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有轻度创伤性脑损伤病史的寻求治疗的退伍军人中的精神共病和心理社会问题。

Psychiatric Comorbidity and Psychosocial Problems Among Treatment-Seeking Veterans With a History of Mild Traumatic Brain Injury.

作者信息

Wojtowicz Magdalena, Silverberg Noah D, Bui Eric, Zafonte Ross, Simon Naomi, Iverson Grant L

机构信息

Dr. Wojtowicz is with the Department of Psychology, York University, Toronto, Canada. She was with the Departments of Psychiatry and Physical Medicine and Rehabilitation, Harvard Medical School, Boston, and Home Base, a Red Sox Foundation and Massachusetts General Hospital program, Boston, at the time this work was completed. Dr. Silverberg is with GF Strong Rehab Centre and the Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, Canada; and Home Base. Drs. Bui and Simon are with the Department of Psychiatry, Harvard Medical School, and Home Base. Dr. Zafonte is with the Department of Physical Medicine and Rehabilitation, Harvard Medical School; is Chief of Physical Medicine and Rehabilitation at Spaulding Rehabilitation Hospital, Massachusetts General Hospital, and Brigham and Women's Hospital, Boston; and is with Home Base. Dr. Iverson is with the Department of Physical Medicine and Rehabilitation, Harvard Medical School; Spaulding Rehabilitation Hospital; and Home Base.

出版信息

Focus (Am Psychiatr Publ). 2017 Oct;15(4):384-389. doi: 10.1176/appi.focus.20170028. Epub 2017 Oct 12.

Abstract

Mild traumatic brain injuries (MTBIs) are common in sports, military service, and daily life. Limited data are available on the mental health needs of veterans with a history of MTBI who are seeking care in the community. The purpose of this article is to describe the mental health and psychosocial difficulties of a group of treatment-seeking veterans with a history of MTBI. The authors examined psychiatric comorbidities, psychosocial problems, and symptom burden in a cross-sectional sample of 129 treatment-seeking post-9/11 U.S. service members and veterans who reported a history of MTBI during a mental health evaluation at a nonprofit specialty outpatient clinic. The most common clinician-rated comorbid psychiatric diagnoses included posttraumatic stress disorder (N=113; 88%), major depressive disorder (N=57; 44%), alcohol use or abuse (N=56; 43%), and substance use or abuse (N=28; 22%). In addition, these service members and veterans endorsed high rates of anger and aggression, hazardous drinking, bodily pain, sleep difficulties, concentration problems, unemployment, and difficulties with family functioning. These clinical data suggest that post-9/11 service members and veterans who present with a history of MTBI represent a group of people who are highly symptomatic, have multiple comorbid conditions, and are struggling with multiple psychiatric, behavioral, and psychosocial difficulties. Clinical services designed to evaluate and treat these veterans should consider careful integration of mental health screening and services.

摘要

轻度创伤性脑损伤(MTBI)在体育活动、军事服役和日常生活中很常见。关于有MTBI病史且在社区寻求治疗的退伍军人的心理健康需求,现有数据有限。本文的目的是描述一组有MTBI病史且寻求治疗的退伍军人的心理健康和心理社会问题。作者在一个横断面样本中对129名9·11事件后寻求治疗的美国现役军人和退伍军人进行了检查,这些人在一家非营利性专科门诊进行心理健康评估时报告有MTBI病史,研究内容包括精神共病、心理社会问题和症状负担。临床医生评定的最常见共病精神诊断包括创伤后应激障碍(N = 113;88%)、重度抑郁症(N = 57;44%)、酒精使用或滥用(N = 56;43%)以及物质使用或滥用(N = 28;22%)。此外,这些现役军人和退伍军人还表示愤怒和攻击性、危险饮酒、身体疼痛、睡眠困难、注意力不集中、失业以及家庭功能方面存在问题的发生率很高。这些临床数据表明,有MTBI病史的9·11事件后现役军人和退伍军人是一组症状严重、有多种共病情况且在多种精神、行为和心理社会问题上挣扎的人群。旨在评估和治疗这些退伍军人的临床服务应考虑仔细整合心理健康筛查和服务。

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