Hardy Morgan, Kennedy Jan, Reid Matthew, Cooper Douglas
Department of Psychiatry, University of Texas Health San Antonio (Drs Hardy and Cooper); 59th Medical Wing, Wilford Hall Ambulatory Surgical Center, Lackland AFB, Texas (Dr Hardy); and Defense and Veterans Brain Injury Center, Brooke Army Medical Center, Fort Sam Houston, Texas (Drs Kennedy, Reid, and Cooper).
J Head Trauma Rehabil. 2020 Jan/Feb;35(1):37-45. doi: 10.1097/HTR.0000000000000486.
This study compares combat-related mild traumatic brain injury (mTBI) to non-combat-related mTBI in rates of posttraumatic stress disorder (PTSD) and depression after injury, severity of postconcussive symptoms (PCSs), and attribution of those symptoms to mTBI versus PTSD.
A total of 371 active duty service members (SMs) with documented history of mTBI, divided into combat and non-combat-related cohorts.
Retrospective cohort study.
Diagnoses of PTSD and depression based on medical record review and self-report. PCSs measured using Neurobehavioral Symptom Index. Attribution of symptoms based on a rating scale asking how much mTBI, PTSD, depression, deployment, or readjustment stress contributed to current symptoms.
Prevalence of PTSD was significantly higher after a combat-related mTBI, compared with a noncombat mTBI (P = .001). Prevalence of depression did not differ between the 2 groups. PCSs were high in both combat and noncombat mTBIs, with no statistical difference between groups. SMs with PTSD reported higher PCS, regardless of combat status. SMs without PTSD attributed symptoms mainly to mTBI, whereas SMs with PTSD, regardless of combat status, were much more likely to attribute symptoms to PTSD, depression, and deployment/readjustment stress.
This research contributes to our understanding of the complex interplay between mTBI and PTSD in both combat and noncombat injuries within the military population and the importance of addressing both simultaneously.
本研究比较了与战斗相关的轻度创伤性脑损伤（mTBI）和非战斗相关的mTBI在受伤后创伤后应激障碍（PTSD）和抑郁症的发生率、脑震荡后症状（PCS）的严重程度，以及这些症状归因于mTBI与PTSD的情况。
共有371名有mTBI记录病史的现役军人（SM），分为与战斗相关和非战斗相关两组。
回顾性队列研究。
根据病历审查和自我报告诊断PTSD和抑郁症。使用神经行为症状指数测量PCS。症状归因基于一个评分量表，询问mTBI、PTSD、抑郁症、部署或重新适应压力对当前症状的影响程度。
与非战斗性mTBI相比，与战斗相关的mTBI后PTSD的患病率显著更高（P = .001）。两组之间抑郁症的患病率没有差异。战斗性和非战斗性mTBI的PCS都很高，两组之间没有统计学差异。患有PTSD的SM报告的PCS更高，无论其战斗状态如何。没有PTSD的SM将症状主要归因于mTBI，而患有PTSD的SM，无论战斗状态如何，更有可能将症状归因于PTSD、抑郁症和部署/重新适应压力。
本研究有助于我们理解军事人群中战斗性和非战斗性损伤中mTBI与PTSD之间的复杂相互作用，以及同时解决这两个问题的重要性。
