Clinical utility of PTSD, resilience, sleep, and blast as risk factors to predict poor neurobehavioral functioning following traumatic brain injury: A longitudinal study in U.S. military service members

Rael T Lange; Louis M French; Jason M Bailie; Victoria C Merritt; Cassandra L Pattinson; Lars D Hungerford; Sara M Lippa; Tracey A Brickell

doi:10.1007/s11136-022-03092-4

Clinical utility of PTSD, resilience, sleep, and blast as risk factors to predict poor neurobehavioral functioning following traumatic brain injury: A longitudinal study in U.S. military service members

Qual Life Res. 2022 Aug;31(8):2411-2422. doi: 10.1007/s11136-022-03092-4. Epub 2022 Jan 25.

Authors

Rael T Lange^{1

2

3

4

5}, Louis M French^{6

7

8

9}, Jason M Bailie^{6

10

11}, Victoria C Merritt^{12

13}, Cassandra L Pattinson¹⁴, Lars D Hungerford^{6

15

11}, Sara M Lippa^{7

8}, Tracey A Brickell^{6

7

8

9

11}

Affiliations

¹ Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA. rael.lange@gmail.com.
² Walter Reed National Military Medical Center, Bethesda, MD, USA. rael.lange@gmail.com.
³ National Intrepid Center of Excellence, Bethesda, MD, USA. rael.lange@gmail.com.
⁴ University of British Columbia, Vancouver, BC, Canada. rael.lange@gmail.com.
⁵ General Dynamics Information Technology, Falls Church, VA, USA. rael.lange@gmail.com.
⁶ Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA.
⁷ Walter Reed National Military Medical Center, Bethesda, MD, USA.
⁸ National Intrepid Center of Excellence, Bethesda, MD, USA.
⁹ Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
¹⁰ Naval Hospital Camp Pendleton, Oceanside, CA, USA.
¹¹ General Dynamics Information Technology, Falls Church, VA, USA.
¹² VA San Diego Healthcare System, San Diego, CA, USA.
¹³ University of California San Diego, La Jolla, CA, USA.
¹⁴ University of Queensland, Brisbane, QLD, Australia.
¹⁵ Naval Medical Center San Diego, San Diego, CA, USA.

PMID: 35076825
DOI: 10.1007/s11136-022-03092-4

Abstract

Purpose: This study examined the clinical utility of post-traumatic stress disorder (PTSD), low resilience, poor sleep, and lifetime blast exposure as risk factors for predicting future neurobehavioral outcome following traumatic brain injury (TBI).

Methods: Participants were 591 U.S. military service members and veterans who had sustained a TBI (n = 419) or orthopedic injury without TBI (n = 172). Participants completed the Neurobehavioral Symptom Inventory, PTSD Checklist, and the TBI-Quality of Life (TBI-QOL) scale at baseline and follow-up.

Results: Using the four risk factors at baseline, 15 risk factor combinations were examined by calculating odds ratios to predict poor neurobehavioral outcome at follow-up (i.e., number of abnormal scores across five TBI-QOL scales [e.g., Fatigue, Depression]). The vast majority of risk factor combinations resulted in odds ratios that were considered to be clinically meaningful (i.e., ≥ 2.5) for predicting poor outcome. The risk factor combinations with the highest odds ratios included PTSD singularly, or in combination with poor sleep and/or low resilience (odds ratios = 4.3-72.4). However, poor sleep and low resilience were also strong predictors in the absence of PTSD (odds ratios = 3.1-29.8).

Conclusion: PTSD, poor sleep, and low resilience, singularly or in combination, may be valuable risk factors that can be used clinically for targeted early interventions.

Keywords: Military; Posttraumatic stress; Resilience; Sleep disturbance; Traumatic brain injury.

MeSH terms

Brain Injuries, Traumatic* / complications
Humans
Longitudinal Studies
Military Personnel*
Quality of Life / psychology
Risk Factors
Sleep
Sleep Initiation and Maintenance Disorders*
Stress Disorders, Post-Traumatic* / diagnosis
Veterans*