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Identifying Unique Symptom Groups Following Mild Traumatic Brain Injury Using the Neurobehavioral Symptom Inventory
Stephanie Agtarap1, Lars D Hungerford, Mark L Ettenhofer
1Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland (Drs Agtarap, Hungerford, and Ettenhofer); Naval Medical Center San Diego, San Diego, California (Drs Agtarap, Hungerford, and Ettenhofer); General Dynamics Information Technology, Falls Church, Virginia (Drs Agtarap, Hungerford, and Ettenhofer); Craig Hospital, Englewood, Colorado (Dr Agtarap); and University of California, San Diego, La Jolla, California (Dr Ettenhofer).
A bifactor model identified distinct groups of posttraumatic stress, depressive, cognitive, and neurological symptoms in military members with mild traumatic brain injury (TBI). These symptom clusters relate to clinical outcomes, aiding TBI treatment.
Area of Science:
- Neuroscience
- Psychiatry
- Military Health
Background:
- Mild traumatic brain injury (TBI) is prevalent in military populations, often co-occurring with posttraumatic stress symptoms.
- Understanding the symptom structure of TBI is crucial for effective clinical management and rehabilitation.
Purpose of the Study:
- To identify shared and unique symptom groups in posttraumatic stress and postconcussive symptoms using bifactor analysis.
- To examine the relationship between these symptom groups and clinical outcomes in Active Duty Service Members.
Main Methods:
- A bifactor analysis was employed on data from 1476 Active Duty Service Members with mild TBI.
- Symptom data were collected using the Neurobehavioral Symptom Inventory (NSI) and PTSD Checklist for DSM-V (PCL-5).
- Concurrent measures included the PHQ-8, PSQI, and HIT-6.
Main Results:
- A bifactor model revealed distinct symptom groups: posttraumatic stress, depressive, cognitive, and neurological/somatic.
- A universal factor representing general distress was identified, with specific symptom groups emerging independently.
- These symptom groups showed differential relationships with measured clinical outcomes.
Conclusions:
- The bifactor structure provides a framework for understanding the complex symptomology of mild TBI in military personnel.
- This approach can help derive clinically meaningful insights from self-reported symptoms to improve TBI treatment strategies.
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