Gender Differences in Outcomes after Traumatic Brain Injury among Service Members and Veterans

Cogan, Alison M.; McCaughey, Virginia K.; Scholten, Joel

doi:10.1002/pmrj.12237

Cited by 30 publications

(18 citation statements)

References 60 publications

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“…One clear conclusion was that women are very underrepresented; most of the studies were not specifically focused on gender differences, and women represented <20% of the sample. The most consistent finding to date was that following a TBI, females in the military are subsequently more susceptible to depression than male service members and veterans (16,19,45,79,80).…”

Section: Women and Military-related Tbimentioning

confidence: 96%

“…However, several studies comparing the outcomes of male and female service members following mTBI have reported differences in the frequencies of specific diagnoses and symptoms between men and women. In a recent scoping study describing the literature addressing gender differences in outcomes following TBI in military populations, Cogan et al (19) identified 29 relevant articles from 2000 to 2018. One clear conclusion was that women are very underrepresented; most of the studies were not specifically focused on gender differences, and women represented <20% of the sample.…”

Section: Women and Military-related Tbimentioning

confidence: 99%

“…The incidence rate of TBI in deployed women is estimated at ~10%, about half that of deployed men ( 16 , 20 , 45 , 73 – 75 ). It should be noted that the causes of TBI in military women differ substantially from those of men; intimate partner violence (including physical and sexual assault) is recognized as a significant risk factor for TBI in military women compared to their nonmilitary peers ( 14 , 19 , 76 ). However, the increasing participation of women in combat operations during deployment in recent years continues to put them at greater risk of combat-related TBI ( 77 ), and like male service members, blast events have been identified as the greatest cause of combat-related injuries, including mTBI, in women during OIF/OEF ( 16 , 78 ).…”

Section: Consequences Of Mtbi In Military Populationsmentioning

confidence: 99%

“…Overall, following combat-related mTBI, women are likely to suffer the same symptom clusters as their male military peers, such as PCS, PTSD, psychiatric complaints (i.e., anxiety and depression), and somatic symptoms (e.g., vestibular and somatosensory dysfunction) ( 16 – 19 , 45 ). However, several studies comparing the outcomes of male and female service members following mTBI have reported differences in the frequencies of specific diagnoses and symptoms between men and women.…”

Section: Consequences Of Mtbi In Military Populationsmentioning

confidence: 99%

“…Although there have been a substantial number of studies comparing outcomes following TBI between men and women in clinical populations, particularly in sports-related contexts [for recent reviews, see (11)(12)(13)], specific attention to the potentially special needs of women who have sustained TBI in the military is a growing concern (14,15). There is substantial evidence that women may be more at risk than men for many neurological and psychiatric conditions following military-acquired TBI [e.g., (16)(17)(18)(19)(20)], and it has been recently shown that up to 50% of older female veterans (>55 years old) with a diagnosed TBI also had a psychiatric diagnosis of depression or posttraumatic stress disorder (PTSD) (21). Furthermore, the authors reported that a diagnosed TBI increased the risk of dementia by 50%, and the risk increased twofold for women who suffered from any two of those conditions (21).…”

Section: Introductionmentioning

confidence: 99%

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Sex as a Biological Variable in Preclinical Modeling of Blast-Related Traumatic Brain Injury

McCabe

Tucker

2020

Front. Neurol.

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Approaches to furthering our understanding of the bioeffects, behavioral changes, and treatment options following exposure to blast are a worldwide priority. Of particular need is a more concerted effort to employ animal models to determine possible sex differences, which have been reported in the clinical literature. In this review, clinical and preclinical reports concerning blast injury effects are summarized in relation to sex as a biological variable (SABV). The review outlines approaches that explore the pertinent role of sex chromosomes and gonadal steroids for delineating sex as a biological independent variable. Next, underlying biological factors that need exploration for blast effects in light of SABV are outlined, including pituitary, autonomic, vascular, and inflammation factors that all have evidence as having important SABV relevance. A major second consideration for the study of SABV and preclinical blast effects is the notable lack of consistent model design-a wide range of devices have been employed with questionable relevance to real-life scenarios-as well as poor standardization for reporting of blast parameters. Hence, the review also provides current views regarding optimal design of shock tubes for approaching the problem of primary blast effects and sex differences and outlines a plan for the regularization of reporting. Standardization and clear description of blast parameters will provide greater comparability across models, as well as unify consensus for important sex difference bioeffects.

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Section: Women and Military-related Tbimentioning

confidence: 96%

Section: Women and Military-related Tbimentioning

confidence: 99%

Section: Consequences Of Mtbi In Military Populationsmentioning

confidence: 99%

Section: Consequences Of Mtbi In Military Populationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Sex as a Biological Variable in Preclinical Modeling of Blast-Related Traumatic Brain Injury

McCabe

Tucker

2020

Front. Neurol.

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Gender differences in disorders comorbid with posttraumatic stress disorder among U.S. Sailors and Marines

Walter

Levine

Madra

et al. 2022

Journal of Traumatic Stress

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Psychological comorbidity, the co‐occurrence of mental health disorders, is more often the rule than the exception among individuals with posttraumatic stress disorder (PTSD). Research shows that prevalence estimates for specific psychological disorders differ by gender; however, little is known about whether these patterns persist in the presence of a comorbid PTSD diagnosis. This study examined gender differences in prevalence estimates for conditions comorbid with PTSD using medical records for 523,626 active duty U.S. Sailors and Marines who entered the military over an 8‐year period. Using chi‐square tests of independence, we detected statistically significant gender differences for specific comorbid conditions in the subsample of 9,447 service members with a PTSD diagnosis. Women were more likely than men to have PTSD with comorbid adjustment, OR = 1.35; depressive, OR = 1.71; and generalized anxiety or other anxiety disorders, OR = 1.16, with the largest effects for eating, OR = 12.60, and personality disorders, OR = 2.97. In contrast, women were less likely than men to have a diagnosis of PTSD with comorbid alcohol use, OR = 0.69, and drug use disorders, OR = 0.72, with the largest effects for insomnia, OR = 0.42, and traumatic brain injury, OR = 0.17. No significant gender differences emerged for comorbid bipolar, obsessive–compulsive, panic/phobic, psychotic, or somatoform/dissociative disorders, ps = .029–.314. The results show gender differences in conditions comorbid with PTSD generally align with internalizing and externalizing dimensions. Differences in comorbidities with PTSD between women and men could have implications for treatment development and delivery.

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Serum Amyloid A is Expressed in the Brain After Traumatic Brain Injury in a Sex-Dependent Manner

et al. 2020

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Serum amyloid A (SAA) is an acute-phase protein upregulated in the liver after traumatic brain injury (TBI). So far, it has not been investigated whether SAA expression also occurs in the brain in response to TBI. For this, we performed a moderate controlled cortical impact injury in adult male and female mice and analyzed brain, blood, and liver samples at 6 hours, 1, 3, and 10 days post-injury (dpi). We measured the levels of SAA in serum and liver by western blot. We used immunohistochemical techniques combined with in situ hybridization to determine SAA expression in the brain. Our results revealed higher levels of SAA in the bloodstream in males compared to females at 6 h post-TBI. Liver and serum SAA levels showed a peak of expression at 1 dpi followed by a decrease at 3 to 10 dpi in both sexes. Both SAA mRNA and protein expression colocalize with astrocytes and macrophages/microglia in the cortex, corpus callosum, thalamus, and hippocampus after brain injury. For the first time, here we show that SAA was expressed in the brain after TBI. Collectively, SAA expression was predominant in males compared to females, and in association with the sex-dependent neuroinflammatory response after brain injury. We suggest that SAA represents a crucial protein associated with the acute neuroinflammatory Terms of use and reuse: academic research for non-commercial purposes, see here for full terms. https://www.springer.com/aamterms-v1

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Gender Differences in Outcomes after Traumatic Brain Injury among Service Members and Veterans

Cited by 30 publications

References 60 publications

Sex as a Biological Variable in Preclinical Modeling of Blast-Related Traumatic Brain Injury

Sex as a Biological Variable in Preclinical Modeling of Blast-Related Traumatic Brain Injury

Gender differences in disorders comorbid with posttraumatic stress disorder among U.S. Sailors and Marines

Serum Amyloid A is Expressed in the Brain After Traumatic Brain Injury in a Sex-Dependent Manner

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