Lopez Francesca V, Hu Ruiyan, Krishnan Tanvi, Dell Kristine C, Walker William C, Merritt Victoria C, Jak Amy
Author Affiliations: Center of Excellence for Stress and Mental Health, Veterans Affairs San Diego Healthcare System, San Diego, California (Drs Lopez, Merritt and Jak); Veterans Affairs San Diego Healthcare System, San Diego, California (Dr Lopez, Ms Hu, Ms Krishnan, and Drs Dell, Merritt, and Jak); Department of Psychiatry, University of California, San Diego, San Diego, California (Drs Lopez, Dell, Merritt and Jak); Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia (Dr Walker); Physical Medicine and Rehabilitation Service, Richmond Veterans Affairs Medical Center, Richmond, Virginia (Dr Walker).
J Head Trauma Rehabil. 2025 Aug 6. doi: 10.1097/HTR.0000000000001095.
To examine the relationship between injury context with psychiatric and cognitive outcomes among combat-exposed Veterans and Service Members with remote mild traumatic brain injury (mTBI).
Veterans and Service Members enrolled in the Long-Term Impact of Military-Relevant Injury Consortium (LIMBIC)-Chronic Effects of Neurotrauma Consortium (CENC).
LIMBIC-CENC-enrolled participants who had sustained an mTBI exclusively in combat zones (c-mTBI +; n = 314), mTBI sustained exclusively in non-combat settings (c-mTBI-; n = 526), or no history of mTBI (no TBI; n = 347). Inclusion criteria for this study included (1) availability of all mTBI injury-related characteristics, (2) completion of all psychiatric symptom measures, and (3) completion of all neuropsychological measures used for this study.
Cross-sectional secondary analysis.
Primary outcomes of interest included total scores on self-reported psychiatric symptom measures (post-traumatic stress, neurobehavioral, and cognitive concerns) and objective cognitive composite test scores (attention, learning, processing speed, executive function, and delayed recall). All analyses adjusted for age, gender, and education.
Results of separate multivariate analyses of variance indicated that the c-mTBI+ group reported higher post-traumatic (ηP2 = .08) and neurobehavioral symptoms (ηP2 = .07), and cognitive concerns (ηP2 = .04) compared to the c-mTBI- and no TBI groups, whereas the c-mTBI- and no TBI groups did not differ except on cognitive concerns. Additionally, groups did not differ across cognitive composite performance except for significant though weak group differences on learning (ηP2 = .01), delayed recall (ηP2 = .03), and processing speed (ηP2 = .01). Separate hierarchical regression analyses indicated psychiatric symptom burden explained 7-18% of the total variance in cognitive composite performance as a function of mTBI group history (ps ≤ .002).
These findings build upon prior work showing that injury context - the context in which mTBI occurs - may play an important role in long-term psychiatric and cognitive outcomes.
探讨在患有远程轻度创伤性脑损伤（mTBI）的参战退伍军人和现役军人中，损伤背景与精神和认知结果之间的关系。
参加军事相关损伤长期影响联盟（LIMBIC）-神经创伤长期影响联盟（CENC）的退伍军人和现役军人。
仅在战区遭受mTBI的LIMBIC-CENC登记参与者（c-mTBI+；n = 314）、仅在非战斗环境中遭受mTBI的参与者（c-mTBI-；n = 526）或无mTBI病史的参与者（无TBI；n = 347）。本研究的纳入标准包括：（1）具备所有与mTBI损伤相关的特征；（2）完成所有精神症状测量；（3）完成本研究使用的所有神经心理学测量。
横断面二次分析。
感兴趣的主要结果包括自我报告的精神症状测量总分（创伤后应激、神经行为和认知问题）以及客观认知综合测试分数（注意力、学习、处理速度、执行功能和延迟回忆）。所有分析均对年龄、性别和教育程度进行了调整。
单独的多变量方差分析结果表明，与c-mTBI-组和无TBI组相比，c-mTBI+组报告的创伤后症状（ηP2 = 0.08）、神经行为症状（ηP2 = 0.07）和认知问题（ηP2 = 0.04）更高，而c-mTBI-组和无TBI组除认知问题外无差异。此外，除了在学习（ηP2 = 0.01）、延迟回忆（ηP2 = 0.03）和处理速度（ηP2 = 0.01）方面存在虽显著但较弱的组间差异外，各组在认知综合表现上没有差异。单独的分层回归分析表明，精神症状负担解释了认知综合表现总方差的7-18%，这是mTBI组病史的函数（p≤0.002）。
这些发现基于先前的研究工作，表明损伤背景——mTBI发生的背景——可能在长期精神和认知结果中起重要作用。
