Van Etten Emily J, Knight Arielle R, Colaizzi Tristan A, Carbaugh Jack, Kenna Alexandra, Fortier Catherine B, Milberg William P
Translational Research Center for TBI and Stress Disorders, Veterans Affairs Boston Healthcare System, Boston, Massachusetts.
Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.
JAMA Netw Open. 2025 Jan 2;8(1):e2455622. doi: 10.1001/jamanetworkopen.2024.55622.
There has been a great deal of interest in mild traumatic brain injury (mTBI) and posttraumatic stress disorder (PTSD) and their association with one another, yet their interaction and subsequent associations with long-term outcomes remain poorly understood.
To compare the long-term outcomes of mTBI that occurred in the context of psychological trauma (peritraumatic context) with mTBI that did not (nonperitraumatic context).
DESIGN, SETTING, AND PARTICIPANTS: This cohort study of post-9/11 US veterans used data from the Translational Research Center for Traumatic Brain Injury and Stress Disorders (TRACTS) study at the Veterans Affairs Boston Healthcare System, which began in 2009; the current study utilized data from baseline TRACTS visits conducted between 2009 and 2024. Data analysis occurred from January to October 2024.
Peritraumatic mTBI, nonperitraumatic mTBI, or no TBI.
The primary outcomes were PTSD severity (measured by the Clinician-Administered PTSD Scale-4th edition), postconcussive symptoms (measured by the Neurobehavioral Symptom Inventory), and self-reported disability status (measured by the World Health Organization Disability Assessment Schedule II). Differences between groups were compared using analyses of covariance with least significant difference comparisons.
This sample of 567 post-9/11 veterans (mean [SD] age, 33.72 [9.29] years; 507 men [89.4%]; mean [SD] years of education, 14.19 [2.16]) included 183 individuals with no TBI, 189 individuals with nonperitraumatic mTBI, and 195 individuals with peritraumatic mTBI. Veterans with a history of peritraumatic mTBI had greater PTSD severity (F2,552 = 8.45; P < .001), postconcussive symptoms (F2,533 = 11.09; P < .001), and disability (F2,527 = 11.13; P < .001) than the nonperitraumatic mTBI and no TBI groups. Importantly, no significant differences in any outcome measure between nonperitraumatic mTBI and no TBI groups were observed.
This cohort study found that mTBI was only associated with long-term consequences when it co-occurred with a traumatic event exposure. This finding raises a novel hypothesis of the association of mTBI with PTSD, in which the acute biological and physiological outcomes of mTBI may be associated with temporarily scaffolding the formation of PTSD symptoms, which could enhance the production of long-term postconcussive symptoms and disability.
轻度创伤性脑损伤（mTBI）和创伤后应激障碍（PTSD）以及它们之间的关联引发了大量关注，然而它们之间的相互作用以及随后与长期预后的关联仍知之甚少。
比较在心理创伤背景下发生的mTBI（创伤周围环境）与非心理创伤背景下发生的mTBI（非创伤周围环境）的长期预后。
设计、设置和参与者：这项针对9·11事件后美国退伍军人的队列研究使用了波士顿退伍军人事务医疗系统创伤性脑损伤与应激障碍转化研究中心（TRACTS）研究的数据，该研究始于2009年；本研究利用了2009年至2024年期间TRACTS基线访视的数据。数据分析于2024年1月至10月进行。
创伤周围mTBI、非创伤周围mTBI或无TBI。
主要结局为PTSD严重程度（通过临床医生管理的PTSD量表第4版测量）、脑震荡后症状（通过神经行为症状量表测量）和自我报告的残疾状况（通过世界卫生组织残疾评估量表第二版测量）。使用协方差分析和最小显著差异比较来比较组间差异。
这个由567名9·11事件后退伍军人组成的样本（平均[标准差]年龄为33.72[9.29]岁；507名男性[89.4%]；平均[标准差]受教育年限为14.19[2.16]年）包括183名无TBI个体、189名非创伤周围mTBI个体和195名创伤周围mTBI个体。有创伤周围mTBI病史的退伍军人的PTSD严重程度（F2,552 = 8.45；P <.001）、脑震荡后症状（F2,533 = 11.09；P <.001）和残疾程度（F2,527 = 11.13；P <.001）均高于非创伤周围mTBI组和无TBI组。重要的是，未观察到非创伤周围mTBI组和无TBI组在任何结局指标上有显著差异。
这项队列研究发现，mTBI仅在与创伤事件暴露同时发生时才与长期后果相关。这一发现提出了一个关于mTBI与PTSD关联的新假设，即mTBI的急性生物学和生理结果可能与暂时搭建PTSD症状的形成有关，这可能会增加长期脑震荡后症状和残疾的产生。
