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  • 1
    In: Military Medicine, Oxford University Press (OUP), Vol. 185, No. 11-12 ( 2020-12-30), p. e1946-e1953
    Abstract: Special Operations Forces (SOF) combat arms and combat support Soldiers are at risk for impaired mental health, such as mood- and stress-related disorders, due to operational and training demands. Additionally, these individuals experience high risk for sustaining mild traumatic brain injury (mTBI). These mTBIs have also been linked to negative psychological outcomes, such as anxiety and depressive symptoms. Studying mental illnesses and their related symptoms alone does not fully address mental health, which may be better understood by 2 separate but overlapping continua measuring both mental illness and subjective well-being (ie, emotional, psychological, and social well-being). Due to the lack of research in this area, current mental health symptoms in active SOF combat Soldiers in relation to mTBI warrants investigation. Materials and Methods In this study, 113 SOF combat and combat support Soldiers completed self-report psychological and mTBI history measures during an in-person laboratory setting. These psychometric measures included (1) psychological distress (Brief Symptom Inventory 18), (2) anxiety (Generalized Anxiety Disorder 7-item), (3) posttraumatic stress (PTSD Checklist for DSM-5), (4) somatization (Patient Health Questionnaire-15), and (5) subjective well-being (Mental Health Continuum Short Form). Results On average, SOF combat Soldiers endorsed moderate well-being and low psychological distress, somatization, posttraumatic stress, and anxiety. Most SOF combat Soldiers had sustained 1 or more mTBI. We observed mTBI history had significant effects on each dependent variable in the expected directions. History of more mTBIs, controlling for age, was associated with lower subjective well-being as well as higher psychological distress, somatization, posttraumatic stress, and anxiety symptoms. Conclusion Although SOF combat Soldiers reported relatively adaptive mental health symptoms across participants, there was considerable variance in the measures reported. Some of the variance in mental health symptoms was accounted for by mTBI history while controlling for age, with reporting higher numbers of lifetime mTBIs and older age being associated with worse mental health symptoms. Longitudinal investigations into these associations and their impact on Soldier performance is warranted.
    Type of Medium: Online Resource
    ISSN: 0026-4075 , 1930-613X
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2020
    detail.hit.zdb_id: 2130577-8
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  • 2
    In: Journal of Special Operations Medicine, Breakaway Media, LLC, Vol. 22, No. 3 ( 2022), p. 129-
    Type of Medium: Online Resource
    ISSN: 1553-9768
    Language: English
    Publisher: Breakaway Media, LLC
    Publication Date: 2022
    detail.hit.zdb_id: 2549862-9
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  • 3
    In: Brain Communications, Oxford University Press (OUP), Vol. 5, No. 4 ( 2023-07-01)
    Abstract: Special Operations Forces combat soldiers sustain frequent blast and blunt neurotrauma, most often classified as mild traumatic brain injuries. Exposure to repetitive mild traumatic brain injuries is associated with persistent behavioural, cognitive, emotional and neurological symptoms later in life. Identifying neurophysiological changes associated with mild traumatic brain injury exposure, in the absence of present-day symptoms, is necessary for detecting future neurological risk. Advancements in graph theory and functional MRI have offered novel ways to analyse complex whole-brain network connectivity. Our purpose was to determine how mild traumatic brain injury history, lifetime incidence and recency affected whole-brain graph theoretical outcome measures. Healthy male Special Operations Forces combat soldiers (age = 33.2 ± 4.3 years) underwent multimodal neuroimaging at a biomedical research imaging centre using 3T Siemens Prisma or Biograph MRI scanners in this cross-sectional study. Anatomical and functional scans were preprocessed. The blood-oxygen-level-dependent signal was extracted from each functional MRI time series using the Big Brain 300 atlas. Correlations between atlas regions were calculated and Fisher z-transformed to generate subject-level correlation matrices. The Brain Connectivity Toolbox was used to obtain functional network measures for global efficiency (the average inverse shortest path length), local efficiency (the average global efficiency of each node and its neighbours), and assortativity coefficient (the correlation coefficient between the degrees of all nodes on two opposite ends of a link). General linear models were fit to compare mild traumatic brain injury lifetime incidence and recency. Nonparametric ANOVAs were used for tests on non-normally distributed data. Soldiers with a history of mild traumatic brain injury had significantly lower assortativity than those who did not self-report mild traumatic brain injury (t148 = 2.44, P = 0.016). The assortativity coefficient was significantly predicted by continuous mild traumatic brain injury lifetime incidence [F1,144 = 6.51, P = 0.012]. No differences were observed between recency groups, and no global or local efficiency differences were observed between mild traumatic brain injury history and lifetime incidence groups. Brain networks with greater assortativity have more resilient, interconnected hubs, while those with lower assortativity indicate widely distributed, vulnerable hubs. Greater lifetime mild traumatic brain injury incidence predicted lower assortativity in our study sample. Less resilient brain networks may represent a lack of physiological recovery in mild traumatic brain injury patients, who otherwise demonstrate clinical recovery, more vulnerability to future brain injury and increased risk for accelerated age-related neurodegenerative changes. Future longitudinal studies should investigate whether decreased brain network resilience may be a predictor for long-term neurological dysfunction.
    Type of Medium: Online Resource
    ISSN: 2632-1297
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
    detail.hit.zdb_id: 3020013-1
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  • 4
    In: Archives of Clinical Neuropsychology, Oxford University Press (OUP), ( 2023-10-08)
    Abstract: Subjective post-concussive neurobehavioral symptoms do not often relate to objective cognitive assessment. This archival analysis aimed to characterize the relationship of subjective neurobehavioral symptoms to neuropsychological tests among military veterans and retired first responders with previous mild TBI (mTBI) presenting to an outpatient multidisciplinary program. Methods 51 patients (88% male; 82% White; 94% veteran), ages 25–68 (M = 43.9, SD = 10.1) underwent neuropsychological evaluation with a flexible battery (M subtests = 29.6; SD = 5.2), through the Transforming Health and Resilience in Veterans (THRIVE) Program at UNC-Chapel Hill. The proportion of below average neuropsychological scores (i.e., ≤ 8th percentile on published norms) was modeled as a function of three subscales (Affective, Cognitive, Somatosensory) on the Neurobehavioral Symptom Inventory (NSI) and estimated premorbid IQ (PIQ) using fractional logit regression with quasi-maximum likelihood estimation and heteroskedasticity consistent “HC1” standard errors. Model diagnostics and sensitivity analyses for overly influential cases (|DFBETAS| ≥ 2/√n) were conducted. Results Thirty-eight individuals were included in analyses after removing those with invalid test performance (n = 4) and missing data (n = 9). The mean (median) observed below average scores was 10.9% (5.7%), with the predicted proportion at 8%. No NSI subscale was related to neuropsychological performance. However, upon removal of two overly influential cases, PIQ was inversely associated with rate of low scores - OR: 0.61 (95% CI: 0.36–0.97), SE: 0.14, p = 0.035. Conclusion Subjective neurobehavioral symptoms were unrelated to objective neuropsychological tests in veterans and first responders seeking care for TBI-related symptoms.
    Type of Medium: Online Resource
    ISSN: 1873-5843
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
    detail.hit.zdb_id: 2003528-7
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  • 5
    In: Journal of Special Operations Medicine, Breakaway Media, LLC, ( 2022)
    Type of Medium: Online Resource
    ISSN: 1553-9768
    Language: English
    Publisher: Breakaway Media, LLC
    Publication Date: 2022
    detail.hit.zdb_id: 2549862-9
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  • 6
    In: Journal of Special Operations Medicine, Breakaway Media, LLC, Vol. 22, No. 3 ( 2022), p. 22-
    Type of Medium: Online Resource
    ISSN: 1553-9768
    Language: English
    Publisher: Breakaway Media, LLC
    Publication Date: 2022
    detail.hit.zdb_id: 2549862-9
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