Durham Veteran Affairs (VA) Health Care System, Durham, NC, USA; VA (VISN 6) Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Duke-UNC Brain Imaging and Analysis Center, Duke University, Durham, NC, USA.
VA (VISN 6) Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Research & Academic Affairs Service Line, W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC, USA; Department of Neurobiology & Anatomy, Wake Forest School of Medicine, Winston-Salem, NC, USA.
J Psychiatr Res. 2024 Apr;172:411-419. doi: 10.1016/j.jpsychires.2024.02.058. Epub 2024 Feb 28.
Mild traumatic brain injury (TBI) is associated with long-term consequences, including greater risk for posttraumatic stress disorder (PTSD) and suicidal ideation. Affective instability is also independently related to PTSD and suicidality, which may explain why some individuals continue to experience chronic psychiatric complaints following mild TBI. The purpose of the present study was to evaluate affective instability as a key factor for PTSD and suicidal ideation among Veterans with and without TBI.
Participants (N = 299 Veterans; 86.96% male) completed the Personality Assessment Inventory (PAI) and structured clinical interviews for TBI and psychiatric diagnoses. Hierarchical linear regression was used to evaluate main and interaction effects.
There were no significant differences in affective instability (p = 0.140) or suicidal ideation (p = 0.453) between Veterans with or without TBI. Individuals with TBI were more likely to have a PTSD diagnosis (p = 0.001). Analyses evaluating PTSD diagnosis as an outcome indicated a main effect of affective instability (p < 0.001), but not TBI (p = 0.619). Analyses evaluating suicidal ideation as an outcome demonstrated an interaction effect between PTSD and affective instability beyond the effects of TBI (p = 0.034).
Severe Affective instability appears to be a key factor in suicidal ideation among Veterans beyond TBI or PTSD history. PTSD was more strongly associated with suicidality at lower and moderate levels of affective instability. At severe levels of affective instability, however, Veterans with and without PTSD experienced suicidal ideation at similar rates. Findings suggests that high levels of affective instability not better explained by other psychiatric conditions confers similar suicidality risk to that of PTSD in a Veteran population.
轻度创伤性脑损伤（TBI）与长期后果相关，包括创伤后应激障碍（PTSD）和自杀意念的风险增加。情绪不稳定也与 PTSD 和自杀意念独立相关，这可能解释了为什么一些人在经历轻度 TBI 后仍持续出现慢性精神疾病症状。本研究旨在评估情绪不稳定是否为 TBI 和非 TBI 退伍军人 PTSD 和自杀意念的关键因素。
参与者（N=299 名退伍军人；86.96%为男性）完成了人格评估量表（PAI）和 TBI 及精神疾病诊断的结构性临床访谈。使用分层线性回归来评估主要和交互作用。
TBI 和非 TBI 退伍军人之间在情绪不稳定（p=0.140）或自杀意念（p=0.453）方面无显著差异。TBI 患者更有可能被诊断为 PTSD（p=0.001）。评估 PTSD 诊断作为结果的分析表明，情绪不稳定存在主要效应（p<0.001），但 TBI 无此效应（p=0.619）。评估自杀意念作为结果的分析表明，PTSD 和情绪不稳定之间存在交互作用，超出了 TBI 的影响（p=0.034）。
严重的情绪不稳定似乎是 TBI 退伍军人自杀意念的关键因素，而 PTSD 或 PTSD 病史则不是。在情绪不稳定的低水平和中水平时，PTSD 与自杀意念的相关性更强。然而，在情绪不稳定的严重水平时，有和没有 PTSD 的退伍军人的自杀意念发生率相似。这些发现表明，在退伍军人人群中，不能用其他精神疾病更好解释的高度情绪不稳定与 PTSD 具有相似的自杀风险。
