 2015 Apr 20.
Military personnel are at increased risk for traumatic brain injury (TBI) from combat and non-combat exposures. Sequelae of moderate-to-severe TBI are well described, but the literature remains conflicted regarding whether mild TBI (mTBI) results in lasting brain injury and functional impairments. This study assessed risk for a range of neuropsychiatric disorders presenting after mTBI while adjusting for the potential confounds of depression and post-traumatic stress disorder (PTSD).
A historical prospective association study was conducted utilising electronic demographic, medical and military-specific data for over 49,000 active duty US Air Force service members (Airmen). This study utilised diagnostic codes considered by an expert panel to be indicative of mTBI to identify cases. Cox proportional hazards modelling calculated HRs for neuropsychiatric outcomes while controlling for varying lengths of follow-up and potentially confounding variables.
Airmen with mTBI were at increased risk for specific neuropsychiatric disorders compared with a similarly injured non-mTBI control group. HRs for memory loss/amnesia, cognitive disorders, schizophrenia, PTSD, and depression were significantly elevated and remained so for at least 6 months post-mTBI, even after eliminating those with previous neuropsychiatric diagnoses.
mTBI was positively associated with neuropsychiatric disorders in this population of primarily young adult males; with increased HRs 6 months post-mTBI. The results support that mTBI is distinguished from moderate-to-severe TBI in terms of risk for developing neuropsychiatric disorders. Further, these findings suggest the importance of screening for psychiatric and cognitive disorders post-mTBI in general medical practice.
军事人员因战斗和非战斗暴露而遭受创伤性脑损伤（TBI）的风险增加。中重度TBI的后遗症已有详尽描述，但关于轻度TBI（mTBI）是否会导致持续性脑损伤和功能障碍，文献中仍存在争议。本研究评估了mTBI后出现一系列神经精神障碍的风险，同时对抑郁症和创伤后应激障碍（PTSD）的潜在混杂因素进行了校正。
采用电子人口统计学、医学和军事特定数据，对49000多名美国空军现役军人（飞行员）进行了一项历史性前瞻性关联研究。本研究利用专家小组认为可指示mTBI的诊断编码来识别病例。Cox比例风险模型计算神经精神结局的风险比（HRs），同时控制不同的随访时间长度和潜在的混杂变量。
与同样受伤的非mTBI对照组相比，患有mTBI的飞行员患特定神经精神障碍的风险增加。记忆力丧失/失忆、认知障碍、精神分裂症、PTSD和抑郁症的HRs显著升高，且在mTBI后至少6个月内一直如此，即使在排除先前有神经精神疾病诊断的患者后也是如此。
在这个主要为年轻成年男性的人群中，mTBI与神经精神障碍呈正相关；mTBI后6个月HRs升高。结果支持mTBI在发生神经精神障碍的风险方面与中重度TBI有所不同。此外，这些发现表明在一般医疗实践中对mTBI后进行精神和认知障碍筛查的重要性。
