Swan Alicia A, Kennedy Eamonn, Cooper Douglas B, Amuan Megan E, Mayo Jamie, Tate David F, Song Kangwon, Eapen Blessen C, Van Cott Anne C, Lopez Maria R, Pugh Mary Jo
Polytrauma Rehabilitation Center, South Texas Veterans Health Care System, San Antonio, TX, United States.
Department of Psychology, The University of Texas at San Antonio, San Antonio, TX, United States.
Front Neurol. 2023 Jul 19;14:1228377. doi: 10.3389/fneur.2023.1228377. eCollection 2023.
The study aimed to examine the association between post-concussive comorbidity burdens [post-traumatic stress disorder (PTSD), depression, and/or headache] and central nervous system (CNS) polypharmacy (five or more concurrent medications) with reported neurobehavioral symptoms and symptom validity screening among post-9/11 veterans with a history of mild traumatic brain injury (mTBI).
Administrative medical record data from the Department of Veterans Affairs (VA) were used in the study.
Post-9/11 veterans with mTBI and at least 2 years of VA care between 2001 and 2019 who had completed the comprehensive traumatic brain injury evaluation (CTBIE) were included in the study.
Retrospective cross-sectional design was used in the study.
Neurobehavioral Symptom Inventory (NSI), International Classification of Diseases, Ninth Revision, and Clinical Modification diagnosis codes were included in the study.
Of the 92,495 veterans with a history of TBI, 90% had diagnoses of at least one identified comorbidity (PTSD, depression, and/or headache) and 28% had evidence of CNS polypharmacy. Neurobehavioral symptom reporting and symptom validity failure was associated with comorbidity burden and polypharmacy after adjusting for sociodemographic characteristics. Veterans with concurrent diagnoses of PTSD, depression, and headache were more than six times more likely [Adjusted odds ratio = 6.55 (99% CI: 5.41, 7.92)]. to fail the embedded symptom validity measure (Validity-10) in the NSI.
TBI-related multimorbidity and CNS polypharmacy had the strongest association with neurobehavioral symptom distress, even after accounting for injury and sociodemographic characteristics. Given the regular use of the NSI in clinical and research settings, these findings emphasize the need for comprehensive neuropsychological evaluation for individuals who screen positively for potential symptom overreporting, the importance of multidisciplinary rehabilitation to restore functioning following mTBI, and the conscientious utilization of symptom validity measures in research efforts.
本研究旨在探讨脑震荡后合并症负担（创伤后应激障碍、抑郁症和/或头痛）与中枢神经系统多重用药（同时使用五种或更多药物）之间的关联，以及这些因素与有轻度创伤性脑损伤（mTBI）病史的9·11事件后退伍军人报告的神经行为症状和症状效度筛查之间的关系。
本研究使用了退伍军人事务部（VA）的行政医疗记录数据。
本研究纳入了有mTBI病史且在2001年至2019年期间接受了至少两年VA护理并完成了综合创伤性脑损伤评估（CTBIE）的9·11事件后退伍军人。
本研究采用回顾性横断面设计。
本研究纳入了神经行为症状量表（NSI）、《国际疾病分类》第九版临床修订版诊断编码。
在92495名有TBI病史的退伍军人中，90%被诊断出至少有一种已确定的合并症（创伤后应激障碍、抑郁症和/或头痛），28%有中枢神经系统多重用药的证据。在调整了社会人口学特征后，神经行为症状报告和症状效度失败与合并症负担和多重用药有关。同时诊断为创伤后应激障碍、抑郁症和头痛的退伍军人在NSI中嵌入的症状效度测量（效度-10）失败的可能性高出六倍多[调整后的优势比=6.55（99%置信区间：5.41，7.92）]。
即使在考虑了损伤和社会人口学特征后，与TBI相关的多种疾病和中枢神经系统多重用药与神经行为症状困扰的关联最强。鉴于NSI在临床和研究环境中的常规使用，这些发现强调了对潜在症状过度报告筛查呈阳性的个体进行全面神经心理学评估的必要性、mTBI后多学科康复以恢复功能的重要性，以及在研究工作中认真使用症状效度测量的重要性。
