Health Outcomes Associated With Military Deployment: Mild Traumatic Brain Injury, Blast, Trauma, and Combat Associations in the Florida National Guard
Health Services Research and Development (HSR&D)/Rehabilitation Research and Development (RR&D) Center of Excellence: Maximizing Rehabilitation Outcomes, James A. Haley Veterans' Hospital, Tampa, FLArchives of physical medicine and rehabilitation (Impact Factor: 2.57). 06/2012; 93(11). DOI: 10.1016/j.apmr.2012.05.024
Vanderploeg RD, Belanger HG, Horner RD, Spehar AM, Powell-Cope G, Luther SL, Scott SG. Health outcomes associated with military deployment: mild traumatic brain injury, blast, trauma, and combat associations in the Florida National Guard. OBJECTIVES: To determine the association between specific military deployment experiences and immediate and longer-term physical and mental health effects, as well as examine the effects of multiple deployment-related traumatic brain injuries (TBIs) on health outcomes. DESIGN: Online survey of cross-sectional cohort. Odds ratios were calculated to assess the association between deployment-related factors (ie, physical injuries, exposure to potentially traumatic deployment experiences, combat, blast exposure, and mild TBI) and current health status, controlling for potential confounders, demographics, and predeployment experiences. SETTING: Nonclinical. PARTICIPANTS: Members (N=3098) of the Florida National Guard (1443 deployed, 1655 not deployed). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Presence of current psychiatric diagnoses and health outcomes, including postconcussive and non-postconcussive symptoms. RESULTS: Surveys were completed an average of 31.8 months (SD=24.4, range=0-95) after deployment. Strong, statistically significant associations were found between self-reported military deployment-related factors and current adverse health status. Deployment-related mild TBI was associated with depression, anxiety, posttraumatic stress disorder (PTSD), and postconcussive symptoms collectively and individually. Statistically significant increases in the frequency of depression, anxiety, PTSD, and a postconcussive symptom complex were seen comparing single to multiple TBIs. However, a predeployment TBI did not increase the likelihood of sustaining another TBI in a blast exposure. Associations between blast exposure and abdominal pain, pain on deep breathing, shortness of breath, hearing loss, and tinnitus suggested residual barotrauma. Combat exposures with and without physical injury were each associated not only with PTSD but also with numerous postconcussive and non-postconcussive symptoms. The experience of seeing others wounded or killed or experiencing the death of a buddy or leader was associated with indigestion and headaches but not with depression, anxiety, or PTSD. CONCLUSIONS: Complex relationships exist between multiple deployment-related factors and numerous overlapping and co-occurring current adverse physical and psychological health outcomes. Various deployment-related experiences increased the risk for postdeployment adverse mental and physical health outcomes, individually and in combination. These findings suggest that an integrated physical and mental health care approach would be beneficial to postdeployment care.
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- "In addition to depression, recent studies also suggest that other mental health conditions may be present in conjunction with mTBI. For example, an online survey of recently deployed Florida National Guard members found that 57.5% reportedly experienced deployment related combat trauma experiences and 51.5% reported blast exposure (Vanderploeg et al., 2012). Strong positive relationships were found between reported mTBI experienced during deployment and anxiety, depression, and PTSD after deployment. "
ABSTRACT: Objective: Given the high prevalence of comorbid conditions found in polytrauma settings, effective screening measures are needed. Several screening tools are commonly used in polytrauma clinics within the Department of Veterans Affairs (VA). This study examined the use of three screening measures [i.e., Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI), and PTSD Checklist-Civilian version (PCL-C)] to predict scores on the Neurobehavioral Symptom Inventory (NSI). Research suggests that the presence of mental health conditions, such as PTSD, share a significant amount of variance with postconcussive symptoms. The investigators hypothesized that the PCL-C would be the best predictor of scores on the NSI. Method: All subjects were administered the screening measures as part of an evaluation in an outpatient Level III polytrauma clinic. Regression analysis was used to determine which instrument might serve as the best predictor of NSI total scores. Results: Regression analysis revealed that BAI, BDI-II, and PCL-C total scores were good predictors of NSI total scores, with the BAI accounting for the majority of the variance. Conclusions: Mental health conditions can account for higher scores on the NSI, and screening of other mental health conditions should be taken into account when reviewing the NSI for individuals in polytrauma settings.
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- "These missions have required multiple deployments from service members, resulting in the risk accumulation of increasingly severe negative psychological consequences over time. The risk for mental health problems among multiply deployed service members is well established (Bliese et al. 2007; Hoge et al. 2004, 2014; Milliken et al. 2007; Vanderploeg et al. 2012; and see Kok et al. 2012, for a meta-analysis). "
ABSTRACT: The risk for mental health problems and relational difficulties in military service members, spouses, and children is well-established. Yet, few services are available for families, particularly during the formative preschool years, when healthy parent-child relationships are crucial to the attainment of major socio-emotional milestones that form the foundation for later development. This paper describes the adaptation of a previously established military and trauma-informed preventive intervention, Families OverComing Under Stress (FOCUS) for use with families with a preschool-aged child (FOCUS for Early Childhood; FOCUS-EC). Grounded in theory and research on family resilience, FOCUS-EC aims to support parents as leaders of the family by providing developmental guidance and psychoeducation on deployment and reintegration, facilitate the construction of a family narrative, and enhance parenting strategies and the parent-child relationship. Furthermore, FOCUS-EC was adapted for use in a telehealth platform, enabling clinicians to reach military and veteran families in their homes, which is particularly useful for high-risk civilian-dwelling military families (including Reserve and National Guard). Pilot work and ongoing data collection as part of a randomized control trial suggest that FOCUS-EC is acceptable and feasible for military and veteran families with preschoolers.
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- "Frontiers in Behavioral Neuroscience www.frontiersin.org June 2014 | Volume 8 | Article 213 | 1 BEHAVIORAL NEUROSCIENCE American Psychiatric Association, 2013; see also Vanderploeg et al., 2012; Vasterling et al., 2012 "
ABSTRACT: Co-morbid mild traumatic brain injury (mTBI) and post-traumatic stress disorder (PTSD) has become the signature disorder for returning combat veterans. The clinical heterogeneity and overlapping symptomatology of mTBI and PTSD underscore the need to develop a preclinical model that will enable the characterization of unique and overlapping features and allow discrimination between both disorders. This study details the development and implementation of a novel experimental paradigm for PTSD and combined PTSD-mTBI. The PTSD paradigm involved exposure to a danger-related predator odor under repeated restraint over a 21day period and a physical trauma (inescapable footshock). We administered this paradigm alone, or in combination with a previously established mTBI model. We report outcomes of behavioral, pathological and biochemical profiles at an acute timepoint. PTSD animals demonstrated recall of traumatic memories, anxiety and an impaired social behavior. In both mTBI and combination groups there was a pattern of disinhibitory like behavior. mTBI abrogated both contextual fear and impairments in social behavior seen in PTSD animals. No major impairment in spatial memory was observed in any group. Examination of neuroendocrine and neuroimmune responses in plasma revealed a trend towards increase in corticosterone in PTSD and combination groups, and an apparent increase in Th1 and Th17 proinflamatory cytokine(s) in the PTSD only and mTBI only groups respectively. In the brain there were no gross neuropathological changes in any groups. We observed that mTBI on a background of repeated trauma exposure resulted in an augmentation of axonal injury and inflammatory markers neurofilament L and ICAM-1. Our observations thus far suggest that this novel stress-trauma-related paradigm may be a useful model for investigating further the overlapping and distinct spatio-temporal and behavioral/biochemical relationship between mTBI and PTSD experienced by combat veterans.
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