Associations between health-related behaviors and self-reported cognitive symptoms in U.S. military personnel injured on deployment

Sarah M Jurick; Cameron T McCabe; Jessica R Watrous; Andrew J MacGregor; Samuel R Walton; Ian J Stewart; Lauren E Walker; Michael R Galarneau

doi:10.1016/j.jpsychires.2023.07.001

Associations between health-related behaviors and self-reported cognitive symptoms in U.S. military personnel injured on deployment

J Psychiatr Res. 2023 Sep:165:48-55. doi: 10.1016/j.jpsychires.2023.07.001. Epub 2023 Jul 5.

Authors

Sarah M Jurick¹, Cameron T McCabe², Jessica R Watrous², Andrew J MacGregor³, Samuel R Walton⁴, Ian J Stewart⁵, Lauren E Walker⁶, Michael R Galarneau³

Affiliations

¹ Leidos, 4161 Campus Point Ct, San Diego, CA, 92121, USA; Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106, USA. Electronic address: sarah.m.juricklefler.ctr@health.mil.
² Leidos, 4161 Campus Point Ct, San Diego, CA, 92121, USA; Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106, USA; Uniformed Services University, 4301 Jones Bridge Rd, Bethesda, MD, 20814, USA.
³ Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106, USA.
⁴ School of Medicine Physical Medicine and Rehabilitation, Virginia Commonwealth University, 1201 E Marshall St #4-100, Richmond, VA, 23298, USA.
⁵ Uniformed Services University, 4301 Jones Bridge Rd, Bethesda, MD, 20814, USA.
⁶ David Grant USAF Medical Center, 101 Bodin Circle, Bldg. 777, Travis AFB, CA, 94535, USA.

PMID: 37459778
DOI: 10.1016/j.jpsychires.2023.07.001

Abstract

Health behaviors may be core contributors to cognition and mental health following mild traumatic brain injury (TBI). The aims of the present study examined: (1) whether health behaviors including sleep duration, alcohol use, and physical activity differed in injured military personnel with and without deployment-related mild TBI history and (2) the relative contributions of health behaviors and deployment-related mild TBI history to self-reported cognitive, posttraumatic stress disorder (PTSD), and depressive symptoms. Participants included 3076 military personnel injured on deployment participating in the Wounded Warrior Recovery Project, an ongoing web-based study. Military personnel with deployment-related mild TBI history reported similar rates of physical activity and levels of alcohol problems as those without, but were less likely to report receiving the recommended duration of sleep. When adjusting for demographic and injury variables, all three health behaviors were associated with cognitive, PTSD, and depressive symptoms. Alcohol problems demonstrated significant but small effects across all outcomes measures (η_p²=.01) whereas physical activity was associated with slightly larger effects albeit still within the small range (η_p²=.02-0.04). Duration of sleep bordered a medium effect for cognitive symptoms (η_p²=.05) and was in the medium range for PTSD and depressive symptoms (η_p²=.06). Although deployment-related mild TBI history was significant in all models, effect sizes were small (η_p²=.01). Findings from the present study provide support that health behaviors have stronger effects with regard to cognitive, PTSD, and depressive symptoms compared to deployment-related mild TBI history in military personnel and, given their modifiable nature, may represent treatment targets in this population.

Keywords: Cognitive functioning; Depression; Mild traumatic brain injury; PTSD; Physical activity; Sleep.