Visual Dysfunction and Associated Co-morbidities as Predictors of Mild Traumatic Brain Injury Seen Among Veterans in Non-VA Facilities: Implications for Clinical Practice

Urosevich, Thomas G.; Boscarino, Joseph J.; Hoffman, Stuart N.; Kirchner, H. Lester; Figley, Charles R.; Adams, Richard E.; Withey, Carrie A; Boscarino, Joseph A.

doi:10.1093/milmed/usy102

Cited by 17 publications

(11 citation statements)

References 16 publications

(15 reference statements)

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“…Concussion history was assessed based on reported concussions experienced during military service (e.g., ever dazed, confused, saw stars, or knocked out) [ 74 ], which is a concussion scale that has been used and validated in previous research [ 1 , 2 , 13 ].…”

Section: Methodsmentioning

confidence: 99%

“…Also, many veterans do not use VA health care services [ 2 , 12 ]. Furhermore, non-VA providers in rural areas may lack the training and experience to manage PTSD and related disorders among veterans [ 6 , 13 ]. Past research has suggested that the provision of mental health services for veterans in rural areas has improved over time, and some health disparities previously reported between rural and non-rural veterarns were often neither clinically significant nor universal to all veterans across VA and non-VA settings [ 9 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

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Mental health status in veterans residing in rural versus non-rural areas: results from the veterans’ health study

et al. 2020

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Background The majority of Veterans Affair (VA) hospitals are in urban areas. We examined whether veterans residing in rural areas have lower mental health service use and poorer mental health status. Methods Veterans with at least 1 warzone deployment in central and northeastern Pennsylvania were randomly selected for an interview. Mental health status, including PTSD, major depression, alcohol abuse and mental health global severity, were assessed using structured interviews. Psychiatric service use was based on self-reported utilization in the past 12 months. Results were compared between veterans residing in rural and non-rural areas. Data were also analyzed using multivariate logistic regression to minimize the influence by confounding factors. Results A total of 1730 subjects (55% of the eligible veterans) responded to the survey and 1692 of them had complete geocode information. Those that did not have this information (n = 38), were excluded from some analyses. Veterans residing in rural areas were older, more often of the white race, married, and experienced fewer stressful events. In comparison to those residing in non-rural areas, veterans residing in rural areas had lower global mental health severity scores; they also had fewer mental health visits. In multivariate logistic regression, rural residence was associated with lower service use, but not with PTSD, major depression, alcohol abuse, and global mental health severity score after adjusting confounding factors (e.g., age, gender, marital status and education). Conclusions Rural residence is associated with lower mental health service use, but not with poor mental health in veterans with former warzone deployment, suggesting rural residence is possibly protective.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Mental health status in veterans residing in rural versus non-rural areas: results from the veterans’ health study

et al. 2020

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“…52 History of in-service concussion was measured based on reported concussions experienced during military deployments (e.g., ever dazed, confused, saw stars, or knocked out), and for this, we used the Brief TBI Screen, 53 a scale used in the previous research. 20,54 Personality measures assessed included the "agreeable" personality trait, which was measured by the 10-item Personality Inventory, a widely used and validated personality measure. 32,33 This trait was selected because it tended to be protective for the onset of mental health disorders.…”

Section: Ptsd Measures and Study Predictor Variablesmentioning

confidence: 99%

<p>Predictors of Current DSM-5 PTSD Diagnosis and Symptom Severity Among Deployed Veterans: Significance of Predisposition, Stress Exposure, and Genetics</p>

Hu¹,

Chu²,

Urosevich³

et al. 2020

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Background: Previously we reported a genetic risk score significantly improved PTSD prediction among a trauma-exposed civilian population. In the current study, we sought to assess this prediction among a trauma-exposed military population. Methods: We examined current PTSD diagnosis and PTSD symptom severity among a random sample of 1042 community-based US military veterans. Main effects and interaction effects were assessed for PTSD genetic risk by trauma exposure using cross-product terms for PTSD x trauma exposures, including combat, lifetime trauma, and adverse childhood exposures. The PTSD risk variants studied were within genetic loci previously associated with PTSD, including CRHR1, CHRNA5, RORA, and FKBP5 genetic variants, which were used to calculate a total PTSD genetic risk score (range=0-8, mean=3.6, SD=1.4). Results: Based on DSM-5 PTSD criteria, 7.1% of veterans (95% CI=5.6-8.8) met criteria for current PTSD. The PTSD genetic risk count was significantly higher among PTSD cases vs noncases (3.92 vs 3.55, p=0.027). Since the PTSD genetic risk score was not significant in the PTSD diagnosis model, we assessed this association using PTSD symptom severity. Because these symptom data were skewed (mean=9.54, SD=12.71, range=0-76), we used negative binomial regression to assess this outcome. This symptom model included a PTSD genetic risk score, demographic factors, trauma exposures, current insomnia, current depression, concussion history, and attention-deficit disorder, expressed as incident rate ratios (IRR), which is an estimate of oneunit increase in PTSD severity, given other variables are held constant. Variables in the final model included age and sex (both p<0.001), PTSD genetic risk (IRR=1.02, p=0.028), warzone tours (IRR=0.94, p=0.003), childhood abuse (IRR=1.50, p<0.0001), current depression (IRR=1.89, p<0.0001), current insomnia (IRR=2.58, p<0.0001), low social support (IRR=1.19, p<0.0001), attention-deficit disorder (IRR=1.51, p<0.0001), agreeable personality (IRR=0.77, p<0.0001), and concussion (IRR=1.38, p<0.0001). Significant interactions were detected for combat and lifetime trauma exposure by PTSD genetic risk (both p<0.0001), suggesting that the impact of trauma exposures on PTSD severity was lower when the PTSD genetic risk was higher. Conclusion: Both warzone and non-warzone factors predicted current PTSD symptoms among veterans, including a PTSD genetic risk score. Interaction effects were detected for combat exposure and lifetime trauma by genetic risk score for PTSD symptoms, suggesting that PTSD symptom manifestation was more dependent on PTSD risk variants than the level of trauma or combat exposure. This suggests that controlling for other factors, the absence of genetic risk variants may confer PTSD resilience. Further research is planned.

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“…TBI attributed to an explosive blast is considered the signature injury of modern warfare, and damage to the visual system is a frequent comorbidity in these individuals. 26,51,52 The earliest molecular changes known to date after neurotrauma include decreased phosphorylation and increased proteolysis of neurofilament in axons 5 min after controlled cortical impact in mice, increased intracellular Ca 2+ 1 min after optic nerve crush, and increased reactive oxygen species. 53,54 Neurofilament structure can affect axon conduction velocity as well as ultimately lead to axonal degeneration attributed to inappropriate localization and transport of organelles.…”

mentioning

confidence: 99%

Rapid Repeat Exposure to Subthreshold Trauma Causes Synergistic Axonal Damage and Functional Deficits in the Visual Pathway in a Mouse Model

Bernardo-Colón

Watkins

Kim

et al. 2019

Journal of Neurotrauma

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We examined the effect of repeat exposure to a non-damaging insult on central nervous system axons using the optic projection as a model. The optic projection is attractive because its axons are spatially separated from the cell bodies, it is easily accessible, it is composed of long axons, and its function can be measured. We performed closed-system ocular neurotrauma in C57Bl/6 mice using bursts of 15 or 26-psi (pounds per square inch) overpressure air that caused no gross damage. We quantified the visual evoked potential (VEP) and total and degenerative axons in the optic nerve. Repeat exposure to a 15-psi air blast caused more axon damage and vision loss than a single exposure to a 26-psi air blast. However, an increased VEP latency was detected in both groups. Exposure to three 15-psi air blasts separated by 0.5 sec caused 15% axon degeneration at 2 weeks. In contrast, no axon degeneration above sham levels was detected when the interinjury interval was increased to 10 min. Exposure to 15-psi air blasts once a day for 6 consecutive days caused 3% axon degeneration. Therefore, repeat mild trauma within an interinjury interval of 1 min or less causes synergistic axon damage, whereas mild trauma repeated at a longer interinjury interval causes additive, cumulative damage. The synergistic damage may underlie the high incidence of traumatic brain injury and traumatic optic neuropathy in blast-injured service members given that explosive blasts are multiple injury events that occur in a very short time span. This study also supports the use of the VEP as a biomarker for traumatic optic neuropathy.

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Visual Dysfunction and Associated Co-morbidities as Predictors of Mild Traumatic Brain Injury Seen Among Veterans in Non-VA Facilities: Implications for Clinical Practice

Cited by 17 publications

References 16 publications

Mental health status in veterans residing in rural versus non-rural areas: results from the veterans’ health study

Mental health status in veterans residing in rural versus non-rural areas: results from the veterans’ health study

<p>Predictors of Current DSM-5 PTSD Diagnosis and Symptom Severity Among Deployed Veterans: Significance of Predisposition, Stress Exposure, and Genetics</p>

Rapid Repeat Exposure to Subthreshold Trauma Causes Synergistic Axonal Damage and Functional Deficits in the Visual Pathway in a Mouse Model

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