Shockwaves of War: Neurobehavioral Symptom Analysis Post-Al Asad Missile Strike, 2020

On January 8, 2020, Al Asad Air Base was attacked with more than 12 Theatre Ballistic Missiles launched by Iran, marking the largest ballistic missile strike on U.S. service members (SMs). Following the attack, many SMs reported experiencing post-concussive symptoms and changes in sleep patterns. This study aimed to assess the long-term health impacts, specifically focusing on neurobehavioral symptoms, sleep disturbances, and the relationship between blast exposure, location during the attack, and symptom severity.

A survey was conducted 4-6 weeks after the missile attack, gathering data from 583 SMs. The survey evaluated self-reported blast exposure, neurobehavioral symptoms (such as difficulty sleeping, anxiety, and headaches), and sleep habits. Latent class analysis was used to identify neurobehavioral phenotypes among respondents based on their symptoms. Additionally, repeated-measures analysis of variance was employed to assess the relationship between neurobehavioral phenotypes and sleep duration, controlling for factors like blast exposure, location at the time of the attack, and age. This study received a "not research" designation by the Department of Defense institutional review board.

Three distinct neurobehavioral phenotypes were identified: "Minimally Affected" (60.5%), "Moderately Affected" (28.8%), and "Profoundly Affected" (10.7%). Service members in the Moderately and Profoundly Affected phenotypes reported higher probabilities of persistent symptoms and shorter sleep durations, especially those who were closer to the missile strikes. Over 80% of participants reported blast exposure. The Profoundly Affected group had a significantly higher likelihood of being within 100 m of a missile strike compared to those who were more than 100 m away or off the base at the time of the attack, who reported milder symptoms. Sleep duration post-attack was significantly shorter for the Moderately and Profoundly Affected groups compared to the Minimally Affected group (P < .001). Furthermore, the Profoundly Affected group reported significantly shorter sleep durations than the Moderately Affected group.

This study highlights the significant impact of missile proximity on both neurobehavioral symptoms and sleep disturbances. The findings suggest that those exposed to the missile strike at closer proximity had more persistent and severe symptoms, including disrupted sleep patterns. The identification of three neurobehavioral phenotypes emphasizes the need for targeted screening and follow-up care to ensure the best long-term response for these SMs, especially for those in the more severely affected groups. Future studies should investigate the long-term effects of such exposure and explore potential interventions to mitigate health impacts for those at risk. The strengths of this study lie in its large sample size and detailed analysis, while limitations include the lack of longitudinal data.