Clinical utility of PTSD, resilience, sleep, and blast as risk factors to predict poor neurobehavioral functioning following traumatic brain injury: A longitudinal study in U.S. military service members

Abstract

Purpose
This study examined the clinical utility of post-traumatic stress disorder (PTSD), low resilience, poor sleep, and lifetime blast exposure as risk factors for predicting future neurobehavioral outcome following traumatic brain injury (TBI).

Methods
Participants were 591 U.S. military service members and veterans who had sustained a TBI (n = 419) or orthopedic injury without TBI (n = 172). Participants completed the Neurobehavioral Symptom Inventory, PTSD Checklist, and the TBI-Quality of Life (TBI-QOL) scale at baseline and follow-up.

Results
Using the four risk factors at baseline, 15 risk factor combinations were examined by calculating odds ratios to predict poor neurobehavioral outcome at follow-up (i.e., number of abnormal scores across five TBI-QOL scales [e.g., Fatigue, Depression]). The vast majority of risk factor combinations resulted in odds ratios that were considered to be clinically meaningful (i.e., ≥ 2.5) for predicting poor outcome. The risk factor combinations with the highest odds ratios included PTSD singularly, or in combination with poor sleep and/or low resilience (odds ratios = 4.3–72.4). However, poor sleep and low resilience were also strong predictors in the absence of PTSD (odds ratios = 3.1–29.8).

Conclusion
PTSD, poor sleep, and low resilience, singularly or in combination, may be valuable risk factors that can be used clinically for targeted early interventions.

Full text

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Quality of Life Research (2022) 31:2411–2422
https://doi.org/10.1007/s11136-022-03092-4
Clinical utility ofPTSD, resilience, sleep, andblast asrisk factors
topredict poor neurobehavioral functioning followingtraumatic brain
injury: Alongitudinal study inU.S. military service members
RaelT.Lange1,2,3,4,11· LouisM.French1,2,3,5· JasonM.Bailie1,6,11· VictoriaC.Merritt7,8· CassandraL.Pattinson9·
LarsD.Hungerford1,10,11· Sara.M.Lippa2,3· TraceyA.Brickell1,2,3,5,11
Accepted: 14 January 2022 / Published online: 25 January 2022
© The Author(s), under exclusive licence to Springer Nature Switzerland AG 2022
Abstract
Purpose This study examined the clinical utility of post-traumatic stress disorder (PTSD), low resilience, poor sleep, and
lifetime blast exposure as risk factors for predicting future neurobehavioral outcome following traumatic brain injury (TBI).
Methods Participants were 591 U.S. military service members and veterans who had sustained a TBI (n = 419) or orthopedic
injury without TBI (n = 172). Participants completed the Neurobehavioral Symptom Inventory, PTSD Checklist, and the
TBI-Quality of Life (TBI-QOL) scale at baseline and follow-up.
Results Using the four risk factors at baseline, 15 risk factor combinations were examined by calculating odds ratios to pre-
dict poor neurobehavioral outcome at follow-up (i.e., number of abnormal scores across five TBI-QOL scales [e.g., Fatigue,
Depression]). The vast majority of risk factor combinations resulted in odds ratios that were considered to be clinically
meaningful (i.e., ≥ 2.5) for predicting poor outcome. The risk factor combinations with the highest odds ratios included
PTSD singularly, or in combination with poor sleep and/or low resilience (odds ratios = 4.3–72.4). However, poor sleep and
low resilience were also strong predictors in the absence of PTSD (odds ratios = 3.1–29.8).
Conclusion PTSD, poor sleep, and low resilience, singularly or in combination, may be valuable risk factors that can be used
clinically for targeted early interventions.
Keywords Traumatic brain injury· Posttraumatic stress· Sleep disturbance· Resilience· Military
Introduction
Traumatic brain injury (TBI) in military service members
and veterans (SMVs) is common [1]. Outcome from TBI can
range from full recovery to long-term disability, and can be
influenced by many factors (e.g., injury severity; access to
care; and biological and psychological factors [2–4]). In the
United States, it has been estimated that the financial cost of
providing medical and rehabilitation services to SMVs with
a history of TBI is four times greater than those SMVs with-
out a TBI diagnosis [5–7]. As such, early identification and
treatment of those individuals ‘at risk’ for poor long-term
outcome following TBI has obvious benefits for increasing
warfighter readiness and reducing the economic impact of
healthcare provision.
Of particular interest to this study is past research exam-
ining neurobehavioral outcome following TBI of all severi-
ties in military and civilian populations that has consistently
demonstrated that common comorbidities such as PTSD [4,
* Rael T. Lange
rael.lange@gmail.com
1 Traumatic Brain Injury Center ofExcellence, SilverSpring,
MD, USA
2 Walter Reed National Military Medical Center, Bethesda,
MD, USA
3 National Intrepid Center ofExcellence, Bethesda, MD, USA
4 University ofBritish Columbia, Vancouver, BC, Canada
5 Uniformed Services University oftheHealth Sciences,
Bethesda, MD, USA
6 Naval Hospital Camp Pendleton, Oceanside, CA, USA
7 VA San Diego Healthcare System, SanDiego, CA, USA
8 University ofCalifornia San Diego, LaJolla, CA, USA
9 University ofQueensland, Brisbane, QLD, Australia
10 Naval Medical Center San Diego, SanDiego, CA, USA
11 General Dynamics Information Technology, FallsChurch,
VA, USA
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