一项退伍军人事务部百万退伍军人计划研究：对接受全面创伤性脑损伤评估的退伍军人完成的神经行为症状量表中种族/民族差异的研究。
An Examination of Racial/Ethnic Differences on the Neurobehavioral Symptom Inventory Among Veterans Completing the Comprehensive Traumatic Brain Injury Evaluation: A Veterans Affairs Million Veteran Program Study.
机构信息
Research & Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA.
Department of Psychiatry, University of California San Diego, La Jolla, CA, USA.
出版信息
Arch Clin Neuropsychol. 2023 Aug 24;38(6):929-943. doi: 10.1093/arclin/acad005.
OBJECTIVE
The purpose of this study was to explore racial/ethnic differences in neurobehavioral symptom reporting and symptom validity testing among military veterans with a history of traumatic brain injury (TBI).
METHOD
Participants of this observational cross-sectional study (N = 9,646) were post-deployed Iraq-/Afghanistan-era veterans enrolled in the VA's Million Veteran Program with a clinician-confirmed history of TBI on the Comprehensive TBI Evaluation (CTBIE). Racial/ethnic groups included White, Black, Hispanic, Asian, Multiracial, Another Race, American Indian or Alaska Native, and Native Hawaiian or Other Pacific Islander. Dependent variables included neurobehavioral symptom domains and symptom validity assessed via the Neurobehavioral Symptom Inventory (NSI) and Validity-10, respectively.
RESULTS
Chi-square analyses showed significant racial/ethnic group differences for vestibular, somatic/sensory, and affective symptoms as well as for all Validity-10 cutoff scores examined (≥33, ≥27, ≥26, >22, ≥22, ≥13, and ≥7). Follow-up analyses compared all racial/ethnic groups to one another, adjusting for sociodemographic- and injury-related characteristics. These analyses revealed that the affective symptom domain and the Validity-10 cutoff of ≥13 revealed the greatest number of racial/ethnic differences.
CONCLUSIONS
Results showed significant racial/ethnic group differences on neurobehavioral symptom domains and symptom validity testing among veterans who completed the CTBIE. An enhanced understanding of how symptoms vary by race/ethnicity is vital so that clinical care can be appropriately tailored to the unique needs of all veterans. Results highlight the importance of establishing measurement invariance of the NSI across race/ethnicity and underscore the need for ongoing research to determine the most appropriate Validity-10 cutoff score(s) to use across racially/ethnically diverse veterans.
目的
本研究旨在探讨有创伤性脑损伤（TBI）病史的退伍军人在神经行为症状报告和症状效度测试方面的种族/民族差异。
方法
本观察性横断面研究（N=9646）的参与者为在退伍军人事务部的百万退伍军人计划中登记、有临床医生确认的 TBI 病史（综合 TBI 评估（CTBIE））的后部署伊拉克/阿富汗时代的退伍军人。种族/民族群体包括白人、黑人、西班牙裔、亚裔、多种族、其他种族、美洲印第安人或阿拉斯加原住民和夏威夷原住民或其他太平洋岛民。因变量包括通过神经行为症状清单（NSI）评估的神经行为症状域和症状效度，以及通过 Validity-10 评估的症状效度。
结果
卡方分析显示，在前庭、躯体/感觉和情感症状以及所有检查的 Validity-10 截断值（≥33、≥27、≥26、>22、≥22、≥13 和≥7）方面，存在显著的种族/民族群体差异。后续分析比较了所有种族/民族群体彼此之间的差异，调整了社会人口统计学和损伤相关特征。这些分析表明，情感症状域和 Validity-10 截断值≥13 显示出最大数量的种族/民族差异。
结论
结果表明，在完成 CTBIE 的退伍军人中，神经行为症状域和症状效度测试存在显著的种族/民族群体差异。增强对症状因种族/民族而异的理解至关重要，以便能够根据所有退伍军人的独特需求适当调整临床护理。结果强调了在种族/民族之间建立 NSI 测量不变性的重要性，并强调需要进行持续研究，以确定在不同种族/民族的退伍军人中使用最合适的 Validity-10 截断值。
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