Department of Psychiatry.
Department of Psychology.
Psychol Assess. 2019 Nov;31(11):1340-1356. doi: 10.1037/pas0000756. Epub 2019 Aug 5.
Prior studies raise questions about whether persistent postconcussive symptoms (PCS) are differentiable from mental health sequelae of traumatic brain injury (TBI). To investigate whether PCS represented a distinct symptom domain, we evaluated the structure of post-concussive and psychological symptoms using data from The Army STARRS Pre/Post Deployment Study, a panel survey of three U.S. Army Brigade Combat Teams that deployed to Afghanistan. Data from 1229 participants who sustained probable TBI during deployment completed ratings of past-30-day post-concussive, posttraumatic stress, and depressive symptoms three months after their return. Exploratory factor analysis (EFA; = 300) and confirmatory factor analysis (CFA; = 929) of symptom ratings were performed in independent subsamples. EFA suggested a model with 3 correlated factors resembling PCS, posttraumatic stress, and depression. CFA confirmed adequate fit of the 3-factor model (CFI = .964, RMSEA = .073 [.070, .075]), contingent upon allowing theoretically defensible cross-loadings. Bifactor CFA indicated that variance in all symptoms was explained by a general factor (λ = .36-.93), but also provided evidence of domain factors defined by (a) reexperiencing/hyperarousal, (b) cognitive/somatic symptoms, and (c) depressed mood/anhedonia. Soldiers with more severe TBI had higher cognitive/somatic scores, whereas soldiers with more deployment stress had higher general and reexperiencing/hyperarousal scores. Thus, variance in PCS is attributable to both a specific cognitive/somatic symptom factor and a general factor that also explains variance in posttraumatic stress and depression. Measurement of specific domains representing cognitive/somatic symptoms, reexperiencing/hyperarousal, and depressed mood/anhedonia may help clarify the relative severity of PCS, posttraumatic stress, and depression among individuals with recent TBI. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
先前的研究提出了这样的问题，即持续性脑震荡后症状（PCS）是否与创伤性脑损伤（TBI）的心理健康后遗症有所区别。为了研究 PCS 是否代表一个独特的症状领域，我们使用了来自美国陆军 STARRS 部署前/后研究的数据来评估脑震荡后和心理症状的结构，这是一项对三个美国陆军旅战斗队的小组调查，这些部队部署到了阿富汗。在返回后的三个月内，1229 名在部署期间可能患有 TBI 的参与者完成了对过去 30 天脑震荡后、创伤后应激和抑郁症状的评分。在独立的子样本中进行了症状评分的探索性因素分析（EFA；=300）和验证性因素分析（CFA；=929）。EFA 表明，存在 3 个相关因素的模型类似于 PCS、创伤后应激和抑郁。CFA 证实了 3 因素模型（CFI=.964，RMSEA=.073[.070，.075]）具有良好的拟合度，前提是允许理论上合理的交叉负荷。双因素 CFA 表明，所有症状的方差均由一个共同因素（λ=.36-.93）解释，但也提供了由（a）重新体验/高度警觉、（b）认知/躯体症状和（c）情绪低落/快感缺失定义的域因素的证据。TBI 更严重的士兵认知/躯体症状得分更高，而部署压力更大的士兵一般和重新体验/高度警觉得分更高。因此，PCS 的差异归因于特定的认知/躯体症状因素和共同因素，后者也解释了创伤后应激和抑郁的差异。测量代表认知/躯体症状、重新体验/高度警觉和情绪低落/快感缺失的特定域可能有助于澄清近期 TBI 个体中 PCS、创伤后应激和抑郁的相对严重程度。（PsycINFO 数据库记录（c）2019 APA，保留所有权利）。
