Associations of Military Service History and Health Outcomes in the First Five Years After Traumatic Brain Injury.
Associations of Military Service History and Health Outcomes in the First Five Years After Traumatic Brain Injury.
复制标题
兵役史与创伤性脑损伤后第一个五年的健康结果的关联。
DOI：
10.1089/neu.2022.0340
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发表时间：
2023
影响因子：
4.2
通讯作者：
Dams-O'Connor,Kristen
中科院分区：
文献类型：
--
作者：
Kumar,RajG;Klyce,Daniel;Nakase-Richardson,Risa;Pugh,MaryJo;Walker,WilliamC;Dams-O'Connor,Kristen
多年来，专家们已经认识到研究现役军人和退伍军人创伤性脑损伤 (TBI) 的重要性。大部分研究是在退伍军人管理局 (VA) 或国防部环境中进行的。然而，人们对在这些环境之外寻求医疗服务的军事人员知之甚少。在民用环境中进行的研究要么没有招募现役或退伍军人参与者，要么未能衡量军事历史，从而排除了根据军事历史对 TBI 结果进行研究。本研究的目的是确定 TBI 后前 5 年的军事史与医疗（25 种合并症健康状况的患病率）、认知（通过电话进行的成人认知简要测试）和心理健康（患者健康问卷 - 9 [PHQ-9]、广泛性焦虑症 - 7、自杀 [PHQ-9 中的第 9 项]）之间的关联。在这项前瞻性研究中，我们分析了 TBI 模型系统国家数据库的数据。参与者是 2010 年 4 月 1 日至 2020 年 11 月 19 日期间入住 21 个民用住院康复机构之一的 7797 名 TBI 患者，并进行了长达 5 年的随访。我们评估了军事历史（任何与无、战斗经历、服役时代和服役持续时间）和 TBI 结果之间的关系。我们发现，在有战斗部署史（肺病、创伤后应激障碍 [PTSD] 和睡眠障碍）、入伍后时代服役（慢性疼痛、肝病、关节炎）和服役超过 4 年（高胆固醇、PTSD、睡眠障碍）的个体中，TBI 后 1 年的特定医疗状况明显更为普遍。与没有参军经历的人相比，有参军经历但未参加战斗的人在受伤后的前 5 年中认知能力和心理健康状况要好一些。我们的数据表明，有军事经历的 TBI 患者相对于非军事人员来说是异质的，有一些有利的和其他有害的健康结果，这可能是由服役特征驱动的，包括战斗经历和服役年限。
For many years, experts have recognized the importance of studying traumatic brain injury (TBI) among active-duty service members and veterans. A majority of this research has been conducted in Veterans Administration (VA) or Department of Defense settings. However, far less is known about military personnel who seek their medical care outside these settings. Studies that have been conducted in civilian settings have either not enrolled active duty or veteran participants, or failed to measure military history, precluding study of TBI outcomes by military history. The purpose of the present study was to determine associations between military history and medical (prevalence of 25 comorbid health conditions), cognition (Brief Test of Adult Cognition by Telephone), and psychological health (Patient Health Questionnaire-9 [PHQ-9], Generalized Anxiety Disorder-7, suicidality [9th item from PHQ-9]) in the first 5 years after TBI. In this prospective study, we analyzed data from the TBI Model Systems National Database. Participants were 7797 individuals with TBI admitted to one of 21 civilian inpatient rehabilitation facilities from April 1, 2010, to November 19, 2020, and followed up to 5 years. We assessed the relationship between military history (any versus none, combat exposure, service era, and service duration) and TBI outcomes. We found specific medical conditions were significantly more prevalent 1 year post-TBI among individuals who had a history of combat deployment (lung disorders, post-traumatic stress disorder [PTSD], and sleep disorder), served in post-draft era (chronic pain, liver disease, arthritis), and served >4 years (high cholesterol, PTSD, sleep disorder). Individuals with military history without combat deployment had modestly more favorable cognition and psychological health in the first 5 years post-injury relative to those without military history. Our data suggest that individuals with TBI with military history are heterogeneous, with some favorable and other deleterious health outcomes, relative to their non-military counterparts, which may be driven by characteristics of service, including combat exposure and era of service.