部署所致创伤性脑损伤对创伤后应激及相关障碍影响的前瞻性纵向评估：来自军队评估军人风险与恢复力研究（陆军STARRS）的结果
Prospective longitudinal evaluation of the effect of deployment-acquired traumatic brain injury on posttraumatic stress and related disorders: results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS).
作者信息
Stein Murray B, Kessler Ronald C, Heeringa Steven G, Jain Sonia, Campbell-Sills Laura, Colpe Lisa J, Fullerton Carol S, Nock Matthew K, Sampson Nancy A, Schoenbaum Michael, Sun Xiaoying, Thomas Michael L, Ursano Robert J
机构信息
From the Department of Psychiatry, University of California San Diego, La Jolla, Calif.; the Department of Family Medicine and Public Health, University of California San Diego, La Jolla, Calif.; the VA San Diego Healthcare System, San Diego; the Department of Health Care Policy, Harvard Medical School, Boston; the University of Michigan, Institute for Social Research, Ann Arbor, Mich.; the National Institute of Mental Health, Bethesda, Md.; the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Md.; and the Department of Psychology, Harvard College, Cambridge, Mass.
出版信息
Am J Psychiatry. 2015 Nov 1;172(11):1101-11. doi: 10.1176/appi.ajp.2015.14121572. Epub 2015 Sep 4.
OBJECTIVE
Traumatic brain injury (TBI) is increasingly recognized as a risk factor for deleterious mental health and functional outcomes. The purpose of this study was to examine the strength and specificity of the association between deployment-acquired TBI and subsequent posttraumatic stress and related disorders among U.S. Army personnel.
METHOD
A prospective, longitudinal survey of soldiers in three Brigade Combat Teams was conducted 1-2 months prior to an average 10-month deployment to Afghanistan (T0), upon redeployment to the United States (T1), approximately 3 months later (T2), and approximately 9 months later (T3). Outcomes of interest were 30-day prevalence postdeployment of posttraumatic stress disorder (PTSD), major depressive episode, generalized anxiety disorder, and suicidality, as well as presence and severity of postdeployment PTSD symptoms.
RESULTS
Complete information was available for 4,645 soldiers. Approximately one in five soldiers reported exposure to mild (18.0%) or more-than-mild (1.2%) TBI(s) during the index deployment. Even after adjusting for other risk factors (e.g., predeployment mental health status, severity of deployment stress, prior TBI history), deployment-acquired TBI was associated with elevated adjusted odds of PTSD and generalized anxiety disorder at T2 and T3 and of major depressive episode at T2. Suicidality risk at T2 appeared similarly elevated, but this association did not reach statistical significance.
CONCLUSIONS
The findings highlight the importance of surveillance efforts to identify soldiers who have sustained TBIs and are therefore at risk for an array of postdeployment adverse mental health outcomes, including but not limited to PTSD. The mechanism(s) accounting for these associations need to be elucidated to inform development of effective preventive and early intervention programs.
目的
创伤性脑损伤（TBI）日益被视为有害心理健康和功能结局的一个风险因素。本研究的目的是检验美国陆军人员中部署期间获得的TBI与随后的创伤后应激及相关障碍之间关联的强度和特异性。
方法
对三个旅战斗队的士兵进行了一项前瞻性纵向调查，在平均为期10个月的阿富汗部署前1 - 2个月（T0）、重新部署到美国时（T1）、大约3个月后（T2）以及大约9个月后（T3）进行。感兴趣的结局包括部署后创伤后应激障碍（PTSD）、重度抑郁发作、广泛性焦虑障碍和自杀行为的30天患病率，以及部署后PTSD症状的存在情况和严重程度。
结果
4645名士兵有完整信息。约五分之一的士兵报告在首次部署期间暴露于轻度（18.0%）或更严重（1.2%）的TBI。即使在调整了其他风险因素（如部署前心理健康状况、部署压力严重程度、既往TBI病史）后，部署期间获得的TBI与T2和T3时PTSD和广泛性焦虑障碍调整后几率升高以及T2时重度抑郁发作几率升高相关。T2时自杀风险似乎同样升高，但这种关联未达到统计学显著性。
结论
研究结果凸显了监测工作的重要性，以识别遭受TBI并因此有一系列部署后不良心理健康结局风险的士兵，这些结局包括但不限于PTSD。需要阐明这些关联的机制，以为有效的预防和早期干预项目的制定提供信息。
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