Mental and Physical Health-Related Quality of Life Following Military Polytrauma.

IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Military Medicine Pub Date : 2024-11-05 DOI:10.1093/milmed/usae055
Jay R McDonald, Matthew Wagoner, Faraz Shaikh, Erica Sercy, Laveta Stewart, Emma R Knapp, John L Kiley, Wesley R Campbell, David R Tribble
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Abstract

Introduction: The long-term impact of deployment-related trauma on mental and physical health-related quality of life (HRQoL) among military personnel is not well understood. We describe the mental and physical HRQoL among military personnel following deployment-related polytrauma after their discharge from the hospital and examine factors associated with HRQoL and longitudinal trends.

Materials and methods: The U.S. military personnel with battlefield-related trauma enrolled in the Trauma Infectious Diseases Outcomes Study were surveyed using SF-8 Health Surveys at 1 month post-discharge (baseline) and at follow-up intervals over 2 years. Inclusion in the longitudinal analysis required baseline SF-8 plus responses during early (3 and/or 6 months) and later follow-up periods (12, 18, and/or 24 months). Associations of demographics, injury characteristics, and hospitalization with baseline SF-8 scores and longitudinal changes in SF-8 scores during follow-up were examined. Survey responses were used to calculate the Mental Component Summary score (MCS) and the Physical Component Summary score (PCS). The MCS focuses on vitality, mental health, social functioning, and daily activity limitations, whereas PCS is related to general health, bodily pain, physical functioning, and physical activity limitations. Longitudinal trends in SF-8 scores were assessed using chi-square tests by comparing the median score at each timepoint to the median 1-month (baseline) score, as well as comparing follow-up scores to the immediately prior timepoint (e.g., 6 months vs. 3 months). Associations with the 1-month baseline SF-8 scores were assessed using generalized linear regression modeling and associations with longitudinal changes in SF-8 were examined using generalized linear regression modeling with repeated measures.

Results: Among 781 enrollees, lower baseline SF-8 total scores and PCS were associated with spinal and lower extremity injuries (P < .001) in the multivariate analyses, whereas lower baseline MCS was associated with head/face/neck injuries (P < .001). Higher baseline SF-8 total was associated with having an amputation (P = .009), and lower baseline SF-8 total was also associated with sustaining a traumatic brain injury (TBI; P = .042). Among 524 enrollees with longitudinal follow-up, SF-8 scores increased, driven by increased PCS and offset by small MCS decreases. Upward SF-8 total score and PCS trends were associated with time post-hospital discharge and limb amputation (any) in the multivariate analyses (P < .05), whereas downward trends were independently associated with spinal injury and developing any post-discharge infection (P ≤ .001). Patients with lower extremity injuries had lower-magnitude improvements in PCS over time compared to those without lower extremity injuries (P < .001). Upward MCS trend was associated with higher injury severity (P = .003) in the multivariate analyses, whereas downward trends were independently associated with having a TBI (P < .001), time post-hospital discharge (P < .001), and occurrence of post-discharge infections (P = .002).

Conclusions: Overall, HRQoL increased during the 2-year follow-up period, driven by PCS improvement. Increasing HRQoL was associated with time since hospital discharge and limb amputation, whereas a downward trend in HRQoL was associated with spinal injury and post-discharge infection. The longitudinal decline in MCS, driven by TBI occurrence, time since hospital discharge, and developing post-discharge infections, emphasizes the importance of longitudinal mental health care in this population.

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军事多重创伤后与身心健康相关的生活质量。
介绍:部署相关创伤对军人身心健康相关生活质量(HRQoL)的长期影响尚不十分清楚。我们描述了遭受与部署相关的多重创伤的军人在出院后的身心健康生活质量,并研究了与身心健康生活质量相关的因素和纵向趋势:参加创伤传染病结果研究的战场相关创伤美军人员在出院后 1 个月(基线)和 2 年的随访期间接受了 SF-8 健康调查。纳入纵向分析需要基线 SF-8 以及早期(3 个月和/或 6 个月)和后期(12 个月、18 个月和/或 24 个月)随访期间的回复。研究对象的人口统计学特征、受伤特征和住院情况与基线 SF-8 评分以及随访期间 SF-8 评分的纵向变化之间的关系。调查回复用于计算心理成分总分 (MCS) 和身体成分总分 (PCS)。MCS 侧重于活力、心理健康、社会功能和日常活动限制,而 PCS 则与一般健康、身体疼痛、身体功能和身体活动限制有关。通过比较每个时间点的中位数得分与 1 个月(基线)的中位数得分,以及比较随访得分与前一个时间点(如 6 个月与 3 个月)的中位数得分,使用卡方检验对 SF-8 分数的纵向趋势进行评估。使用广义线性回归模型评估与 1 个月基线 SF-8 分数的关联,使用重复测量的广义线性回归模型检查与 SF-8 纵向变化的关联:结果:在 781 名参保者中,基线 SF-8 总分和 PCS 较低与脊柱和下肢损伤有关(P<0.05):总体而言,在 2 年的随访期间,受 PCS 改善的推动,HRQoL 有所提高。HRQoL 的提高与出院时间和截肢有关,而 HRQoL 的下降趋势与脊柱损伤和出院后感染有关。创伤性脑损伤的发生、出院后的时间以及出院后感染等因素导致了 MCS 的纵向下降,这强调了纵向心理健康护理在这一人群中的重要性。
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来源期刊
Military Medicine
Military Medicine MEDICINE, GENERAL & INTERNAL-
CiteScore
2.20
自引率
8.30%
发文量
393
审稿时长
4-8 weeks
期刊介绍: Military Medicine is the official international journal of AMSUS. Articles published in the journal are peer-reviewed scientific papers, case reports, and editorials. The journal also publishes letters to the editor. The objective of the journal is to promote awareness of federal medicine by providing a forum for responsible discussion of common ideas and problems relevant to federal healthcare. Its mission is: To increase healthcare education by providing scientific and other information to its readers; to facilitate communication; and to offer a prestige publication for members’ writings.
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