Neurobehavioral Symptoms in U.S. Special Operations Forces in Rehabilitation After Traumatic Brain Injury: A TBI Model Systems Study

Author:

Garcia Amanda12ORCID,Miles Shannon R23,Reljic Tea4,Silva Marc A2345,Dams-O’Connor Kristen67,Belanger Heather G389,Bajor Laura2310,Richardson Risa124

Affiliation:

1. Traumatic Brain Injury Center of Excellence, James A. Haley Veterans’ Hospital, Tampa, FL 33612, USA

2. Mental Health and Behavioral Sciences Section (MHBSS), James A. Haley Veterans’ Hospital, Tampa, FL 33612, USA

3. Department of Psychiatry & Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL 33613, USA

4. Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL 33612, USA

5. Department of Psychology, University of South Florida, Tampa, FL 33620, USA

6. Department of Rehabilitation and Human Performance, Icahn School of Medicine, New York, NY 10029, USA

7. Department of Neurology, Icahn School of Medicine, New York, NY 10029, USA

8. United States Special Operations Command (USSOCOM), MacDill AFB, FL 33621, USA

9. St Michael’s Inc., Woodbridge, VA 22192, USA

10. Harvard South Shore Psychiatry Residency Program, Brockton, MA 02301, USA

Abstract

ABSTRACT Introduction Special Operations Forces (SOF) personnel are at increased risk for traumatic brain injury (TBI), when compared with conventional forces (CF). Prior studies of TBI in military samples have not typically investigated SOF vs. CF as specific subgroups, despite documented differences in premorbid resilience and post-injury comorbidity burden. The aim of the current study was to compare SOF vs. CF on the presence of neurobehavioral symptoms after TBI, as well as factors influencing perception of symptom intensity. Materials and Methods This study conducted an analysis of the prospective veterans affairs (VA) TBI Model Systems Cohort, which includes service members and veterans (SM/V) who received inpatient rehabilitation for TBI at one of the five VA Polytrauma Rehabilitation Centers. Of those with known SOF status (N = 342), 129 participants identified as SOF (average age = 43 years, 98% male) and 213 identified as CF (average age = 38.7 years, 91% male). SOF vs. CF were compared on demographics, injury characteristics, and psychological and behavioral health symptoms. These variables were then used to predict neurobehavioral symptom severity in univariable and multivariable analyses. Results SOF personnel reported significantly greater posttraumatic stress disorder (PTSD) symptoms but less alcohol and drug use than the CF. SOF also reported greater neurobehavioral symptoms. When examining those with TBIs of all severities, SOF status was not associated with neurobehavioral symptom severity, while race, mechanism of TBI, and PTSD symptoms were. When examining only those with mTBI, SOF status was associated with lower neurobehavioral symptoms, while PTSD severity, white race, and certain mechanisms of injury were associated with greater neurobehavioral symptoms. Conclusions Among those receiving inpatient treatment for TBI, SOF SM/V reported higher neurobehavioral and symptom severity. PTSD was the strongest predictor of neurobehavioral symptoms and should be considered an important treatment target in both SOF and CF with co-morbid PTSD/TBI. A proactive human performance approach towards identification and treatment of psychological and neurobehavioral symptoms is recommended for SOF.

Publisher

Oxford University Press (OUP)

Subject

Public Health, Environmental and Occupational Health,General Medicine

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