title: Deployment-related psychiatric and behavioral conditions and their association with functional disability in OEF/OIF/OND veterans.
abstract: Understanding the factors that influence veterans' functional outcome after deployment is critical to provide appropriately targeted care. Mild traumatic brain injury (mTBI) and posttraumatic stress disorder (PTSD) have been related to disability, but other psychiatric and behavioral conditions are not as well examined. We investigated the impact of deployment-related psychiatric and behavioral conditions on disability among 255 OEF/OIF/OND service members and veterans. Structured clinical interviews assessed TBI and the psychiatric conditions of depression, PTSD, anxiety, and substance use. Self-report questionnaires assessed disability and the behavioral conditions of sleep disturbance and pain. Over 90% of participants had a psychiatric and/or behavioral condition, with approximately half presenting with ≥ 3 conditions. Exploratory factor analysis revealed 4 clinically relevant psychiatric and behavioral factors which accounted for 76.9% of the variance: (a) depression, PTSD, and military mTBI (deployment trauma factor); (b) pain and sleep (somatic factor); (c) anxiety disorders, other than PTSD (anxiety factor); and (d) substance abuse or dependence (substance use factor). Individuals with the conditions comprising the deployment trauma factor were more likely to be substantially disabled than individuals with depression and PTSD, but no military mTBI, OR = 3.52; 95% CI [1.09, 11.37]. Depression, PTSD, and a history of military mTBI may comprise an especially harmful combination associated with high risk for substantial disability.
authors.affiliation: Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education and Clinical Center (GRECC), VA Boston Healthcare System Boston, Massachusetts, USA; Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.
authors.forename: Sara M
authors.initials: SM
authors.lastname: Lippa
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Fonda
authors.forename: Catherine B
authors.initials: CB
authors.lastname: Fortier
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Amick
authors.forename: Alexandra
authors.initials: A
authors.lastname: Kenna
authors.forename: William P
authors.initials: WP
authors.lastname: Milberg
authors.forename: Regina E
authors.initials: RE
authors.lastname: McGlinchey
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D001008:Anxiety Disorders / Q000453:epidemiology / Q000523:psychology; D001930:Brain Injuries / Q000453:epidemiology* / Q000523:psychology; D059350:Chronic Pain / Q000453:epidemiology / Q000523:psychology; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology / Q000523:psychology; D004185:Disability Evaluation; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000523:psychology*; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D057566:Self Report; D012893:Sleep Wake Disorders / Q000453:epidemiology / Q000523:psychology; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000523:psychology; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000523:psychology; D014481:United States; D014728:Veterans / Q000523:psychology*; D000067398:War-Related Injuries / Q000453:epidemiology* / Q000523:psychology; D055815:Young Adult