Examining Alcohol Use after Combat-Acquired Traumatic Brain Injury

描述（由申请人提供）：军人不健康饮酒的比例高于一般公众，造成健康后果并影响部队战备状态。对于那些从战斗部署返回持久自由行动和伊拉克自由行动的人来说，急性应激反应和损伤，包括创伤性脑损伤（TBI），可能会加剧不健康饮酒，这在持久自由行动/伊拉克自由行动的服役人员中很常见。尽管民间研究表明，脑外伤造成的损伤可能导致不健康饮酒的风险增加，但军方很少研究脑外伤是否会影响服役人员的饮酒行为，迄今为止的证据也参差不齐。此外，创伤性脑损伤和创伤后应激障碍（PTSD）有重叠的症状，可能同时发生，从而使对这两种疾病的评估复杂化。本应用程序的三个研究目的是：1)比较经历过TBI和未经历过TBI的服役人员的部署后饮酒行为；2)检验经历过TBI与部署后饮酒相关负面后果之间的关系；3)检验创伤后应激障碍对经历过TBI与两个结果变量（饮酒行为和部署后负面后果）之间的关系可能的中介作用。为了分析这些研究目的，本研究将使用2008年美国国防部现役军人健康相关行为调查，这是一项基于全球人口的评估。该调查是自主进行的匿名调查，回复率为71.6%。提出的研究是一个准实验设计。研究样本包括最近一次战斗部署（去年）和部署后至少六个月完成调查（超过4,000名受访者）的服务人员队列，允许研究检查部署后饮酒行为及其后果。本研究将使用多元线性和逻辑回归来评估经历TBI与1)饮酒行为和2)负面后果之间的关系，以及路径分析来检验创伤后应激障碍是否介导TBI与饮酒行为和负面后果之间的关系。这项研究具有重要意义，因为它将使用基于人口的军事评估来检查关于战斗获得性TBI与部署后饮酒及其后果之间关系的知识差距，并关注对年轻服役人员的影响。通过改进与战斗相关的创伤性脑损伤的测量方法，并利用路径分析技术解决了该领域关于创伤性脑损伤与创伤后应激障碍之间潜在混淆的争议，从而加强了研究。这一创新研究应用将为未来的研究提供信息，从而为国防部（DOD）提供设计有针对性的早期和二级干预措施的信息，以解决不健康饮酒及其后果，帮助减少对军事人员和国防部的负面影响。

DESCRIPTION (provided by applicant): Military service members engage in unhealthy drinking at higher rates than the general public, causing health consequences and affecting force readiness. For those returning from combat deployment to Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF), unhealthy drinking may be exacerbated by acute stress reactions and injury, including traumatic brain injury (TBI), which is common among service members in OEF/OIF. Although civilian research suggests that impairments due to TBI may lead to an increased risk for unhealthy drinking, scant military research exists to examine whether TBI influences drinking behaviors among service members and evidence to date has been mixed. Further, TBI and posttraumatic stress disorder (PTSD) have overlapping symptoms and may co-occur, thus complicating assessment for both conditions. The three research aims of this application are to: 1) compare the post-deployment drinking behaviors for service members who experienced a TBI to those who did not, 2) to examine the relationship between experiencing a TBI and post-deployment drinking-related negative consequences, and 3) to examine the possible mediational effect of PTSD on the relationship between having experienced a TBI and the two outcome variables (drinking behaviors and negative post-deployment consequences). To analyze these research aims, this study will use the 2008 Department of Defense Survey of Health Related Behaviors among Active Duty Military Personnel, a worldwide population-based assessment. The survey was self-administered and anonymous with a response rate of 71.6 percent. The proposed study is a quasi-experimental design. The study sample includes a cohort of service members with a recent combat deployment (past year) and at least six months post-deployment before completing the survey (over 4,000 respondents), allowing the study to examine post-deployment drinking behaviors and consequences. The study will use multivariate linear and logistic regressions to assess the relationship between experiencing a TBI and 1) drinking behaviors and 2) negative consequences, as well as path analysis to examine whether PTSD mediates the relationship between TBI and drinking behaviors and negative consequences. This study is significant because it will use a population-based assessment of the military to examine the gap in knowledge regarding the association between combat-acquired TBI and post-deployment drinking and consequences, with attention to impacts on younger service members. The study is strengthened by improving upon methods for measuring combat-related TBI and addressing the controversy in the field about potential confounding between TBI and PTSD by using path analysis techniques. This innovative research application will inform future research, thus providing the Department of Defense (DOD) with information to design targeted early and secondary intervention practices to address unhealthy drinking and its consequences, helping to reduce the negative impacts to military personnel and the DOD.