Mild traumatic brain injury, PTSD symptom severity, and behavioral dyscontrol: a LIMBIC-CENC study

Kelsee M Stromberg; Sarah L Martindale; William C Walker; Zhining Ou; Terri K Pogoda; Shannon R Miles; Clara E Dismuke-Greer; Kathleen F Carlson; Jared A Rowland; Maya E O'Neil; Mary Jo Pugh

doi:10.3389/fneur.2023.1286961

Mild traumatic brain injury, PTSD symptom severity, and behavioral dyscontrol: a LIMBIC-CENC study

Front Neurol. 2024 Jan 11:14:1286961. doi: 10.3389/fneur.2023.1286961. eCollection 2023.

Authors

Kelsee M Stromberg^{1

2}, Sarah L Martindale^{3

4

5}, William C Walker^{6

7}, Zhining Ou², Terri K Pogoda^{8

9}, Shannon R Miles^{10

11}, Clara E Dismuke-Greer¹², Kathleen F Carlson^{13

14}, Jared A Rowland^{3

4

15}, Maya E O'Neil^{16

17}, Mary Jo Pugh^{1

2}

Affiliations

¹ Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, UT, United States.
² Department of Internal Medicine, Division of Epidemiology, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, United States.
³ Research and Academic Affairs Service Line, W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC, United States.
⁴ Veterans Integrated Service Networks (VISN)-6 Mid-Atlantic Mental Illness, Research Education and Clinical Center (MIRECC), Durham, NC, United States.
⁵ Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC, United States.
⁶ Department of Physical Medicine and Rehabilitation (PM&R), School of Medicine, Virginia Commonwealth University, Richmond, VA, United States.
⁷ Department of PM&R, Central Virginia VA Health Care System, Richmond, VA, United States.
⁸ Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, United States.
⁹ Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, United States.
¹⁰ Mental Health and Behavioral Sciences Services, James A. Haley Veterans' Hospital, Tampa, FL, United States.
¹¹ Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL, United States.
¹² Health Economics Resource Center (HERC), Ci2i, VA Palo Alto Health Care System, Menlo Park, CA, United States.
¹³ VA HSR&D Center to Improve Veteran Involvement in Care (CIVIC) and RR&D National Center for Rehabilitative Auditory Research (NCRAR), Veterans Affairs Portland Health Care System, Portland, OR, United States.
¹⁴ Oregon Health and Science University - Portland State University School of Public Health, Oregon Health & Science University, Portland, OR, United States.
¹⁵ Department of Neurobiology and Anatomy, Wake Forest School of Medicine, Winston-Salem, NC, United States.
¹⁶ Department of Psychiatry, Oregon Health & Science University, Portland, OR, United States.
¹⁷ Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, United States.

Abstract

Background: Behavioral dyscontrol occurs commonly in the general population and in United States service members and Veterans (SM/V). This condition merits special attention in SM/V, particularly in the aftermath of deployments. Military deployments frequently give rise to posttraumatic stress disorder (PTSD) and deployment-related mild TBI traumatic brain injury (TBI), potentially leading to manifestations of behavioral dyscontrol.

Objective: Examine associations among PTSD symptom severity, deployment-related mild traumatic brain injury, and behavioral dyscontrol among SM/V.

Design: Secondary cross-sectional data analysis from the Long-Term Impact of Military-Relevant Brain Injury Consortium - Chronic Effects of Neurotrauma Consortium prospective longitudinal study among SM/V (N = 1,808).

Methods: Univariable and multivariable linear regression models assessed the association and interaction effects between PTSD symptom severity, as assessed by the PTSD Checklist for the Diagnostic and Statistical Manual, 5th edition (PCL-5), and deployment-related mild TBI on behavioral dyscontrol, adjusting for demographics, pain, social support, resilience, and general self-efficacy.

Results: Among the 1,808 individuals in our sample, PTSD symptom severity (B = 0.23, 95% CI: 0.22, 0.25, p < 0.001) and deployment-related mild TBI (B = 3.27, 95% CI: 2.63, 3.90, p < 0.001) were significantly associated with behavioral dyscontrol in univariable analysis. Interaction effects were significant between PTSD symptom severity and deployment mild TBI (B = -0.03, 95% CI: -0.06, -0.01, p = 0.029) in multivariable analysis, indicating that the effect of mild TBI on behavioral dyscontrol is no longer significant among those with a PCL-5 score > 22.96.

Conclusion: Results indicated an association between PTSD symptom severity, deployment-related mild TBI, and behavioral dyscontrol among SM/V. Notably, the effect of deployment-related mild TBI was pronounced for individuals with lower PTSD symptom severity. Higher social support scores were associated with lower dyscontrol, emphasizing the potential for social support to be a protective factor. General self-efficacy was also associated with reduced behavioral dyscontrol.

Keywords: TBI – traumatic brain injury; concussion; dysregulation; military members; transition introduction.

Abstract

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