No abstract

Objective: Mild traumatic brain injury (TBI) that occurs in a deployment environment is characteristically different from mild TBI that occurs outside of deployment. This study evaluated differential and interaction effects of deployment and nondeployment mild TBI on cognitive and behavioral health outcomes. Research Method: Combat veterans (N ϭ 293) who passed performance-validity measures completed the Mid-Atlantic MIRECC Assessment of TBI (MMA-TBI), Clinician-Administered Posttraumatic Stress Disorder (PTSD) Scale (CAPS-5), a neuropsychological assessment battery, and self-report questionnaires. A 2 ϫ 2 ϫ 2 analysis of variance (ANOVA) was conducted to evaluate the main and interaction effects across mild TBI groups and PTSD diagnosis. Results: Deployment TBI was associated with poorer outcomes on several cognitive tests: Wechsler Adult Intelligence Scale, 4th edition (WAIS-IV); Working Memory Index (WMI; p ϭ .018); Trail Making Test A (TMT-A; p Ͻ .001); and Trail Making Test B (TMT-B; p ϭ .002). Deployment TBI and PTSD were also associated with increased PTSD, depressive, and neurobehavioral symptoms; pain interference; and poorer sleep quality. Nondeployment TBI had no effect on cognitive performance and was associated only with poorer sleep quality. PTSD had the strongest associations with symptom measures and deployment TBI with cognitive outcomes. There were no significant interaction effects after adjusting for multiple comparisons. Conclusions: Remote outcomes associated with mild deployment TBI are different from those associated with nondeployment mild TBI and are robust beyond PTSD. This suggests that the environment surrounding a TBI event influences cognitive and symptom sequelae. Veterans who experience mild TBI during deployment may report changes in cognition, but most will continue to function within the expected range. Impact and ImplicationsMild deployment traumatic brain injury (TBI) was associated with lower performance on measures of attention and processing speed. Veterans who experience mild TBI during deployment may be more likely to report changes in cognition to providers. Although most will function in an expected range, implementation of skill building, compensatory strategies, and patient education about recovery from mild TBI may be beneficial in supporting recovery.

FIGURE 1 and COVER. Unlike physical senses, the "sense" of internal time does not have a specific dedicated brain region. Temporal perception (inner experience of time) is an abstract concept, constructed within the brain based on available information (external and internal sensory, memory) by a network of areas that are variably recruited depending on specific task demands (1-10). The approximate locations of commonly implicated cortical and subcortical areas are shown on representative MRI.

Objective: The goal of this study was to examine the associations among posttraumatic stress disorder (PTSD), traumatic brain injury (TBI), sleep quality, pain interference, and quality of life in combat veterans. Method: Veterans (N ϭ 289, 86.51% male) completed the Mid-Atlantic MIRECC Assessment of Traumatic Brain Injury, the Clinician-Administered PTSD Scale for DSM-5, and measures of sleep quality, pain interference, and quality of life. Results: Hierarchical linear regressions evaluated associations between PTSD severity, deployment TBI severity, sleep quality, and the outcomes of pain interference and quality of life after adjusting for demographic variables and the number of nondeployment TBIs. PTSD severity, B ϭ 0.15, SE B ϭ 0.04, deployment TBI severity, B ϭ 3.98, SE B ϭ 1.01, and sleep quality, B ϭ 0.74, SE B ϭ 0.13, were significantly associated with pain interference, p Ͻ .001. PTSD severity, B ϭ Ϫ0.57, SE B ϭ 0.07, and pain interference, B ϭ Ϫ0.45, SE B ϭ 0.11, were significantly, independently associated with quality of life, p Ͻ .001. However, pain interference, B ϭ Ϫ0.24, SE B ϭ 0.11, was no longer significantly associated with quality of life when sleep quality, B ϭ Ϫ1.56, SE B ϭ 0.25, was included in the model. There was no significant association between deployment TBI severity and quality of life. Interactions among the studied variables were not significant for either of the outcome variables. Conclusions: PTSD symptom severity, deployment TBI history, and sleep quality may be important to consider in treatment planning for veterans experiencing pain-related functional interference. For veterans with numerous conditions comorbid with pain, treatment plans may include interventions targeting sleep and PTSD to maximize quality of life improvements.

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Abstract. The scope of the United Nations Development Programme (2019) emphasizes combating adaptive challenges, building resilience, and sustainability. This systematic review offers a range of perspectives through an in-depth overview of existing literature on the coronavirus disease 2019 (COVID-19) pandemic and the psychological impact it is having on the South Asian community in India. The selected studies focused on COVID-19 were mixed; however, the consensus among articles had themes relating to fear, stress, and anxiety. The results yielded 17 unique articles. Overall, the review supports the understanding of challenges related to mental healthcare and the attitudes and awareness of South Asians toward the COVID-19 pandemic. This review aims to assist healthcare providers to be better informed on the impact of COVID-19 on South Asians.

Cross-cultural exploration and adaptation of psychological tests and assessments is critical to ensure accurate and reliable results. This research study conducted a qualitative cultural exploration of the National Institutes of Health (NIH) Toolbox Cognition Battery assessments in India as an initial step towards the cultural adaptation and validation of the instruments. As the assessments were developed in the United States, they required cultural exploration before they were used in India. Using interpretive phenomenological analysis, the study included a sample of 30 participants across Mumbai, Surat, and Derod. Five themes emerged from the data analysis: contentedness, lack of relatability, recommendations for change, the rural Indian lifestyle, and the variable of education. The most common code was “satisfied.” While this research does indicate that participants comprehend the assessments, recommendations were made to change images and storylines to reflect the Indian culture. They focused on Indian food, Indian clothing, Indian festivals, family, and religion in India. The findings from this study can be used to inform future adaptation and validation of the National Institutes of Health (NIH) Toolbox Cognition Battery assessments in India.