Jordan M Wyrwa, Lisa A Brenner, Xiang-Dong Yan, Alexandra L Schneider, Lindsay Burke, Samuel E King, Jeri E Forster, Adam R Kinney
{"title":"神经行为症状部分介导抑郁症和创伤后应激障碍对轻度创伤性脑损伤退伍军人参与的影响：一项横断面研究","authors":"Jordan M Wyrwa, Lisa A Brenner, Xiang-Dong Yan, Alexandra L Schneider, Lindsay Burke, Samuel E King, Jeri E Forster, Adam R Kinney","doi":"10.1097/HTR.0000000000001012","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To examine whether neurobehavioral symptoms mediate the relationship between comorbid mental health conditions (major depressive disorder [MDD] and/or posttraumatic stress disorder [PTSD]) and participation restriction among Veterans with mild traumatic brain injury (mTBI).</p><p><strong>Setting: </strong>Veterans Health Administration (VHA).</p><p><strong>Participants: </strong>National sample of Veterans with mTBI who received VHA outpatient care between 2012 and 2020.</p><p><strong>Design: </strong>Secondary data analysis of VHA clinical data. We specified a latent variable path model to estimate relationships between: (1) comorbid mental health conditions and 3 latent indicators of neurobehavioral symptoms (vestibular-sensory; mood-behavioral; cognitive); (2) latent indicators of neurobehavioral symptoms and 2 latent indicators of participation restriction (social and community participation; productivity); and (3) comorbid mental health conditions and participation restriction.</p><p><strong>Main measures: </strong>International Classification of Diseases codes, Neurobehavioral Symptom Inventory, and Mayo-Portland Adaptability Inventory Participation Index to measure mental health conditions, neurobehavioral symptoms, and participation restrictions, respectively.</p><p><strong>Results: </strong>Indirect effect estimates indicated that comorbid MDD and/or PTSD was associated with greater social and community participation restrictions, as mediated by mood-behavioral ( β = .22-.33; 99% CI 0.18-0.4; small to medium effect) and cognitive symptoms ( β = .08-.13; 99% CI 0.05-0.18; small effect), and with greater productivity restrictions, as mediated by vestibular-sensory ( β = .06-.11; 99% CI 0.04-0.15; small effect) and cognitive symptoms ( β = .08-.13; 99% CI 0.05-0.18; small effect). Direct effect estimates indicated that comorbid MDD and/or PTSD was associated with greater challenges with both social and community participation ( β = .19-.40; 99% CI 0.12-0.49; small to medium effect) and productivity ( β = .08-.44; 99% CI -0.02 to 0.55; small to medium effect).</p><p><strong>Conclusion: </strong>Neurobehavioral symptoms partially mediated the impact of MDD and/or PTSD on participation restrictions among Veterans with mTBI. These findings advance the understanding of explanatory mechanisms underlying participation challenges among Veterans with comorbid mTBI and mental health challenges, thereby informing the development of tailored intervention strategies.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"E281-E291"},"PeriodicalIF":3.3000,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Neurobehavioral Symptoms Partially Mediate the Effects of Depression and PTSD on Participation for Veterans With Mild Traumatic Brain Injury: A Cross-Sectional Study.\",\"authors\":\"Jordan M Wyrwa, Lisa A Brenner, Xiang-Dong Yan, Alexandra L Schneider, Lindsay Burke, Samuel E King, Jeri E Forster, Adam R Kinney\",\"doi\":\"10.1097/HTR.0000000000001012\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>To examine whether neurobehavioral symptoms mediate the relationship between comorbid mental health conditions (major depressive disorder [MDD] and/or posttraumatic stress disorder [PTSD]) and participation restriction among Veterans with mild traumatic brain injury (mTBI).</p><p><strong>Setting: </strong>Veterans Health Administration (VHA).</p><p><strong>Participants: </strong>National sample of Veterans with mTBI who received VHA outpatient care between 2012 and 2020.</p><p><strong>Design: </strong>Secondary data analysis of VHA clinical data. We specified a latent variable path model to estimate relationships between: (1) comorbid mental health conditions and 3 latent indicators of neurobehavioral symptoms (vestibular-sensory; mood-behavioral; cognitive); (2) latent indicators of neurobehavioral symptoms and 2 latent indicators of participation restriction (social and community participation; productivity); and (3) comorbid mental health conditions and participation restriction.</p><p><strong>Main measures: </strong>International Classification of Diseases codes, Neurobehavioral Symptom Inventory, and Mayo-Portland Adaptability Inventory Participation Index to measure mental health conditions, neurobehavioral symptoms, and participation restrictions, respectively.</p><p><strong>Results: </strong>Indirect effect estimates indicated that comorbid MDD and/or PTSD was associated with greater social and community participation restrictions, as mediated by mood-behavioral ( β = .22-.33; 99% CI 0.18-0.4; small to medium effect) and cognitive symptoms ( β = .08-.13; 99% CI 0.05-0.18; small effect), and with greater productivity restrictions, as mediated by vestibular-sensory ( β = .06-.11; 99% CI 0.04-0.15; small effect) and cognitive symptoms ( β = .08-.13; 99% CI 0.05-0.18; small effect). Direct effect estimates indicated that comorbid MDD and/or PTSD was associated with greater challenges with both social and community participation ( β = .19-.40; 99% CI 0.12-0.49; small to medium effect) and productivity ( β = .08-.44; 99% CI -0.02 to 0.55; small to medium effect).</p><p><strong>Conclusion: </strong>Neurobehavioral symptoms partially mediated the impact of MDD and/or PTSD on participation restrictions among Veterans with mTBI. 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引用次数: 0
摘要
目的：探讨神经行为症状是否介导轻度颅脑损伤（mTBI）退伍军人共病精神健康状况（重度抑郁障碍（MDD）和/或创伤后应激障碍（PTSD））与参与限制的关系。单位：退伍军人健康管理局（VHA）。参与者：2012年至2020年间接受VHA门诊治疗的mTBI退伍军人的全国样本。设计：对VHA临床资料进行二次资料分析。我们指定了一个潜在变量路径模型来估计以下三者之间的关系：(1)共病精神健康状况与神经行为症状的3个潜在指标(前庭-感觉；mood-behavioral;认知);(2)潜在的神经行为症状指标和2个潜在的参与限制指标(社会和社区参与；生产率);(3)共病心理健康状况及参与限制。主要测量方法：国际疾病分类代码、神经行为症状量表和Mayo-Portland适应性量表参与指数，分别测量心理健康状况、神经行为症状和参与限制。结果：间接效应估计表明，共病性重度抑郁症和/或创伤后应激障碍与更大的社会和社区参与限制有关，这是由情绪-行为介导的(β = 0.22 - 0.33；99% ci 0.18-0.4；小到中等效应)和认知症状(β = 0.08 - 0.13；99% ci 0.05-0.18；小影响)，并且有更大的生产力限制，由前庭-感觉介导(β = 0.06 - 0.11；99% ci 0.04-0.15；小效应)和认知症状(β = 0.08 - 0.13；99% ci 0.05-0.18；小的效果)。直接效应估计表明，共病性重度抑郁症和/或创伤后应激障碍与社会和社区参与方面的更大挑战相关(β = 0.19 - 0.40；99% ci 0.12-0.49；中小型效应)和生产率(β = 0.08 - 0.44；99% CI -0.02 ~ 0.55；小到中等效果)。结论：神经行为症状部分介导重度抑郁症和/或创伤后应激障碍对mTBI退伍军人参与限制的影响。这些发现促进了对合并mTBI和心理健康挑战的退伍军人参与挑战的解释机制的理解，从而为制定量身定制的干预策略提供了信息。
Neurobehavioral Symptoms Partially Mediate the Effects of Depression and PTSD on Participation for Veterans With Mild Traumatic Brain Injury: A Cross-Sectional Study.
Objective: To examine whether neurobehavioral symptoms mediate the relationship between comorbid mental health conditions (major depressive disorder [MDD] and/or posttraumatic stress disorder [PTSD]) and participation restriction among Veterans with mild traumatic brain injury (mTBI).
Setting: Veterans Health Administration (VHA).
Participants: National sample of Veterans with mTBI who received VHA outpatient care between 2012 and 2020.
Design: Secondary data analysis of VHA clinical data. We specified a latent variable path model to estimate relationships between: (1) comorbid mental health conditions and 3 latent indicators of neurobehavioral symptoms (vestibular-sensory; mood-behavioral; cognitive); (2) latent indicators of neurobehavioral symptoms and 2 latent indicators of participation restriction (social and community participation; productivity); and (3) comorbid mental health conditions and participation restriction.
Main measures: International Classification of Diseases codes, Neurobehavioral Symptom Inventory, and Mayo-Portland Adaptability Inventory Participation Index to measure mental health conditions, neurobehavioral symptoms, and participation restrictions, respectively.
Results: Indirect effect estimates indicated that comorbid MDD and/or PTSD was associated with greater social and community participation restrictions, as mediated by mood-behavioral ( β = .22-.33; 99% CI 0.18-0.4; small to medium effect) and cognitive symptoms ( β = .08-.13; 99% CI 0.05-0.18; small effect), and with greater productivity restrictions, as mediated by vestibular-sensory ( β = .06-.11; 99% CI 0.04-0.15; small effect) and cognitive symptoms ( β = .08-.13; 99% CI 0.05-0.18; small effect). Direct effect estimates indicated that comorbid MDD and/or PTSD was associated with greater challenges with both social and community participation ( β = .19-.40; 99% CI 0.12-0.49; small to medium effect) and productivity ( β = .08-.44; 99% CI -0.02 to 0.55; small to medium effect).
Conclusion: Neurobehavioral symptoms partially mediated the impact of MDD and/or PTSD on participation restrictions among Veterans with mTBI. These findings advance the understanding of explanatory mechanisms underlying participation challenges among Veterans with comorbid mTBI and mental health challenges, thereby informing the development of tailored intervention strategies.
期刊介绍：
The Journal of Head Trauma Rehabilitation is a leading, peer-reviewed resource that provides up-to-date information on the clinical management and rehabilitation of persons with traumatic brain injuries. Six issues each year aspire to the vision of “knowledge informing care” and include a wide range of articles, topical issues, commentaries and special features. It is the official journal of the Brain Injury Association of America (BIAA).
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