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Context Matters: Influence of Injury Context on Long-Term Psychiatric and Cognitive Outcomes in Combat Veterans With
Francesca V Lopez1, Ruiyan Hu, Tanvi Krishnan
1Author Affiliations: Center of Excellence for Stress and Mental Health, Veterans Affairs San Diego Healthcare System, San Diego, California (Drs Lopez, Merritt and Jak); Veterans Affairs San Diego Healthcare System, San Diego, California (Dr Lopez, Ms Hu, Ms Krishnan, and Drs Dell, Merritt, and Jak); Department of Psychiatry, University of California, San Diego, San Diego, California (Drs Lopez, Dell, Merritt and Jak); Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia (Dr Walker); Physical Medicine and Rehabilitation Service, Richmond Veterans Affairs Medical Center, Richmond, Virginia (Dr Walker).
Objective:
To examine the relationship between injury context with psychiatric and cognitive outcomes among combat-exposed Veterans and Service Members with remote mild traumatic brain injury (mTBI).
Setting:
Veterans and Service Members enrolled in the Long-Term Impact of Military-Relevant Injury Consortium (LIMBIC)-Chronic Effects of Neurotrauma Consortium (CENC).
Participants:
LIMBIC-CENC-enrolled participants who had sustained an mTBI exclusively in combat zones (c-mTBI +; n = 314), mTBI sustained exclusively in non-combat settings (c-mTBI-; n = 526), or no history of mTBI (no TBI; n = 347). Inclusion criteria for this study included (1) availability of all mTBI injury-related characteristics, (2) completion of all psychiatric symptom measures, and (3) completion of all neuropsychological measures used for this study.
Design:
Cross-sectional secondary analysis.
Main Measures:
Primary outcomes of interest included total scores on self-reported psychiatric symptom measures (post-traumatic stress, neurobehavioral, and cognitive concerns) and objective cognitive composite test scores (attention, learning, processing speed, executive function, and delayed recall). All analyses adjusted for age, gender, and education.
Results:
Results of separate multivariate analyses of variance indicated that the c-mTBI+ group reported higher post-traumatic ( ηP2 = .08) and neurobehavioral symptoms ( ηP2 = .07), and cognitive concerns ( ηP2 = .04) compared to the c-mTBI- and no TBI groups, whereas the c-mTBI- and no TBI groups did not differ except on cognitive concerns. Additionally, groups did not differ across cognitive composite performance except for significant though weak group differences on learning ( ηP2 = .01), delayed recall ( ηP2 = .03), and processing speed ( ηP2 = .01). Separate hierarchical regression analyses indicated psychiatric symptom burden explained 7-18% of the total variance in cognitive composite performance as a function of mTBI group history ( p s ≤ .002).
Conclusions:
These findings build upon prior work showing that injury context - the context in which mTBI occurs - may play an important role in long-term psychiatric and cognitive outcomes.
