Longitudinal associations between insomnia, cannabis use and stress among US veterans.

Insomnia is highly prevalent among military veterans, with rates nearly double that of civilian populations. Insomnia typically co-occurs with other psychological problems, including substance use (e.g. cannabis) and perceived stress. Much of the research focused on insomnia, stress and cannabis use explores cannabis as a sleep aid and a mechanism for stress relief. However, recent theoretical and empirical evidence suggests a dynamic interplay between insomnia, cannabis use and perceived stress, yet few longitudinal studies exist. Using a sample of 1105 post-9/11 veterans assessed over four time points across 12 months, we used latent difference score modelling to examine proportional change between insomnia, perceived stress and cannabis use. Results revealed a complex interplay between all three constructs. In particular, we show that higher prior levels of insomnia are associated with greater increases in perceived stress, and greater prior levels of stress are associated with greater increases in cannabis use. Perhaps more importantly, our results also point to cannabis use as a catalyst for greater increases in both stress and insomnia severity. Our results suggest there may be both benefits and costs of cannabis use among veterans. Specifically, for veterans who experience chronic sleep problems, perceived stress may become overwhelming, and the benefit of stress reduction from increased cannabis use may come at the cost of increasing insomnia symptomology.

Childhood adversity, combat experiences, and military sexual trauma: a test and extension of the stress sensitization hypothesis.

BACKGROUND: U.S. veterans report high rates of traumatic experiences and mental health symptomology [e.g. posttraumatic stress disorder (PTSD)]. The stress sensitization hypothesis posits experiences of adversity sensitize individuals to stress reactions which can lead to greater psychiatric problems. We extend this hypothesis by exploring how multiple adversities such as early childhood adversity, combat-related trauma, and military sexual trauma related to heterogeneity in stress over time and, subsequently, greater risk for PTSD. METHODS: 1230 veterans were recruited for an observational, longitudinal study. Veterans responded to questionnaires on PTSD, stress, and traumatic experiences five times over an 18-month study period. We used latent transition analysis to understand how heterogeneity in adverse experiences is related to transition into stress trajectory classes. We also explored how transition patterns related to PTSD symptomology. RESULTS: Across all models, we found support for stress sensitization. In general, combat trauma in combinations with other types of adverse experiences, namely early childhood adversity and military sexual trauma, imposed a greater probability of transitioning into higher risk stress profiles. We also showed differential effects of early childhood and military-specific adversity on PTSD symptomology. CONCLUSION: The present study rigorously integrates both military-specific and early life adversity into analysis on stress sensitivity, and is the first to examine how sensitivity might affect trajectories of stress over time. Our study provides a nuanced, and specific, look at who is risk for sensitization to stress based on previous traumatic experiences as well as what transition patterns are associated with greater PTSD symptomology.

Military-to-civilian transition strains and risky behavior among post-9/11 veterans.

Many military veterans face significant challenges in civilian reintegration that can lead to troublesome behavior. Drawing on military transition theory (MTT) and using data from a survey of post-9/11 veterans in two metropolitan areas (n = 783), we investigate previously unexamined relationships between post-discharge strains, resentment, depression, and risky behavior, taking into account a set of control variables, including combat exposure. Results indicated that unmet needs at time of discharge and perceived loss of military identity are associated with increased risky behavior. Much of the effects of unmet discharge needs and loss of military identity are mediated by depression and resentment toward civilians. The results of the study are consistent with insights from MTT, providing evidence of specific ways in which transitions can affect behavioral outcomes. Moreover, the findings highlight the importance of helping veterans meet their post-discharge needs and adapt to changing identity, in order to reduce the risk of emotional and behavioral problems.

A temporal analysis of mental health symptoms relative to separation from the military.

BACKGROUND: The transition from military to civilian life is a dramatic change that is often stressful for veterans. However, little is known regarding how mental health symptoms fluctuate in the period leading up to and following separation from the military. METHODS: The current study examined posttraumatic stress disorder and depression symptoms reported on surveys completed within 1 year of military separation from 23,887 active duty Millennium Cohort Study participants. A series of general linear models and graphs stratified by demographic and military characteristics examined the association between time until/since separation and mental health symptoms. RESULTS: Character of discharge had the most striking relationship between time until/since separation and mental health. Personnel with Honorable discharges did not differ in their level of mental health symptoms across the study period. In contrast, personnel with Other than Honorable/General discharges reported normal levels of mental health symptoms 1 year-prior to separation but reported progressively greater symptoms leading to separation which persisted through the remainder of study period. CONCLUSIONS: This study suggests that additional outreach is needed for personnel with Other than Honorable/General discharges. However, for most other personnel, increased mental health symptomatology around military separation is not a normative phenomenon and any instance should be treated promptly.

Satisfaction of the Use of Telehealth and Access to Care for Veterans During the COVID-19 Pandemic.

Background: While many health care providers have shifted toward telehealth services in response to the COVID-19 pandemic, little is known about the perception and acceptance of such services, particularly among vulnerable populations. Veterans, who are at increased risk of physical and mental health needs, may benefit from the use and availability of telehealth services. Materials and Methods: Cross sectional survey data related to telehealth use, satisfaction, and access were collected through an online survey. Participants from previous research studies and veterans receiving care at a national veteran behavioral health organization were invited to participate. Results: A total of 404 veterans participated. Before the pandemic, many veterans had never used telehealth for physical (72%) or mental (76%) health care. Since the start of the pandemic, 62% of participants reported they received some care through telehealth services. Most participants found telehealth valuable and helpful (82%), indicated the technology was well explained (77%), and felt that issues were resolved quickly and easily (67%). Access to care was limited among participants who utilize massage therapy (64%), dental care (53%), routine checkups (50%), acupuncture (50%), and physical therapy (48%). Discussion: These findings showed an increase in the use of telehealth services and overwhelming satisfaction among veterans. Despite this, some veterans indicated barriers to receiving physical and mental health care. Conclusions: This provides an opportunity to expand the use of telehealth services to meet the health care needs of veterans. Barriers to care should be addressed to minimize the impact on the well-being of veterans.

Mental Health Outcomes Associated with Risk and Resilience among Military-Connected Youth.

The present study aimed to describe patterns of risk and protective factors affecting U.S. Army families and their association with mental health diagnoses among military-connected children. Wartime military service is associated with increased adverse outcomes for military-connected youth, but few studies have explored the impact of concurrent risk and access to protective factors. Using big data methods to link existing datasets, protective factors (e.g., marital and family functioning) were drawn from a voluntary survey completed by 1,630 US Army spouses. Risk factors (e.g., parent mental health, family moves, deployment) were drawn from Department of Defense (DoD) archival data. Rates of mental health diagnoses among youth were derived from DoD healthcare records. Using the three-step method of latent profile analysis, five profiles emerged with variability across risk and protective factors. The largest group (40% of the sample) had considerable protective factors and limited risk exposure. Statistically significant differences in the prevalence of mental health diagnoses among military-connected youth were observed across profiles (χ2  = 30.067, df = 4, p < .001), with the highest rates (31.1% and 30.5%) observed in the two profiles with the lowest protective factors. Findings suggest most military families are faring well and highlight the importance of a thorough assessment that evaluates both the stressors military families face and the strengths they possess.

el presente estudio tuvo como finalidad describir los patrones de riesgo y los factores protectores que afectan a las familias del Ejército de los Estados Unidos y su asociación con los diagnósticos de salud mental entre niños relacionados con los militares. El servicio militar en tiempos de guerra está asociado con mayores consecuencias adversas para los jóvenes relacionados con los militares, pero pocos estudios han analizado el efecto del riesgo simultáneo y el acceso a los factores protectores. Utilizando métodos de datos masivos para conectar conjuntos de datos existentes, se extrajeron los factores protectores (p. ej.: funcionamiento familiar y conyugal) de una encuesta voluntaria contestada por 1630 cónyuges de militares del Ejército de los Estados Unidos. Los factores de riesgo (p. ej.: la salud mental de los padres, las mudanzas familiares, las comisiones) se obtuvieron de los datos de archivo del Departamento de Defensa (DoD). Los índices de los diagnósticos de salud mental entre los jóvenes se extrajeron de los expedientes de asistencia sanitaria del DoD. Utilizando el método de tres pasos del análisis de perfiles latentes, surgieron cinco perfiles con variabilidad entre los factores de riesgo y los factores protectores. El grupo más grande (el 40% de la muestra) tuvo factores protectores considerables y una exposición a riesgos limitada. Se observaron diferencias estadísticamente significativas en la prevalencia de diagnósticos de salud mental entre los jóvenes relacionados con los militares en los perfiles (χ2 = 30.067, df = 4, p < .001), y los índices más altos (31.1% and 30.5%) se observaron en los 2 perfiles con factores protectores más bajos.Los resultados sugieren que la mayoría de las familias militares se encuentran bien y destacan la importancia de una evaluación exhaustiva que evalúe tanto los factores desencadenantes de estrés que enfrentan las familias de militares como las fortalezas que poseen.

Symptom Severity, Self-efficacy and Treatment-Seeking for Mental Health Among US Iraq/Afghanistan Military Veterans.

Military veterans have high rates of mental health problems, yet the majority do not seek treatment. Understanding treatment-seeking in this population is important. This study investigated if symptom severity and self-efficacy are associated with treatment-seeking among US Iraq/Afghanistan veterans. Survey data from 525 veterans meeting clinical criteria for PTSD and depression were included of which, 54.4% had sought treatment in the past 12 months. Multivariate logistic regression analysis indicated that high symptom severity was associated with treatment seeking, whereas high self-efficacy was associated with a decreased likelihood to seek treatment. Self-efficacy could be an underlying mechanism of treatment seeking decisions.

Measuring Aggregated and Specific Combat Exposures: Associations Between Combat Exposure Measures and Posttraumatic Stress Disorder, Depression, and Alcohol-Related Problems.

Research has shown combat exposure to be associated with negative mental health outcomes. Different combat exposure measures are not composed of the same combat experiences, and few combat exposure measures have been directly compared to another measure. Furthermore, research about the unique associations between specific combat experiences and mental health is lacking. We investigated associations between new-onset posttraumatic stress disorder (PTSD), new-onset depression, and alcohol-related problems and two commonly used measures of combat among a sample of 20,719 recently deployed U.S. military personnel. A 13-item measure assessed both direct and indirect combat exposures, and a 5-item measure assessed only indirect exposures. Both combat measures were associated with all outcomes in the same direction (e.g., PTSD, odds ratio [OR] = 2.97 vs. 4.01; depression, OR = 2.03 vs. 2.42; alcohol-related problems, OR = 1.41 vs. 1.62, respectively, for the 5- and 13-item measures). The 13-item measure had a stronger association with some outcomes, particularly PTSD. Each specific item had significant bivariate associations with all outcomes, ORs = 1.43-4.92. After adjusting for other combat exposures, items assessing witnessing abuse, feeling in danger, and knowing someone injured or killed remained associated with all outcomes, ORs = 1.18-2.72. After this adjustment, several items had unexpected protective associations with some mental health outcomes. Results indicated these two combat exposure measures were approximately equally effective for determining risk for negative mental health outcomes in a deployed population, despite having different content. Additional research is needed to replicate and understand how specific combat exposures affect health.

Unethical battlefield conduct reported by soldiers serving in the Iraq war.

Research involving military service members has shown a strong relationship between combat experiences and increased risk for posttraumatic stress disorder (PTSD) and other mental health problems. Comparatively little research has examined the relationship between combat experiences, PTSD, aggression, and unethical conduct on the battlefield, although news stories sometimes suggest links between unethical conduct and disorders such as PTSD. This study systematically examined whether unethical conduct is a proxy for aggression and whether specific combat experiences and PTSD are independently associated with unethical behavior. The results of this study indicate that aggression (ß = 0.30) and specific combat experiences (particularly, witnessing war atrocities [ß = 0.14] and fighting [ß = 0.13]) are much more strongly associated with unethical conduct than is PTSD (ß = 0.04).

"That's kind of like the big struggle right now is can we get PrEP?": Facilitators and Barriers to PrEP Uptake Among Active Duty Gay and Bisexual Men.

Introduction: The US Military is experiencing a rise in HIV infections among gay and bisexual men (GBM) serving on active duty, yet little is known about this population's uptake of pre-exposure prophylaxis (PrEP), an evidence-based intervention for HIV prevention. This mixed methods study examines the facilitators and barriers to PrEP access and uptake among active duty GBM. Methods: Active duty GBM were recruited using respondent-driven sampling (2017 and 2018). Participants (n = 93) answered quantitative survey questions on PrEP interest and accessibility. Another set of participants (n = 10) discussed their PrEP experiences in qualitative interviews. We conducted descriptive and bivariate analyses of quantitative data, while qualitative data were analyzed using structural and descriptive coding techniques. Results: Approximately 71% of active duty GBM indicated interest in accessing PrEP. A greater proportion of those who disclosed (vs. did not disclose) their sexual orientation to their military doctor discussed (p < 0.001) or accessed (p = 0.017) PrEP. The following qualitative themes emerged: (1) providers' negative views and knowledge gaps related to PrEP; (2) lack of a systems approach to PrEP access; (3) confidentiality concerns; and (4) reliance on peer networks for PrEP guidance and support. Conclusions: Study results indicate that active duty GBM are interested in and want to discuss PrEP with their military doctors, but gaps in providers' PrEP-related knowledge and skills, as well as mistrust in the military health care system, remain. Policy Implications: A system-wide approach that addresses confidentiality concerns and removes procedural barriers to PrEP access is recommended to improve PrEP uptake in this population.

Development and Validation of the Military Minority Stress Scale.

Despite affecting nearly 3% of active-duty service members, little is known about how LGBT-related stress experiences may relate to health outcomes. Thus, the present study sought to create a Military Minority Stress Scale and assess its initial reliability and construct validity in a cross-sectional study of active-duty LGBT service members (N = 248). Associations between 47 candidate items and health outcomes of interest were analyzed to retain those with substantial betas. Item response theory analyzes, reliability testing, invariance testing, and exploratory factor analysis were performed. Construct validity of the final measure was assessed through associations between the sum score of the final measure and the health outcomes. The final 13-item measure demonstrated an excellent reliability (ω = 0.95). Bivariate linear regressions showed significant associations between the sum score of the measure and overall health (ß = -0.26, p < 0.001), overall mental health (ß = -0.34, p < 0.001), physical health (ß = 0.45, p < 0.001), life satisfaction (ß = -0.24, p < 0.001), anxiety (ß = 0.34, p < 0.001), depressive symptoms (ß = 0.37, p < 0.001), suicidality (ß = 0.26, p < 0.001), and PTSD (ß = 0.42, p < 0.001), respectively. This study provides the first evidence that minority stressors in the military setting can be operationalized and measured. They appear to have a role in the health of LGBT service members and may explain the continued health disparities experienced by this population. Little is known regarding the experiences of LGBT active-duty service members, including experiences of discrimination. Understanding these experiences and their associated health outcomes during military service may therefore help and guide further etiological studies and intervention development.

Toward a dual process model of moral injury and traumatic illness.

Moral injury has emerged as a topic of significant research and clinical interest over the last decade. However, much work remains to be done to comprehensively define the moral injury construct, with implications for understanding the etiology and maintenance of moral injury, its symptoms, associations with and distinctions from traumatic illness, and treatment approaches. We provide a brief overview of the existing moral injury literature and introduce a novel dual process model (DPM) of moral injury and traumatic illness. The DPM posits an event exposure which may satisfy DSM-5 posttraumatic stress disorder (PTSD) criterion A, potential morally injurious event (PMIE) criteria, or both, followed by individual role appraisal as a perpetrator through action or inaction, a witness, a victim, or a combination of the these. Role appraisal influences symptoms and processes across biological, psychological, behavioral, social, spiritual/religious, as well as values, character, and identity domains to support a label of traumatic illness, moral injury, or both. The DPM provides a flexible analytical framework for evaluating symptoms associated with moral injury and traumatic stress and has important implications for treatment. The most thoroughly reviewed evidence-based interventions for traumatic stress hinge on exposure and habituation mechanisms to manage dysregulation of fear and memory systems, but these mechanisms often do not address core domains of moral injury identified in the DPM, including spiritual, religious, values, character, and identity domains as these exist largely outside of the putative fear network. We provide brief vignettes to illustrate the practical application of the DPM and argue that adjunct and stand-alone approaches which address values and character domains, leveraging principles of Stoicism, non-judgment of experience, acceptance, and values-oriented action, are more likely than traditional trauma treatment approaches to positively affect moral injury symptoms.

Changes in perceived stress during the COVID-19 pandemic among American veterans.

American veterans are a population that suffer from both context specific stressors as well as many population-specific major-life events. The present exploratory study utilises a longitudinal cohort of 1230 U.S. veterans surveyed from February 2020 through February 2021. We sought to understand heterogeneity in perceived stress, using growth mixture modelling, over this time period, how COVID-specific factors such as negative reactions to the pandemic, loneliness, and employment disruptions influence perceived stress trajectories, and how veterans vary across distal outcomes including posttraumatic stress disorder (PTSD), pain, depression, sleep problems, physical health, and alcohol use disorder. Results revealed a 4-class solution: Stable High, Stable Low, Steady Increasing, and Steady Decreasing classes. In terms of COVID specific factors, negative reactions to COVID were consistently associated with perceived stress for those in the Stable High and Steady Increasing classes whereas loneliness was associated with stress trajectories for all emergent classes. Finally, in terms of our distal outcomes, results showed a relatively robust pattern with veterans in the Stable High or Steady Increasing classes reporting worse scores across all outcomes including PTSD, pain, sleep problems, physical health, depression, and alcohol use disorder. Understanding the interplay between existing vulnerabilities, ongoing stressors, and behavioural health outcomes among veterans is crucial for prevention and intervention efforts.

What's sleep got to do with it? Longitudinal associations between insomnia, PTSD, and alcohol use among U.S. Veterans.

U.S. veterans are at risk for insomnia, which often co-occurs with symptoms of posttraumatic stress disorder (PTSD) and alcohol use. Much of the research on veterans and these three constructs is cross-sectional and focused on unidirectional pathways. Recent theoretical and empirical evidence suggests a dynamic interplay between insomnia, PTSD, and alcohol use, yet few longitudinal studies exist. A clearer understanding of these pathways is needed to help inform integrated treatments. Using a sample of 1,230 post-9/11 veterans assessed over four time points across 12 months, we used a latent difference score modeling approach to examine proportional and dynamic change between insomnia, PTSD, and alcohol. Results revealed a complex interplay between all three constructs. Higher prior levels of both PTSD and alcohol use were associated with greater subsequent changes in insomnia symptoms (i.e., worse sleep). Moreover, although veterans drank less frequently as their insomnia symptoms worsened over time, greater changes in insomnia symptoms (i.e., worse symptoms) was a mechanism linking PTSD and more frequent drinking. As the research on interventions addressing insomnia, PTSD, and alcohol is limited, there are opportunities for researchers and clinicians to develop programs that effectively target all three in integrated treatments.

Mild traumatic brain injury in U.S. Soldiers returning from Iraq.

BACKGROUND: An important medical concern of the Iraq war is the potential long-term effect of mild traumatic brain injury, or concussion, particularly from blast explosions. However, the epidemiology of combat-related mild traumatic brain injury is poorly understood. METHODS: We surveyed 2525 U.S. Army infantry soldiers 3 to 4 months after their return from a year-long deployment to Iraq. Validated clinical instruments were used to compare soldiers reporting mild traumatic brain injury, defined as an injury with loss of consciousness or altered mental status (e.g., dazed or confused), with soldiers who reported other injuries. RESULTS: Of 2525 soldiers, 124 (4.9%) reported injuries with loss of consciousness, 260 (10.3%) reported injuries with altered mental status, and 435 (17.2%) reported other injuries during deployment. Of those reporting loss of consciousness, 43.9% met criteria for post-traumatic stress disorder (PTSD), as compared with 27.3% of those reporting altered mental status, 16.2% with other injuries, and 9.1% with no injury. Soldiers with mild traumatic brain injury, primarily those who had loss of consciousness, were significantly more likely to report poor general health, missed workdays, medical visits, and a high number of somatic and postconcussive symptoms than were soldiers with other injuries. However, after adjustment for PTSD and depression, mild traumatic brain injury was no longer significantly associated with these physical health outcomes or symptoms, except for headache. CONCLUSIONS: Mild traumatic brain injury (i.e., concussion) occurring among soldiers deployed in Iraq is strongly associated with PTSD and physical health problems 3 to 4 months after the soldiers return home. PTSD and depression are important mediators of the relationship between mild traumatic brain injury and physical health problems.

Coming home may hurt: risk factors for mental ill health in US reservists after deployment in Iraq.

BACKGROUND: Little research has been conducted on the factors that may explain the higher rates of mental health problems in United States National Guard soldiers who have deployed to the Iraq War. AIMS: To examine whether financial hardship, job loss, employer support and the effect of deployment absence on co-workers were associated with depression and post-traumatic stress disorder (PTSD). METHOD: Cross-sectional data were obtained from 4034 National Guard soldiers at two time points. All measures were assessed by self-report. RESULTS: The four factors were associated with depression and PTSD, with variability based on outcome and time point. For example, job loss increased the odds of meeting criteria for depression at 3 and 12 months and for PTSD at 12 months; the negative effect of deployment absence on co-workers increased the likelihood of meeting criteria for PTSD, but not depression, at both time points. CONCLUSIONS: The findings demonstrate that National Guard soldiers have unique post-deployment social and material concerns that impair their mental health.

Mental health advisory teams: a proactive examination of mental health during combat deployments.

Mental health advisory teams (MHATs) conduct comprehensive mental health surveillance of US service members in combat environments. Since 2003, six teams have deployed to Iraq and four have deployed to Afghanistan, and results have played a key role influencing behavioural health policy. The repeated deployments of the teams have provided opportunities for processes to be refined, and this refinement has led to a scientifically rigorous and replicable approach. In this article we focus on two themes. The first theme is how changes in sampling have influenced the nature of the inferences drawn from the survey-based surveillance data. The second theme is how the ability to utilize different forms of data has served to strengthen the programme. Focusing on these two themes provides a way to discuss key findings, recommendations and limitations while also interspersing practical observations intended to help inform the design of broad-scale, in-theatre mental health surveillance efforts. We believe that future surveillance efforts should build on the lessons of the MHATs and attempt to replicate the more rigorous sampling methods; nonetheless, we also strive to convey that large surveillance efforts are valuable even if they cannot be executed with random sampling.

Mental health outcomes associated with profiles of risk and resilience among U.S. Army spouses.

The current study examined patterns of risk and protective factors among military families and associations with mental health diagnoses among U.S. Army spouses. Spouses (N = 3,036) completed a survey of family psychosocial fitness, which informed protective factors including coping, family cohesion, and social support. Survey results were linked with Department of Defense archival data, which provided information on military-specific risks, including relocation, deployments, and reunification, as well as mental health care diagnoses. The three-step method of latent profile analysis identified six profiles, suggesting significant heterogeneity in military families with respect to their access to resources and exposure to risk. The largest profile of families (40.48% of the sample) had limited risk exposure and considerable strengths. Variability in risk and protection across profiles was associated with statistically significant differences in the prevalence of mental health diagnoses among spouses (χ² = 108.968, df = 5, p < .001). The highest prevalence of mental health diagnoses among Army spouses (41.2%) was observed in the profile with the lowest levels of protective factors. Findings point to the importance of evaluating both concurrent risk and protective factors. Increasing access to resources may be a fruitful avenue for prevention among military families that are struggling. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Mental Health and Health Risk Behaviors of Active Duty Sexual Minority and Transgender Service Members in the United States Military.

Purpose: The aim of this study was to examine health risk behaviors and mental health outcomes among sexual minority and transgender active duty military service members and their heterosexual and cisgender counterparts. Methods: Participants (N = 544) were recruited by using respondent-driven sampling between August 2017 and March 2018 and completed an online survey by using validated measures of cigarette smoking, alcohol use, anxiety, depression, post-traumatic stress disorder (PTSD), and suicidality. Bayesian random intercept multiple logistic regressions were used to understand differences between sexual minority participants and heterosexual participants as well as between transgender participants and both their cisgender sexual minority and cisgender heterosexual peers. Results: Cisgender sexual minority women service members were more likely to meet criteria for problematic alcohol use (adjusted odds ratio [aOR] = 10.11) and cigarette smoking (aOR = 7.12) than cisgender heterosexual women. Cisgender sexual minority men had greater odds of suicidality (aOR = 4.73) than their cisgender heterosexual counterparts. Transgender service members had greater odds of anxiety, PTSD, depression, and suicidality than their cisgender peers. Conclusion: Military researchers and policymakers who seek to improve the overall health and well-being of sexual minority and transgender service members should consider programs and policies that are tailored to specific health outcomes and unique sexual minority and transgender subgroups.

Mild traumatic brain injury (concussion) during combat: lack of association of blast mechanism with persistent postconcussive symptoms.

OBJECTIVE: To determine whether screening for a blast mechanism of concussion identifies individuals at higher risk of persistent postconcussive symptoms (PCS). SETTING: United States Army post. PARTICIPANTS: 3952 US Army infantry soldiers were administered anonymous surveys 3 to 6 months after returning from a yearlong deployment to Iraq. MAIN OUTCOME MEASURES: Self-reported concussion (defined as an injury that resulted in being "dazed, confused, or 'seeing stars'"; "not remembering the injury"; or "losing consciousness [knocked out]): Patient Health Questionnaire 15-item scale for physical symptoms and PCS; Posttraumatic Stress Disorder Checklist; and Patient Health Questionnaire depression module. RESULTS: Of the 587 soldiers (14.9% of the total sample) who met criteria for concussion, 201 (34.2%) reported loss of consciousness, and 373 (63.5%) reported only an alteration of consciousness without loss of consciousness; 424 (72.2%) reported a blast mechanism, and 150 (25.6%) reported a nonblast mechanism. Among soldiers who lost consciousness, blast mechanism was significantly associated with headaches and tinnitus 3 to 6 months postdeployment compared with a nonblast mechanism. However, among the larger group of soldiers reporting concussions without loss of consciousness, blast was not associated with adverse health outcomes. CONCLUSIONS: Blast mechanism of concussion was inconsistently associated with PCS, depending on the definition of concussion utilized. A self-reported history of blast mechanism was not associated with persistent PCS for the majority of US soldiers with concussions.