Deployment, suicide, and overdose among comorbidity phenotypes following mild traumatic brain injury: A retrospective cohort study from the Chronic Effects of Neurotrauma Consortium


Autoři: Mary Jo Pugh aff001;  Alicia A. Swan aff003;  Megan E. Amuan aff001;  Blessen C. Eapen aff004;  Carlos A. Jaramillo aff006;  Roxana Delgado aff006;  David F. Tate aff007;  Kristine Yaffe aff008;  Chen-Pin Wang aff009
Působiště autorů: VA Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City, Utah, United States of America aff001;  Department of Internal Medicine, University of Utah, School of Medicine, Salt Lake City, Utah, United States of America aff002;  Department of Psychology, University of Texas at San Antonio, San Antonio, Texas, United States of America aff003;  Department of Physical Medicine and Rehabilitation, VA Greater Los Angeles Health Care System, Los Angeles, California, United States of America aff004;  Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America aff005;  Polytrauma Rehabilitation Center, South Texas Veterans Health Care System, San Antonio, Texas, United States of America aff006;  Missouri Institute of Mental Health, University of Missouri-St. Louis, St. Louis, Missouri, United States of America aff007;  Department of Psychiatry, Neurology & Epidemiology, University of California, San Francisco, San Francisco, California, United States of America aff008;  Department of Epidemiology and Biostatistics, University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States of America aff009
Vyšlo v časopise: PLoS ONE 14(9)
Kategorie: Research Article
doi: 10.1371/journal.pone.0222674

Souhrn

Mild traumatic brain injury in the Veteran population is frequently comorbid with pain, post-traumatic stress disorder, and/or depression. However, not everyone exposed to mild traumatic brain injury experiences these comorbidities and it is unclear what factors contribute to this variability. The objective of this study was to identify comorbidity phenotypes among Post-9/11 deployed Veterans with no or mild traumatic brain injury and examine the association of comorbidity phenotypes with adverse outcomes. We found that Veterans with mild traumatic brain injury (n = 93,003) and no brain injury (n = 434,378) were mean age of 32.0 (SD 9.21) on entering Department of Veterans Health Administration care, were predominantly Caucasian non-Hispanic (64.69%), and served in the Army (61.31%). Latent class analysis revealed five phenotypes in each subcohort; Moderately Healthy and Mental Health phenotypes were common to both. The Healthy phenotype was found only in no brain injury. Unique phenotypes in mild traumatic brain injury included Moderately Healthy+Decline, Polytrauma, and Polytrauma+Improvement. There was substantial variation in adverse outcomes. The Polytrauma+Improvement phenotype had the lowest likelihood of adverse outcomes. There were no differences between Moderately Healthy+Decline and Polytrauma phenotypes. Phenotypes of comorbidity vary significantly by traumatic brain injury status including divergence in phenotypes (and outcomes) over time in the mild traumatic brain injury subcohort. Understanding risk factors for the divergence between Polytrauma vs. Polytrauma+Improvement and Moderately Healthy vs. Moderately Healthy+Decline, will improve our ability to proactively mitigate risk, better understand the early patterns of comorbidity that are associated with neurodegenerative sequelae following mild traumatic brain injury, and plan more patient-centered care.

Klíčová slova:

Medicine and health sciences – Critical care and emergency medicine – Trauma medicine – Traumatic injury – Neurotrauma – Traumatic brain injury – Mental health and psychiatry – Suicide – Neuropsychiatric disorders – Anxiety disorders – Post-traumatic stress disorder – Neuroses – Mood disorders – Depression – Health care – Veteran care – Biology and life sciences – Genetics – Phenotypes – Social sciences – Political science – Governments – Armed forces – Military personnel – Veterans


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PLOS One


2019 Číslo 9

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