Potential Concussive Event Narratives of Post-9/11 Combat Veterans: Chronic Effects of Neurotrauma Consortium Study.

INTRODUCTION: Deployment-related mild traumatic brain injury (mTBI) affects a significant proportion of those who served in Post-9/11 combat operations. The prevalence of head injuries, including those that lead to mTBI, is often reported quantitatively. However, service member (SM) and Veteran firsthand accounts of their potential concussive events (PCEs) and mTBIs can serve as a rich resource for better understanding the nuances and context of these exposures. MATERIALS AND METHODS: Post-9/11 SMs and Veterans with a history of combat deployment were recruited through the Chronic Effects of Neurotrauma Consortium's observational study of deployment-related mTBI. During a comprehensive assessment, participants completed the Virginia Commonwealth University retrospective Concussion Diagnostic Interview, a specialized validated interview measure which obtains detailed narratives of deployment-incurred blast and non-blast-related PCEs. Qualitative thematic analysis was used to identify and code recurring themes within the narratives. RESULTS: Among the sample of 106 SMs and Veterans, deployment-related mTBI was highly prevalent (67.0%). Over half (50.9%) of the participants identified a blast as the cause of their worst PCE, frequently with accompanying themes of self-reported acute neurological symptoms, intense physical blast forces, and tertiary head impact. Exposure to blast at close range, such as driving directly over an improvised explosive device, occurred in 24.7% of all blast-related narratives and in 59.3% of narratives where blast was identified as causing the worst PCE. Themes of potentially preventable head impacts experienced during noncombat circumstances were also frequent, accounting for 35% of all non-blast-related head injuries in the sample. CONCLUSIONS: Prevalence of deployment-related close-range blast exposure, non-blast impact PCEs, and mTBIs among this Post-9/11 combatant sample was substantial, and in many cases potentially preventable. The use of detailed semi-structured interviews may help health care providers and policymakers to better understand the context and circumstances of deployment-related PCEs and mTBIs.

Veterans' perspectives on military sexual trauma-related communication with VHA providers.

Given the number of veterans who have experienced military sexual trauma (MST) and the impact of these experiences on veteran health, Veterans Health Administration (VHA) providers frequently communicate with patients about these experiences, either as part of the VHA's universal MST screening program or more comprehensive clinical care. The purpose of this study was to understand veterans' perceptions of communication related to MST disclosures with VHA providers. We conducted qualitative interviews, including a numeric rating question, with 55 veterans whose medical records indicated recent MST-related interactions with VHA providers. The sample included men and women, with and without histories of MST. We analyzed interview transcripts using matrices and identified themes related to satisfaction with communication. Veterans from all groups reported generally high satisfaction with MST-related communication, although men, as a group, reported a much larger range of satisfaction ratings than women. Key provider-related indicators of satisfaction included providers' communication mechanics and nonspecific patient-centered skills and characteristics. One patient-related indicator of lower satisfaction-inherent discomfort discussing MST experiences-was particularly represented among men with MST histories. These data from veteran patients will be reassuring to providers whose concerns about patient reactions to these conversations may inhibit them from raising this important issue. Understanding variables that promote patient satisfaction with MST disclosure communication is critical for promoting sensitive patient-provider interactions about MST. This ultimately can have important downstream effects on veteran health, allowing veterans to forge satisfying relationships with providers and ultimately facilitate recovery from traumatic experiences. (PsycInfo Database Record (c) 2021 APA, all rights reserved).