Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.
Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
J Trauma Stress. 2020 Jun;33(3):318-329. doi: 10.1002/jts.22480. Epub 2020 May 7.
Concurrent posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) is common in military populations. The purpose of this study was to examine long-term neurobehavioral outcomes in service members and veterans (SMVs) with versus without PTSD symptoms following TBI of all severities. Participants were 536 SMVs prospectively enrolled from three military medical treatment facilities who were recruited into three experimental groups: TBI, injured controls (IC), and noninjured controls (NIC). Participants completed the PTSD Checklist, Neurobehavioral Symptom Inventory, and the TBI-Quality of Life (TBI-QOL) and were divided into six subgroups based on the three experimental categories, two PTSD categories (i.e., present vs. absent), and two broad TBI severity categories (unMTBI, which included uncomplicated mild TBI; and smcTBI, which included severe TBI, moderate TBI, and complicated mild TBI): (a) NIC/PTSD-absent, (b) IC/PTSD-absent, (c) unMTBI/PTSD-absent, (d) unMTBI/PTSD-present, (e) smcTBI/PTSD-absent, and (f) smcTBI/PTSD-present. There were significant main effects across the six groups for all TBI-QOL measures, ps < .001. Select pairwise comparisons revealed significantly lower scores, p < .001, on all TBI-QOL measures in the PTSD-present groups when compared to the PTSD-absent groups within the same TBI severity classification, ds = 0.90-2.11. In contrast, when controlling for PTSD, there were no significant differences among the TBI severity groups for any TBI-QOL measures. These results provide support for the strong influence of PTSD but not TBI severity on neurobehavioral outcomes following TBI. Concurrent PTSD and TBI of all severities should be considered a risk factor for poor long-term neurobehavioral outcomes that require ongoing monitoring.
创伤后应激障碍（PTSD）和创伤性脑损伤（TBI）在军事人群中很常见。本研究的目的是检查不同严重程度 TBI 后 PTSD 症状存在与否的军人和退伍军人（SMV）的长期神经行为结果。参与者是从三家军事医疗机构前瞻性招募的 536 名 SMV，他们被招募到三个实验组中：TBI、受伤对照组（IC）和非受伤对照组（NIC）。参与者完成了 PTSD 检查表、神经行为症状清单和 TBI 生活质量问卷（TBI-QOL），并根据三个实验类别、两个 PTSD 类别（即存在和不存在）以及两个广泛的 TBI 严重程度类别（unMTBI，包括无并发症轻度 TBI；和 smcTBI，包括重度 TBI、中度 TBI 和复杂性轻度 TBI）分为六个亚组：（a）NIC/PTSD-无，（b）IC/PTSD-无，（c）unMTBI/PTSD-无，（d）unMTBI/PTSD-有，（e）smcTBI/PTSD-无，和（f）smcTBI/PTSD-有。所有 TBI-QOL 测量的六个组之间均存在显著的主效应，p<0.001。选择的成对比较显示，在同一 TBI 严重程度分类中，与 PTSD 无组相比，PTSD 存在组的所有 TBI-QOL 测量的得分显著降低，p<0.001，ds=0.90-2.11。相比之下，当控制 PTSD 时，任何 TBI-QOL 测量的 TBI 严重程度组之间均无显著差异。这些结果支持 PTSD 但不是 TBI 严重程度对 TBI 后神经行为结果的强烈影响。所有严重程度的并发 PTSD 和 TBI 都应被视为导致长期神经行为结果不良的危险因素，需要持续监测。
