Long-term negative emotional outcomes of warzone TBI

Objective: Many veterans of the Iraq and Afghanistan Wars have experienced traumatic brain injury (TBI). Although prior work has examined associations between TBI and development of psychi- atric syndromes, less is known about associations between TBI and component emotions constituting these syndromes, especially in the long term. The purpose of this study was to examine the long-term emotional consequences of deployment-related TBI. Methods: As part of VA Cooperative Studies Program #566, we assessed a sample of n1⁄4456US Army soldiers prior to an index deployment to Iraq, and again an average of 8.3 years (SD1⁄42.4years) after their deployment for a long-term follow-up assessment. In this report, we used adjusted regression analyses to examine the relationship of deployment TBI to depression, anxiety, and stress symptom severity measured at the long-term follow-up assessment. A structured interview was used to determine TBI history; the Depression, Anxiety, and Stress Scale, 21-item version (DASS-21) was used to determine emotional status at the follow-up evaluation. Results: Warzone TBI events, particularly when greater than mild in severity, were independently associated with depression, anx- iety, and stress severity at long-term follow-up, even after taking into account variance attributable to pre-deployment emotional distress and war-zone stress. Post-hoc analyses did not detect independent associations of either number of events or injury mechanism with outcomes. Conclusions: These findings highlight the potentially enduring and multi-faceted emotional effects of deployment TBI, underscor- ing the need for early assessment of negative affectivity in war- zone veterans reporting TBI

Long-term negative emotional outcomes of warzone TBI

Objective: Many veterans of the Iraq and Afghanistan Wars have experienced traumatic brain injury (TBI). Although prior work has examined associations between TBI and development of psychi- atric syndromes, less is known about associations between TBI and component emotions constituting these syndromes, especially in the long term. The purpose of this study was to examine the long-term emotional consequences of deployment-related TBI. Methods: As part of VA Cooperative Studies Program #566, we assessed a sample of n1⁄4456US Army soldiers prior to an index deployment to Iraq, and again an average of 8.3 years (SD1⁄42.4years) after their deployment for a long-term follow-up assessment. In this report, we used adjusted regression analyses to examine the relationship of deployment TBI to depression, anxiety, and stress symptom severity measured at the long-term follow-up assessment. A structured interview was used to determine TBI history; the Depression, Anxiety, and Stress Scale, 21-item version (DASS-21) was used to determine emotional status at the follow-up evaluation. Results: Warzone TBI events, particularly when greater than mild in severity, were independently associated with depression, anx- iety, and stress severity at long-term follow-up, even after taking into account variance attributable to pre-deployment emotional distress and war-zone stress. Post-hoc analyses did not detect independent associations of either number of events or injury mechanism with outcomes. Conclusions: These findings highlight the potentially enduring and multi-faceted emotional effects of deployment TBI, underscor- ing the need for early assessment of negative affectivity in war- zone veterans reporting TBI

Health-related quality of life in Huntington’s Disease patients: a comparison of proxy assessment and patient self-rating using the disease-specific Huntington’s Disease health-related quality of life questionnaire (HDQoL)

Huntington’s disease (HD) is a fatal, neurodegenerative disease for which there is no known cure. Proxy evaluation is relevant for HD as its manifestation might limit the ability of persons to report their health-related quality of life (HrQoL). This study explored patient–proxy ratings of HrQoL of persons at different stages of HD, and examined factors that may affect proxy ratings. A total of 105 patient–proxy pairs completed the Huntington’s disease health-related quality of life questionnaire (HDQoL) and other established HrQoL measures (EQ-5D and SF-12v2). Proxy–patient agreement was assessed in terms of absolute level (mean ratings) and intraclass correlation. Proxies’ ratings were at a similar level to patients’ self-ratings on an overall Summary Score and on most of the six Specific Scales of the HDQoL. On the Specific Hopes and Worries Scale, proxies on average rated HrQoL as better than patients’ self-ratings, while on both the Specific Cognitive Scale and Specific Physical and Functional Scale proxies tended to rate HrQoL more poorly than patients themselves. The patient’s disease stage and mental wellbeing (SF-12 Mental Component scale) were the two factors that primarily affected proxy assessment. Proxy scores were strongly correlated with patients’ self-ratings of HrQoL, on the Summary Scale and all Specific Scales. The patient–proxy correlation was lower for patients at moderate stages of HD compared to patients at early and advanced stages. The proxy report version of the HDQoL is a useful complementary tool to self-assessment, and a promising alternative when individual patients with advanced HD are unable to self-report

Pre-Stressor Interference Control and Intrusive Memories

Although intrusive imagery is a common response in the aftermath of a stressful or traumatic event, only a minority of trauma victims show persistent re-experiencing and related psychopathology. Individual differences in pre-trauma executive control possibly play a critical role. Therefore, this study investigated whether a relatively poor pre-stressor ability to resist proactive interference in working memory might increase risk for experiencing undesirable intrusive memories after being exposed to a stressful event. Non-clinical participants (N = 85) completed a modified version of a widely used test of interference control in working memory (CVLT; Kramer and Delis 1991) and subsequently watched an emotional film fragment. Following presentation of the fragment, intrusive memories were recorded in a 1-week diary and at a follow up session 7 days later. A relatively poor ability to resist proactive interference was related to a relatively high frequency of film-related intrusive memories. This relationship was independent of neuroticism and gender. These findings are consistent with the idea that a pre-morbid deficit in the ability to resist proactive interference reflects a vulnerability factor for experiencing intrusive memories after trauma exposure

Are Iraq and Afghanistan Veterans Using Mental Health Services? New Data From a National Random-Sample Survey

This study analyzed data from a national survey of Iraq and Afghanistan veterans to improve understanding of mental health services use and perceived barriers

Criminal justice involvement, trauma, and negative affect in Iraq and Afghanistan war era veterans.

Although criminal behavior in veterans has been cited as a growing problem, little is known about why some veterans are at increased risk for arrest. Theories of criminal behavior postulate that people who have been exposed to stressful environments or traumatic events and who report negative affect such as anger and irritability are at increased risk of antisocial conduct. We thus hypothesized that veterans with posttraumatic stress disorder (PTSD) or traumatic brain injury (TBI) who report anger/irritability would show higher rates of criminal arrests. To test this, we examined data in a national survey of N=1388 Iraq and Afghanistan War Era Veterans. We found that 9% of respondents reported arrests since returning home from military service. Most arrests were associated with nonviolent criminal behavior resulting in incarceration for less than two weeks. Unadjusted bivariate analyses revealed that veterans with probable PTSD or TBI who reported anger/irritability were most likely to be arrested. In multivariate analyses, arrests were found to be significantly related to younger age, male gender, having witnessed family violence, prior history of arrest, alcohol/drug misuse, and PTSD with high anger/irritability but were not significantly related to combat exposure or TBI. Findings show that a subset of veterans with PTSD and negative affect may be at increased risk of criminal arrest. Since arrests are more strongly linked to substance abuse and criminal history, clinicians should also consider non-PTSD factors when evaluating and treating veterans with criminal justice involvement

Protective mechanisms and prevention of violence and aggression in veterans.

Although a subset of Iraq and Afghanistan Veterans show aggression toward others after they return home from military service, little is known about protective mechanisms that could be bolstered to prevent violence. A national longitudinal survey was conducted between 2009 and 2011 using a random sample of veterans who served in Operation Iraqi Freedom or Operation Enduring Freedom. One thousand ninety veterans, from 50 states representing all military branches, completed two waves of data collection, one-year apart (retention rate=79%). The final sample resembled the U.S. military post 9/11 in terms of age, sex, ethnicity, geography, and service branch. Protective mechanisms in socioeconomic (money to cover basic needs, stable employment), psychosocial (resilience, perceiving control over one’s life, social support), and physical (healthy sleep, no physical pain) domains were examined. We found these protective mechanisms predicted decreased aggression and violence at follow-up, particularly with higher risk veterans. Multivariable analyses confirmed protective mechanisms lowered violence through their interaction with risk factors. This study identifies protective mechanisms related to decreased community violence in veterans and indicates that rehabilitation aimed at improving socioeconomic, psychosocial, and physical well-being has potential promise to reduce aggression and violence among veterans after returning home from military service