Association between traumatic brain injury and risk of posttraumatic stress disorder in active-duty Marines.
Association between traumatic brain injury and risk of posttraumatic stress disorder in active-duty Marines.
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DOI：
10.1001/jamapsychiatry.2013.3080
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发表时间：
2014-02
期刊：
影响因子：
25.8
通讯作者：
K. Yurgil;D. Barkauskas;J. Vasterling;C. Nievergelt;G. Larson;N. Schork;B. Litz;W. Nash;D. Baker
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文献类型：
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作者：
K. Yurgil;D. Barkauskas;J. Vasterling;C. Nievergelt;G. Larson;N. Schork;B. Litz;W. Nash;D. Baker
创伤性脑损伤(TBI)是否是创伤后应激障碍(PTSD)的危险因素的重要性一直很难确定，因为合并疾病、重叠症状和横断面样本的流行。目的研究在考虑战斗强度和部署前心理健康症状的情况下，自我报告的部署前和部署相关的创伤后应激障碍的风险增加的程度。设计、设置和参与者作为前瞻性纵向海洋复原力研究(2008年6月至2012年5月)的一部分，在部署到伊拉克或阿富汗的7个月前约1个月进行结构化临床访谈和自我报告评估，并在部署后3至6个月再次进行。这项研究是在南加州海军陆战队基地的训练区或圣地亚哥退伍军人事务部医疗中心进行的。最终分析样本的参与者是1648名现役海军陆战队和海军军人，他们完成了部署前和部署后评估。排除的原因是未部署(n=34)、数据丢失(n=181)以及士官和军衔(n=66)。主要结果和指标主要结果是部署3个月后临床医生管理的创伤后应激障碍量表(CAPS)的总分。结果在部署前评估中，56.8%的参与者报告了先前的创伤；在部署后评估中，19.8%的参与者报告在部署前和部署后评估之间存在持续的创伤(即与部署相关的创伤)。约87.2%的部署相关≥是轻微的；在287名报告创伤后遗忘症的参与者中，有250人(87.1%)报告创伤后遗忘症不到24小时(37人报告TBI 24小时)，117名失去知觉的人中有111人(94.9%)报告意识不到30分钟。部署前CAPS得分和战斗强度得分提高了部署后3个月CAPS得分预测，每单位增加1.02(P<；.001；95%CI，1.02-1.02)和1.02(P<；.001；95%CI，1.01-1.02)。与部署相关的轻度脑损伤将预测CAPS分数提高1.23倍(P<；.001；95%CI，1.11-1.36)，而中/重度脑损伤将预测分数提高1.71(P<；.001；95%CI，1.37-2.12)。具有严重部署前症状、高战斗强度和部署相关脑外伤的参与者患创伤后应激障碍的可能性最高。对于部署前创伤后应激障碍症状不那么严重的参与者，创伤性脑损伤使创伤后应激障碍的发生率翻了一番或几乎翻了一番。结论和相关性即使考虑到部署前症状、先前的脑创伤和战斗强度，最近一次部署期间的脑创伤是部署后创伤后应激障碍症状的最强预测因子。
IMPORTANCE Whether traumatic brain injury (TBI) is a risk factor for posttraumatic stress disorder (PTSD) has been difficult to determine because of the prevalence of comorbid conditions, overlapping symptoms, and cross-sectional samples. OBJECTIVE To examine the extent to which self-reported predeployment and deployment-related TBI confers increased risk of PTSD when accounting for combat intensity and predeployment mental health symptoms. DESIGN, SETTING, AND PARTICIPANTS As part of the prospective, longitudinal Marine Resiliency Study (June 2008 to May 2012), structured clinical interviews and self-report assessments were administered approximately 1 month before a 7-month deployment to Iraq or Afghanistan and again 3 to 6 months after deployment. The study was conducted at training areas on a Marine Corps base in southern California or at Veterans Affairs San Diego Medical Center. Participants for the final analytic sample were 1648 active-duty Marine and Navy servicemen who completed predeployment and postdeployment assessments. Reasons for exclusions were nondeployment (n = 34), missing data (n = 181), and rank of noncommissioned and commissioned officers (n = 66). MAIN OUTCOMES AND MEASURES The primary outcome was the total score on the Clinician-Administered PTSD Scale (CAPS) 3 months after deployment. RESULTS At the predeployment assessment, 56.8% of the participants reported prior TBI; at postdeployment assessment, 19.8% reported sustaining TBI between predeployment and postdeployment assessments (ie, deployment-related TBI). Approximately 87.2% of deployment-related TBIs were mild; 250 of 287 participants (87.1%) who reported posttraumatic amnesia reported less than 24 hours of posttraumatic amnesia (37 reported ≥ 24 hours), and 111 of 117 of those who lost consciousness (94.9%) reported less than 30 minutes of unconsciousness. Predeployment CAPS score and combat intensity score raised predicted 3-month postdeployment CAPS scores by factors of 1.02 (P < .001; 95% CI, 1.02-1.02) and 1.02 (P < .001; 95% CI, 1.01-1.02) per unit increase, respectively. Deployment-related mild TBI raised predicted CAPS scores by a factor of 1.23 (P < .001; 95% CI, 1.11-1.36), and moderate/severe TBI raised predicted scores by a factor of 1.71 (P < .001; 95% CI, 1.37-2.12). Probability of PTSD was highest for participants with severe predeployment symptoms, high combat intensity, and deployment-related TBI. Traumatic brain injury doubled or nearly doubled the PTSD rates for participants with less severe predeployment PTSD symptoms. CONCLUSIONS AND RELEVANCE Even when accounting for predeployment symptoms, prior TBI, and combat intensity, TBI during the most recent deployment is the strongest predictor of postdeployment PTSD symptoms.