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Psychological Health of Female Service Members and Veterans Associated With Mild Traumatic Brain Injury History: A
Landon B Lempke1, Samuel R Walton, Carrie Esopenko
1Author Affiliations: Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, Virginia (Drs Lempke, Walton, Mills, Cifu, Walker, and Oldham); Richmond Veterans Affairs Medical Center, Central Virginia VA Health Care System, Richmond, Virginia (Drs Lempke, Walton, Cifu, and Walker); Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York (Dr Esopenko); Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT (Drs Esopenko, de Souza and Wilde); George E. Wahlen VA Salt Lake City Healthcare System, Salt Lake City, Utah (Dr Wilde); and Injury Prevention Center, Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan (Dr Bretzin).
Objectives:
To (1) evaluate differences in psychological health outcomes between US female service members and veterans (FSMVs) with and without mild traumatic brain injury (mTBI) history, and (2) examine the associations between psychological health and lifetime mTBI history, time since last mTBI, blast-mTBI history, and combat-mTBI history.
Setting:
Ten military and veteran health care study sites nationwide.
Participants:
FSMV enrolled in the Long-term Impact of Military-relevant Brain Injury Consortium-Chronic Effects of Neurotrauma Consortium (LIMBIC-CENC) study. We used 2:1 propensity score matching to match FSMVs with a prior mTBI (n = 148; age: 40.0 ± 8.7 years; time since last mTBI: 11.6 ± 9.4 years) to those without mTBI history (n = 74) on demographic and health-history confounders.
Design:
Prospective, longitudinal study design with current cross-sectional analysis.
Main Measures:
FSMVs completed thorough health history evaluations and standardized assessments consisting of the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL5), Patient Health Questionnaire-9 (PHQ-9), Neurobehavioral Symptom Inventory (NSI), Satisfaction With Life Scale (SWLS), and the Traumatic Brain Injury-Quality of Life (TBI-QoL) anxiety and emotional-behavioral dyscontrol modules.
Results:
Compared to the no mTBI group, FSMVs with any lifetime mTBI displayed worse PCL-5, PHQ-9, NSI, and TBI-QoL Anxiety total scores ( P ≤ .002), but not SWLS or TBI-QoL emotional-behavioral dyscontrol. Combat mTBI history demonstrated worse PCL-5, SWLS, and TBI-QoL Anxiety total scores ( P ≤ .047). Greater SWLS scores were observed for each year since their last mTBI ( P = .048). No significant differences for cumulative mTBI history or any blast-mTBI history were observed across outcomes ( P ≥ .146).
Conclusions:
FSMVs with ≥1 mTBI history reported greater psychological symptoms than those without. Among FSMVs with lifetime mTBI history, combat-mTBI history was associated with worse PTSD, life satisfaction, and anxiety symptoms. Our findings indicate that a single mTBI, notably combat-related, may adversely impact psychological health, but future research is necessary for longitudinal, comprehensive FSMV health understanding across the lifespan post-mTBI.
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