title: Prospective Analysis of Premilitary Mental Health, Somatic Symptoms, and Postdeployment Postconcussive Symptoms.
abstract: OBJECTIVE
  Many recent studies of service members returning from deployment have focused on the health impacts of mild traumatic brain injury (mTBI), including persistent postconcussive symptoms (PCS). However, cross-sectional study designs have made it difficult to understand the role of mental health in the etiology of persistent PCS.
  
  
  METHODS
  Participants were 3319 military personnel (primarily men [90%] of 25-34 years [54%]) who had completed health surveys at basic training and after deployment, on average, 4.6 years later. Negative binomial regression was used to assess the association of PCS with demographic covariates, premilitary mental health and somatic symptoms, combat experiences and mTBI during deployment, in addition to postdeployment mental health and non-PCS somatic symptoms.
  
  
  RESULTS
  Premilitary mental health and somatic symptoms predicted PCS even when adjusting for other variables, yielding an elevated incidence rate ratio (IRR) for posttraumatic stress disorder (PTSD; IRR = 1.23, 95% confidence interval [CI] = 1.06-1.41) and somatic symptoms (mild versus minimal somatic symptoms: IRR = 1.43, 95% CI = 1.31-1.55; moderate/severe versus minimal somatic symptoms: IRR = 1.69, 95% CI = 1.43-2.06), but not for depressive symptoms. When postdeployment mental health and somatic symptom measures were added to the model, the effect of premilitary somatic symptoms remained significant.
  
  
  CONCLUSIONS
  Findings point to potential etiological contributions of premilitary characteristics, particularly a tendency to experience somatic symptoms and PTSD, as well as mTBI and combat experiences, to the development of PCS. PCS were also strongly related to concurrent postdeployment mental health.
authors.affiliation: From the Director General Military Personnel Research and Analysis (Lee) and Directorate of Mental Health (Garber, Zamorski), Department of National Defence, Ottawa, Canada.
authors.forename: Jennifer E C
authors.initials: JE
authors.lastname: Lee
authors.forename: Bryan
authors.initials: B
authors.lastname: Garber
authors.forename: Mark A
authors.initials: MA
authors.lastname: Zamorski
mesh_terms: D000328:Adult; D002170:Canada / Q000453:epidemiology; D003130:Combat Disorders / Q000523:psychology; D003863:Depression / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D008297:Male; D008603:Mental Health; D008889:Military Personnel / Q000523:psychology*; D038223:Post-Concussion Syndrome / Q000453:epidemiology* / Q000523:psychology; D011446:Prospective Studies; D057566:Self Report; D012720:Severity of Illness Index; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000209:etiology; D063189:Symptom Assessment; D014857:Warfare