Network analysis of mild traumatic brain injury, persistent neurobehavioral and psychiatric symptoms, and functional disability among recent-era United States veterans.

Autor: Fonda JR; Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education and Clinical Center (GRECC), VA Boston Health Care System, Boston, Massachusetts, USA.; Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA.; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA., Crowe ML; National Center for Posttraumatic Stress Disorder, VA Boston Healthcare System, Boston, Massachusetts, USA., Levin LK; Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education and Clinical Center (GRECC), VA Boston Health Care System, Boston, Massachusetts, USA., Jagger-Rickels A; Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA.; Boston Attention and Learning Laboratory, VA Boston Healthcare System, Boston, Massachusetts, USA., Marx BP; Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA.; National Center for Posttraumatic Stress Disorder, VA Boston Healthcare System, Boston, Massachusetts, USA., Milberg WP; Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education and Clinical Center (GRECC), VA Boston Health Care System, Boston, Massachusetts, USA.; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA., McGlinchey RE; Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education and Clinical Center (GRECC), VA Boston Health Care System, Boston, Massachusetts, USA.; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA., Fortier CB; Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education and Clinical Center (GRECC), VA Boston Health Care System, Boston, Massachusetts, USA.; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.
Jazyk: angličtina
Zdroj: Journal of traumatic stress [J Trauma Stress] 2022 Oct; Vol. 35 (5), pp. 1546-1558. Date of Electronic Publication: 2022 Aug 05.
DOI: 10.1002/jts.22860
Abstrakt: Recent-era U.S. veterans are clinically complex, with a high prevalence of co-occurring mild traumatic brain injury (mTBI), psychiatric conditions, and behavioral dysfunction. The current study examined the direct and indirect associations between mTBI and persistent neurobehavioral, psychiatric, and functional disability symptoms among recent-era U.S. veterans and service members (n = 648). We evaluated the postconcussive syndrome (PCS) potential causal model with two network analysis modeling approaches. Separate analyses were conducted for military mTBI and lifetime mTBI. An exploratory factor analysis was conducted to limit topological overlap in the network analysis. The most influential symptoms (i.e., the unique variables most strongly associated with the rest of the network) in the military mTBI network were behavioral disengagement, expected influence (EI) = 1.10; cognitive difficulties, EI = 1.08; agitation/irritability, EI = 1.05; and PTSD-related reexperiencing and avoidance symptoms, EI = 0.98. After accounting for other symptoms, mTBI was only minimally informative, EI = 0.34. Additionally, military mTBI did not moderate the association between symptoms or the overall connectivity of the network. The results for lifetime mTBI were consistent with those for military mTBI. The present analyses identified a variety of behavioral, cognitive, and emotional symptoms that play an important role in understanding comorbidity and daily functioning among recent-era U.S. veterans. Associations between cumulative mTBI that occurred in civilian or military settings were indirect and relatively small in magnitude. The current results add to a growing literature raising doubts about the PCS model.
(Published 2022. This article is a U.S. Government work and is in the public domain in the USA.)
Databáze: MEDLINE
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