PURPOSETo examine a the association of caregiver health-related quality of life (HRQOL) and service member/veteran (SMV) neurobehavioral outcomes with caregiver resilience; b longitudinal change in ...resilience at the group and individual level; and c the magnitude of change at the individual level.METHODSCaregivers (N = 232) of SMVs with traumatic brain injury completed a resilience measure, and 18 caregiver HRQOL and SMV neurobehavioral outcome measures at a baseline evaluation and follow-up evaluation three years later. Caregivers were divided into two resilience groups at baseline and follow-up: 1 Low Resilience (≤ 45 T, baseline n = 99, follow-up n = 93) and 2 High Resilience (> 45 T, baseline n = 133, follow-up n = 139).RESULTSAt baseline and follow-up, significant effects were found between Low and High Resilience groups for the majority of outcome measures. There were no significant differences in resilience from baseline to follow-up at the group-mean level. At the individual level, caregivers were classified into four longitudinal resilience groups: 1 Persistently Low Resilience (Baseline + Follow-up = Low Resilience, n = 60), 2 Reduced Resilience (Baseline = High Resilience + Follow-up = Low Resilience, n = 33), 3 Improved Resilience (Baseline = Low Resilience + Follow-up = High Resilience, n = 39), and 4 Persistently High Resilience (Baseline + Follow-up = High Resilience, n = 100). From baseline to follow-up, approximately a third of the Reduced and Improved Resilience groups reported a meaningful change in resilience (≥ 10 T). Nearly all of the Persistently High and Persistently Low Resilience groups did not report meaningful change in resilience (< 10 T).CONCLUSIONResilience was not a fixed state for all caregivers. Early intervention may stall the negative caregiving stress-health trajectory and improve caregiver resilience.
The present study aimed to examine the impact of lifetime blast exposure (LBE) on neuropsychological functioning in service members and veterans (SMVs).
Participants were 282 SMVs, with and without ...history of traumatic brain injury (TBI), who were prospectively enrolled in a Defense and Veterans Brain Injury Center (DVBIC)-Traumatic Brain Injury Center of Excellence (TBICoE) Longitudinal TBI Study. A cross-sectional analysis of baseline data was conducted. LBE was based on two factors: Military Occupational Speciality (MOS) and SMV self-report. Participants were divided into three groups based on LBE: Blast Naive (
= 61), Blast + Low Risk MOS (
= 96), Blast + High Risk MOS (
= 125). Multivariate analysis of variance (MANOVA) was used to examine group differences on neurocognitive domains and the Minnesota Multiphasic Personality Inventory-2 Restructured Form.
There were no statistically significant differences in attention/working memory, processing speed, executive functioning, and memory (
< 1.75, ps > .1, η
s < .032) or in General Cognition (
0.95, ps > .3, η
s < .008). Prior to correction for covariates, lifetime blast exposure was related to Restructured Clinical (
(18,542)
1.77,
= .026, η
= .055), Somatic/Cognitive (
(10,550)
1.99,
= .033, η
= .035), and Externalizing Scales (
(8,552)
2.17,
= .028, η
= .030); however, these relationships did not remain significant after correction for covariates (
1.53, ps > .145, η
s < .032).
We did not find evidence of a relationship between LBE and neurocognitive performance or psychiatric symptoms. This stands in contrast to prior studies demonstrating an association between lifetime blast exposure and highly sensitive blood biomarkers and/or neuroimaging. Overall, findings suggest the neuropsychological impact of lifetime blast exposure is minimal in individuals remaining in or recently retired from military service.
The Blast Exposure Threshold Survey (BETS) is a recently developed and promising new self-report measure of lifetime blast exposure (LBE). However, there are no studies that have examined the ...psychometric properties of the BETS, which currently limits its clinical utility. The purpose of this study was to examine the convergent and discriminant validity of the BETS by comparing the BETS Generalized Blast Exposure Value (GBEV) to six variables hypothesized to be associated with LBE (i.e., single-item LBE, combat exposure, years in the military, number of combat deployments, and military occupation specialty MOS) and three variables hypothesized not to be associated with LBE (i.e., age at the time of injury, estimated pre-morbid Full-Scale Intelligence Quotient FSIQ, and resilience). Participants were 202 United States service members and veterans prospectively enrolled from three military medical treatment facilities (68.7%) and via community recruitment initiatives (31.3%). Participants completed the BETS, Combat Exposure Scale (CES), Deployment Risk and Resiliency Inventory-2 Combat Experiences (DRRI-2 CE), Traumatic Brain Injury-Quality of Life Resilience scale, and a brief structured interview. For some analyses, participants were classified into two blast risk MOS groups: high (
= 89) and low (
= 94). The BETS GBEV was not significantly correlated with all three non-blast related variables (r
= 0.01 to r
= -0.12). In contrast, GBEV was significantly (
< 0.001) associated with all blast-related variables; single-item LBE (r
= 0.76), CES (r
= 0.58), number of combat deployments (r
= 0.53), DRRI-2 CE (r
= 0.48), and high blast risk MOS (r = 0.36, medium effect size). However, a stronger relationship was found between the blast-related variables and three modified GBEV scores when excluding some small weapons categories; single-item LBE (r
= 0.80-0.82), CES (r
= 0.64-0.67), number of combat deployments (r
= 0.56), DRRI-2 CE (r
= 0.51-0.53), and high blast risk MOS (r = 0.42-0.49, medium-large effect size). This is the first study to examine the psychometric properties of the BETS. Overall, these results offer support for the convergent and discriminant validity of the BETS. In order to ensure that the BETS can be confidently used as a valid and reliable measure of LBE, more research is needed to further examine the psychometric properties of the test, particularly with regard to the establishment of test-retest reliability.
Concurrent mild traumatic brain injury (mTBI) and posttraumatic stress disorder (PTSD) are common in U.S. military service members and veterans. Tau and amyloid‐beta‐42 (Aβ42) are proteins that have ...been linked to cognitive impairment, neurological hallmarks of Alzheimer's disease, and may also relate to recovery from mTBI. However, the role of these proteins in the maintenance or resolution of chronic symptoms has not yet been determined. Participants in the current study were 102 service members and veterans who had sustained an mTBI (n = 84) or injured controls (IC) without TBI (n = 18). They were categorized into three groups based on the presence or absence of mTBI and PTSD: IC/PTSD‐Absent (n = 18), mTBI/PTSD‐Absent (n = 63), and mTBI/PTSD‐Present (n = 21). Concentrations of tau and Aβ42 in peripheral blood plasma were measured using SimoaTM, an ultrasensitive technology, and compared across groups. Tau concentrations were highest in the mTBI/PTSD‐Present group, F(2, 99) = 4.33, p = .016, compared to the other two groups. Linear multiple regression was conducted to determine the independent effects of PTSD and mTBI on tau concentrations, controlling for gender and sleep medication. PTSD was a significant and independent predictor of tau concentrations, β = .25, p = .009, ηp2 = .26. Aβ42 concentrations did not differ between the groups. The results indicated that PTSD was associated with an elevation of tau in peripheral blood and suggest that there may be increased biological effects of PTSD in this young cohort of service members and veterans following mTBI.
Resumen
Spanish s by Asociación Chilena de Estrés Traumático (ACET)
La Lesión Cerebral Traumática Leve Concurrente con Trastorno de Estrés Postraumático se asocia a elevadas concentraciones de Tau en Plasma de Sangre Periférica
TRASTORNO DE ESTRÉS POSTRAUMÁTICO Y TAU ELEVADA
La comorbilidad entre lesión cerebral traumática leve (mTBI por su sigla en inglés) y Trastorno de Estrés Postraumático (TEPT) es común en miembros del ejército estadounidense en servicio y en veteranos. Tau y beta‐amiloide‐42 (Aβ42) son proteínas que han sido relacionadas a deterioro cognitivo, son marcadores neurológicos de Enfermedad de Alzheimer, y pueden también relacionarse a la recuperación de mTBI. Sin embargo, el rol de estas proteínas en la mantención o resolución de síntomas crónicos aún no ha sido determinado. Los participantes del presente estudio fueron 102 miembros en servicio y veteranos que habían sufrido una mTBI (n = 84) o controles heridos (CH) sin TBI (n = 18). Fueron categorizados en tres grupos de acuerdo con la presencia o ausencia de mTBI y TEPT; CH/TEPT‐Ausente (n = 18), mTBI/TEPT‐Ausente (n = 63) y mTBI‐TEPT Presente (n = 21). Se midieron las concentraciones de Tau y Aβ42 en plasma de sangre periférica usando SimoaTM, una tecnología ultrasensible, y fueron comparadas entre grupos. Las concentraciones de Tau fueron más altas en el grupo mTBI/TEPT‐Presente, F(2, 99) = 4.33, p = .016, en comparación a los otros dos grupos. Se realizó una regresión lineal múltiple para determinar los efectos independientes del TEPT y mTBI sobre la concentración de Tau, controlando el género y la medicación para dormir. El TEPT fue un predictor significativo e independiente de concentraciones de Tau, β = .25, p = .009, ηp2 = .26. Las concentraciones de Aβ42 no difirieron entre los grupos. Los resultados indicaron que el TEPT se asoció a una elevación de Tau en sangre periférica y sugieren que puede haber efectos biológicos del TEPT incrementados en esta joven cohorte de miembros en servicio y veteranos luego de una mTBI.
抽象
Traditional and Simplified Chinese s by the Asian Society for Traumatic Stress Studies (AsianSTSS)
簡體及繁體中文撮要由亞洲創傷心理研究學會翻譯
Concurrent Mild Traumatic Brain Injury and Post‐Traumatic Stress Disorder is Associated with Elevated Tau Concentrations in Peripheral Blood Plasma
Traditional Chinese
標題: 同時患輕微創傷性腦損傷及創傷後壓力症跟外周血漿中Tau 蛋白的濃度提升有關
撮要: 同時患輕微創傷性腦損傷(mTBI)及創傷後壓力症(PTSD), 在美國現役和退役軍人中普遍。過往研究發現, Tau 蛋白和澱粉樣蛋白β42(Aβ42)跟認知功能障礙及阿茲海默症的神經特徵有關, 亦可能跟mTBI康復有關。可是, 仍未有研究檢視以上兩種蛋白是否會影響慢性症狀維持或改善。本研究樣本為102名現役和退役軍人, 當中一些有mTBI (n = 84), 一些則有受傷(IC)但無TBI (n = 18)以用作對照。我們基於樣本是否有mTBI和PTSD, 把他們歸類為三個組別:IC/無PTSD(n = 18)、mTBI/無PTSD(n = 63)、mTBI/有PTSD(n = 21)。我們採用超靈敏技術SimoaTM, 測量外周血漿中Tau蛋白和Aβ42蛋白的濃度, 再比較不同組別的數據。三組中, mTBI/有PTSD組別中的Tau 蛋白濃度最高(F(2, 99) = 4.33, p = .016)。多元線性迴歸用以找出PTSD與mTBI個別對Tau蛋白濃度的效應, 並以性別和睡眠藥物作對照。PTSD對Tau蛋白濃度是顯著和獨立的預測變量(β = .25, p = .009, ηp2 = .26)。Aβ42蛋白濃度在組別間並無差異。結果反映, PTSD跟外周血漿中Tau蛋白濃度提升有關, 並反映在年輕、有mTBI的現役和退役軍人樣本中, PTSD可能產生較高水平的生理效應。
Simplified Chinese
标题: 同时患轻微创伤性脑损伤及创伤后压力症跟外周血浆中Tau 蛋白的浓度提升有关
撮要: 同时患轻微创伤性脑损伤(mTBI)及创伤后压力症(PTSD), 在美国现役和退役军人中普遍。过往研究发现, Tau 蛋白和淀粉样蛋白β42(Aβ42)跟认知功能障碍及阿兹海默症的神经特征有关, 亦可能跟mTBI康复有关。可是, 仍未有研究检视以上两种蛋白是否会影响慢性症状维持或改善。本研究样本为102名现役和退役军人, 当中一些有mTBI (n = 84), 一些则有受伤(IC)但无TBI (n = 18)以用作对照。我们基于样本是否有mTBI和PTSD, 把他们归类为三个组别:IC/无PTSD(n = 18)、mTBI/无PTSD(n = 63)、mTBI/有PTSD(n = 21)。我们采用超灵敏技术SimoaTM, 测量外周血浆中Tau蛋白和Aβ42蛋白的浓度, 再比较不同组别的数据。三组中, mTBI/有PTSD组别中的Tau 蛋白浓度最高(F(2, 99) = 4.33, p = .016)。多元线性回归用以找出PTSD与mTBI个别对Tau蛋白浓度的效应, 并以性别和睡眠药物作对照。PTSD对Tau蛋白浓度是显著和独立的预测变量(β = .25, p = .009, ηp2 = .26)。Aβ42蛋白浓度在组别间并无差异。结果反映, PTSD跟外周血浆中Tau蛋白浓度提升有关, 并反映在年轻、有mTBI的现役和退役军人样本中, PTSD可能产生较高水平的生理效应。
This study examined whether sleep disturbances were associated with neurobehavioral outcome following a traumatic brain injury (TBI) in a well characterized group of service members and veterans.
Six ...hundred and six participants were enrolled into the Defense and Veterans Brain Injury Center, 15-Year Longitudinal TBI study. All participants completed a battery of tests measuring self-reported sleep disturbances, neurobehavioral symptoms, and posttraumatic stress disorder symptoms. Data were analyzed using analysis of variance with post hoc comparisons. Four groups were analyzed separately: uncomplicated mild TBI; complicated mild, moderate, severe, or penetrating combined TBI; injured controls (ie, orthopedic or soft-tissue injury without TBI); and noninjured controls.
A higher proportion of the mild TBI group reported moderate-severe sleep disturbances (66.5%) compared to the injured control group (54.9%), combined TBI (47.5%), and noninjured control groups (34.3%). Participants classified as having Poor Sleep had significantly worse scores on the majority of TBI-Quality of Life scales compared to those classified as having Good Sleep, regardless of TBI severity or the presence of TBI. There was a significant interaction between sleep disturbances and posttraumatic stress disorder. While sleep disturbances and posttraumatic stress disorder by themselves were significant factors associated with worse outcome, both factors combined resulted in worse outcome than either singularly.
Regardless of group (injured or noninjured control), sleep disturbances were common and were associated with significantly worse neurobehavioral functioning. When experienced concurrently with posttraumatic stress disorder, sleep disturbances pose significant burden to service members and veterans.
Pattinson CL, Brickell TA, Bailie J, et al. Sleep disturbances following traumatic brain injury are associated with poor neurobehavioral outcomes in US military service members and veterans.
. 2021;17(12):2425-2438.
To describe and compare cohorts between 2 large, longitudinal, federally-funded TBI studies of Service members and veterans across demographic, self-report, and neuropsychological variables.
Analysis ...of data from the DVBIC-TBICoE and LIMBIC-CENC prospective longitudinal studies (PLS).
Recruitment locations spanning Department of Defense and Veterans Affairs hospitals across the U.S.
1463 participants (N=1463) enrolled in the DVBIC-TBICoE study and divided among non-injured (NIC) (n=191), injured control (IC) (n=349), mild TBI (mTBI) (n=682), and (severe, moderate, penetrating, and complicated mild traumatic brain injury (smcTBI) (n=241) subgroups. 1550 participants enrolled in the LIMBIC-CENC study and divided between IC (n=285) and mTBI (n=1265) subgroups. IC and mTBI study groups were compared across demographic and military characteristics, self-reported symptoms, and neuropsychological test scores.
None.
Neurobehavioral Symptom Inventory, PTSD Checklist-Military Version, TBI quality of life, Test of Premorbid Functioning, Wechsler Adult Intelligence Scale-IV Visual Puzzles, Symbol Search, Coding, Letter-Number Sequencing, and Digit Span, Trail Making Test, Delis-Kaplan Executive Functioning System Verbal Fluency, Letter Fluency, and Category Fluency, California Verbal Learning Test-II, and Grooved Pegboard.
Compared with DVBIC-TBICoE, LIMBIC-CENC participants have higher enrollment age, education level, proportion of Black race, and time from injury as well as less combat deployments and are less likely to be married. The distribution of military service branches also differed. Further, symptom profiles differed between cohorts. LIMBIC-CENC participants endorsed higher posttraumatic stress disorder symptomatology. DVBIC-TBICoE study IC participants endorsed higher somatosensory and vestibular symptoms (medium effect sizes). Other symptom measure differences had very small effect sizes (≤0.2). Differences were found on many cognitive test results, but are difficult to interpret given the demographic differences and generally very small effect sizes.
The heavy use of National Institutes of Health common data elements in both studies and collaboration with the DVBIC-TBICoE study team on development of the LIMBIC-CENC assessment battery enabled this comparative analysis. Results highlight unique differences in study cohorts and add perspective and interpretability for assimilating past and future findings.
Traumatic brain injury (TBI) can be associated with long-term neurobehavioral symptoms. Here, we examined levels of neurofilament light chain (NfL) and glial fibrillary acidic protein (GFAP) in ...extracellular vesicles isolated from blood, and their relationship with TBI severity and neurobehavioral symptom reporting. Participants were 218 service members and veterans who sustained uncomplicated mild TBIs (mTBI, n = 107); complicated mild, moderate, or severe TBIs (smcTBI, n = 66); or Injured controls (IC, orthopedic injury without TBI, n = 45). Within one year after injury, but not after, NfL was higher in the smcTBI group than mTBI (p = 0.001, d = 0.66) and IC (p = 0.001, d = 0.35) groups, which remained after controlling for demographics and injury characteristics. NfL also discriminated the smcTBI group from IC (AUC:77.5%, p < 0.001) and mTBI (AUC:76.1%, p < 0.001) groups. No other group differences were observed for NfL or GFAP at either timepoint. NfL correlated with post-concussion symptoms (r
= - 0.38, p = 0.04) in the mTBI group, and with PTSD symptoms in mTBI (r
= - 0.43, p = 0.021) and smcTBI groups (r
= - 0.40, p = 0.024) within one year after injury, which was not confirmed in regression models. Our results suggest the potential of NfL, a protein previously linked to axonal damage, as a diagnostic biomarker that distinguishes TBI severity within the first year after injury.
Primary objective: The purpose of this study was to examine the relationship between resilience and symptom reporting following mild traumatic brain injury (mTBI). It was hypothesized that, as ...resilience increases, self-reported symptoms would decrease.
Research design: Cross-sectional design.
Methods and procedures: Participants were 142 US military service members who sustained a mTBI, divided into three resilience groups based on participants' responses on the Response to Stressful Experiences Scale: Moderate (n = 42); High (n = 51); and Very High (n = 49). Participants completed the Neurobehavioral Symptom Inventory (NSI) and PTSD Checklist-Civilian Version (PCL-C) within 12 months following injury.
Main outcomes and results: There were significant main effects for the NSI total score, cognitive cluster and affective cluster, as well as for the PCL-C total score, avoidance cluster and hyperarousal cluster. Pairwise comparisons revealed that there was a negative relationship between resilience and self-reported symptoms overall. Specifically, participants with higher resilience reported fewer post-concussion and PTSD-related symptoms than participants with lower levels of resilience.
Conclusions: These findings underscore the important role that resilience plays in symptom expression in military service members with mTBI and suggest that research on targeted interventions to increase resilience in the acute phase following injury is indicated.
Purpose
To examine factors related to resilience in military caregivers across caregiver health-related quality of life (HRQOL), caregiver sociodemographic variables, and service member/veteran (SMV) ...injury and health status.
Methods
Caregivers (
N
= 346, Female = 96.2%; Spouse = 91.0%; Age:
M
= 40.6 years, SD = 9.3) of SMVs following a mild, moderate, severe, or penetrating TBI were recruited from U.S. military treatment facilities and via community outreach. Caregivers completed select TBI-CareQOL and NIH Toolbox scales, the Caregiver Appraisal Scale, Caregiver Questionnaire, and Mayo-Portland Adaptability Inventory-4. Caregivers were divided into three groups using the TBI-QOL Resilience scale: (1) Low-Moderate Resilience (
n
= 125), (2) Moderate Resilience (
n
= 122), and (3) Moderate-High Resilience (
n
= 99).
Results
Factors related to low caregiver resilience were strain on employment, financial burden from out-of-pocket expenses, caring for children, less personal time, caring for both verbal and physical irritability, anger, and aggression, and lower SMV functional ability (all
p
’s < .05). The Low-Moderate Resilience group had consistently worse HRQOL scores compared to the Moderate and Moderate-High Resilience groups (
p
s < .001;
d
= .50–1.60), with the exception of Caregiving Ideology.
Conclusion
Lower resilience among caregivers of SMVs following TBI is associated with poorer caregiver HRQOL. Programs aimed at promoting and maintaining resilience in military caregivers long-term is important for their own health, the health of the SMV, and the health of their children.
Purpose/Objective: To examine longitudinal change in health-related quality of life (HRQOL) in caregivers of service members/veterans with traumatic brain injury and factors associated with ...clinically elevated symptoms. Research Method/Design: Caregivers (N = 220) completed nine HRQOL outcome measures and 10 risk factor measures at a baseline evaluation and follow-up evaluation 3 years later. Caregiver's responses on the nine HRQOL outcome measures were classified into four clinical change categories based on the presence/absence of clinically elevated T-scores (≥60 T) at baseline and follow-up: (a) Persistent (baseline ≥ 60T + follow-up ≥ 60 T), (b) Developed (baseline < 60 T + follow-up ≥ 60 T), (c) Improved (baseline ≥ 60 T + follow-up < 60 T), and (d) Asymptomatic (baseline < 60 T + follow-up < 60 T). A clinical change composite score was calculated by summing the number of Persistent or Developed HRQOL outcome measures and used to create three clinical change groups: (a) No Symptoms (n = 69, zero measures), (b) Some Symptoms (n = 88, one to three measures), and (c) Numerous Symptoms (n = 63, four to nine measures). Results: Of the nine HRQOL outcome measures, Bodily Pain, Perceived Stress, Sleep-Related Impairment, and Fatigue were most frequently classified as Persistent or Developed from baseline to follow-up in the entire sample. A linear relationship was found between the vast majority of risk factors across the three clinical change groups at baseline and follow-up (Numerous > Some > None). The risk factors were correlated with the number of elevated HRQOL symptoms at baseline and follow-up. Most Asymptomatic or Persistent caregivers did not have meaningful change (≥1 SD) in HRQOL scores. A sizable proportion of Developed or Improved caregivers had either meaningful or no change in HRQOL scores. Conclusions/Implications: There is a need for ongoing clinical services for military caregivers.
Impact and Implications
This study extended previous cross-sectional research by examining risk factors for poor physical, psychological, and social health-related quality of life (HRQOL) in caregivers of service members/veterans with traumatic brain injury over three years. Most caregivers reported stability in HRQOL over three years (symptomatic to symptomatic or asymptomatic to asymptomatic); however, some reported a decline (asymptomatic to symptomatic) or improvement (symptomatic to asymptomatic). Constructs related to positive affect, relationships, social support, caregiving, economic, and service members and veteran functioning were risk factors for persistent or developed clinical symptoms. Early intervention while in Department of Defense health care may help military families adapt to and cope with caregiving and stall the stress-health process.
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