Neuropsychiatric Outcomes in UK Military Veterans With Mild Traumatic Brain Injury and Vestibular Dysfunction
Abstract: The objective of the study is to estimate the frequency of vestibular dysfunction following blunt, blast, and combined blunt and blast mild traumatic brain injury (mTBI) and thereon assess the long-term impact of vestibular dysfunction on neurobehavioral function and disability independently of comorbid psychiatric symptoms. The study setting is Combat Stress residential and Veterans' Outreach drop-in centers for psychological support. Participants: One hundred sixty-two help-seeking UK military veterans. Main Measures: Self-reported frequency and severity of mTBI (using the Ohio State TBI Identification Method), Vertigo Symptom Scale, PTSD Checklist for DSM-5, Kessler Psychological Distress Scale (K10), Neurobehavioral Symptom Inventory, Headache Impact Test (HIT6), Memory Complaints Inventory, World Health Organization Disability Assessment Schedule II short version (WHODAS 2.0). Seventy-two percent of the sample reported 1 or more mTBIs over their lifetime. Chi-square analyses indicated that vestibular disturbance, which affected 69% of participants, was equally prevalent following blunt (59%) or blast (47%) injury and most prevalent following blunt and blast combined (83%). Mediation analysis indicated that when posttraumatic stress disorder, depression, and anxiety were taken into account, vestibular dysfunction in participants with mTBI was directly and independently associated with increased postconcussive symptoms and functional disability. Vestibular dysfunction is common after combined blunt and blast mTBI and singularly predictive of poor long-term mental health. From a treatment perspective, vestibular rehabilitation may provide relief from postconcussive symptoms other than dizziness and imbalance.
Abstract: Objective: The present study is a retrospective quasi-experimental study to evaluate the effectiveness of the Warrior PATHH (WP) program at improving posttraumatic growth (PTG) outcomes and reducing PTSD symptoms compared to a waitlist control among a sample of Veterans. Method: Participants (n = 164) were U.S. military Veterans with a history of trauma. Participants were either undergoing the Warrior PATHH program or a waitlist. Primary outcome measures were administered at baseline and at 90-day follow-up and consisted of the Posttraumatic Growth Inventory – Expanded (PTGI-X) and the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5). Secondary outcome measures assessed psychosocial functioning and included measures of depression and anxiety symptoms, sleep, wellbeing, and social support. Results: Significant differences were observed between groups on the PTGI-X (F(1, 205) = 23.667, p < .001, partial η2 = 0.103), and the PCL-5 (F(1, 205) = 262.460, p < .001, partial η2 = 0.561) with the WP group showing significant positive psychological change following a traumatic event as measured by the PTGI-X and decreased PTSD symptoms as measured by the PCL-5 compared to those in the waitlist condition. Those in the treatment arm also demonstrated gains to psychosocial functioning. Conclusions: Consistent with previous research, participants in the Warrior PATHH program exhibited significant increases in PTG outcomes, decreased PTSD symptoms, and broad improvements to psychosocial functioning. These findings suggest it is an effective training program to foster PTG outcomes among Veterans. This study is unique as it is the first to compare the effects of WP programming with a sample of waitlisted Veterans.