Journal of Head Trauma Rehabilitation最新文献

Objective: Although traumatic brain injury (TBI) has been identified as a risk factor for suicide among individuals from civilian and military cohorts, less is known about suicidal ideation (SI) and suicide attempts (SA), which often predate suicide. Moreover, little work has been conducted to evaluate sex-based differences.

Data sources: Department of Defense, Military Health System (MHS), and Department of Veterans Affairs, Corporate Data Warehouse.

Participants: Active Duty military service members (SM) with a history of TBI in the MHS (January 2000-March 2022); overall cohort with sex in medical record n = 354 972, males n = 305 284, and females n = 49 688.

Design: Descriptive retrospective observational study.

Main measures: In the MHS, index TBIs were identified via diagnostic codes. SI and SA codes were captured: (1) prior to index TBI; and (2) within 1, 2, and 5 years post-index TBI; total and newly identified. Sex was identified using MHS data.

Results: Most injuries sustained by males and females were mild, 65.9% and 77.2%, respectively. Post-TBI incidence of SI and SA was higher than the prevalence of these diagnoses prior to TBI. At all post-TBI time points, the risk of SI and SA was significantly higher for females compared to males. The risk ratio (RR; females:males) at 1-year post-TBI was 1.59 (95% confidence interval [CI]: 1.48, 1.70) and 2.66 (95% CI: 2.06, 3.43), for SI and SA, respectively. Risk remained higher for females through 5-year post-TBI with SI RR = 1.20 (95% CI: 1.13, 1.26) and SA RR = 1.94 (95% CI: 1.58, 2.37).

Conclusions: Findings highlight the risk of SI and SA by female and male SMs post-index TBI, with female SMs being at higher risk than males, as well as the need for suicide risk screening for those with a history of TBI. Implementing screening in settings where females commonly receive care should be considered.

Objective: To determine whether there are sex-specific associations between traumatic brain injury (TBI) and nonfatal drug overdose, when considering psychiatric conditions as mediators of this association.

Setting: Veterans receiving care at national Department of Veterans Affairs (VA) facilities from April 2007 to December 2019.

Participants: 1 231 406 post-9/11 veterans aged 18 to 65, with 11.0% males and 2.9% females with confirmed TBI.

Design: Retrospective, longitudinal cohort study using VA medical record data.

Main measures: Deployment-related TBI was defined as a confirmed diagnosis according to the VA TBI comprehensive evaluation; no deployment-related TBI was defined as no deployment-related head injury. Nonfatal overdose (any drug, and opioid-specific) were defined using International Classification of Diseases, Ninth and Tenth Revision codes. We performed sex-specific Cox-proportional hazards regressions for any drug and opioid overdose outcomes, adjusted for demographic and military characteristics. Mediation analyses were conducted to examine the role of psychiatric conditions (substance use, anxiety, mood, and posttraumatic stress disorders).

Results: Compared to veterans without TBI, veterans with a history of TBI had approximately a 2-fold increased adjusted rate of any drug overdose (males: adjusted hazards ratio [aHR] = 1.93, 95% confidence interval [CI] = 1.84, 2.03; females: aHR = 1.82, 95% CI = 1.56, 2.12) and over a 2-fold increased adjusted rate of opioid-related overdose (males: aHR = 2.29, 95% CI = 2.03, 2.59; females: aHR = 2.43, 95% CI = 1.58, 3.74). The associations were partially attributable to comorbid psychiatric conditions, yet remained present after adjustment, for any drug overdose (males: aHR range, 1.38-1.86; females: aHR range, 1.45-1.89) and opioid-specific overdose (males: aHR range, 1.58-2.15; females: aHR range, 1.56-2.80) outcomes.

Conclusions: Veterans with deployment-related TBIs have a higher rate of nonfatal overdose, with similar associations for males and females. The associations were partially attributable to, but not fully explained by, comorbid psychiatric conditions.

Objective: This study examined sex differences in subacute plasma biomarkers in adolescents post-concussion and their associations with post-concussion symptom (PCS) burden. We hypothesized that biomarker levels would differ by sex and relate to PCS severity.

Setting: Participants were recruited from outpatient settings as part of the Concussion Assessment, Research, and Education for Kids (CARE4Kids) multi-site observational study.

Participants: Adolescents 11 to 17.99 years with a concussion based on Concussion In Sport Group criteria were eligible. Participants were assessed 7 to 35 days post-injury and required to report at least one PCS exceeding pre-injury baseline. A total of 339 participants (174 females, 145 males) with both blood biomarkers and PCS data were analyzed.

Design: Plasma levels of glial fibrillary acidic protein, neurofilament light chain (NFL), ubiquitin C-terminal hydrolase (UCH-L1), tau, and phosphorylated tau at threonine 181 (p-tau181) were measured and compared between sexes. PCS severity was assessed using the Post-Concussion Symptom Inventory, 2nd Ed (PCSI-2) Retrospective Adjusted Post-Injury Difference (RAPID) scoring system.

Main measures: Primary outcomes were sex differences in biomarker levels and their associations with RAPID scores.

Results: Females had significantly higher tau (females: M = 6.18, SD = 8.02; males: M = 4.55, SD = 5.53; P = .012) and lower p-tau181/tau ratios (females: M = 6.18, SD = 8.02; males: M = 4.55, SD = 5.53; P = .002) after adjusting for age, BMI, and days post-injury. In both sexes, cognitive symptoms were associated with higher p-tau181. In females, emotional symptoms were associated with elevated NFL and UCH-L1. In males, physical and overall symptoms were associated with lower NFL, UCH-L1, and p-tau181.

Conclusion: This study highlights sex-specific biomarker differences during adolescent concussion recovery and the importance of understanding how sex differences may influence symptom burden and recovery trajectories. Future research should examine hormonal influences on biomarker profiles and prolonged symptomatology.

Objectives: Sex differences have been identified in terms of post-concussion symptoms and recovery rate in athletes in high impact sports, although specific alterations in pre- and post-concussion cognitive measures have not been examined. Some studies show that either an acute concussion or a history of concussion can lead to cognitive impairment, with more pronounced long-term deficits observed in females. The objective in the current study was to examine differences in cognitive performance based on self-reported history of concussion and/or sex in NCAA Division 1 and high school athletes.

Participants: Participants in high impact sports at an NCAA Division I university and high school were recruited.

Method: Athletes completed 6 subscales from the Automated Neuropsychological Assessment Metrics (ANAM) UltraMobile as the primary outcome measure. Using a cross-sectional design, we investigated differences in cognitive performance based on sport-related concussion (SRC) history and potential interactions with biological sex using hierarchical regressions while accounting for age effects.

Results: Findings revealed significant differences in concussion recovery, with female athletes reporting longer recovery time than males. Results of regressions indicated biological sex as a moderator of developmental trends in cognitive inhibition, with history of concussion potentially impairing inhibition (increasing impulsivity) in males but increasing inhibition (increasing hypervigilance) in females. Athletes with a history of SRC showed less improvement in simple reaction time (SRT) over a single ANAM administration compared to athletes with no history of SRC. Sex differences, regardless of concussion history, were identified for working memory and variability ofSRT, with females having faster and less variable reaction times.

Conclusions: Potential implications include the use of the go-no/go, matching-to-sample, and SRT subscales on the ANAM UltraMobile along with calculating change in reaction time to detect prolonged deficits in cognitive performance following SRC which may vary by sex.

Objective: To examine the interaction of race/ethnicity and sex on societal participation (productivity and overall participation) among individuals with traumatic brain injury (TBI).

Setting: Community.

Participants: A total of 8861 individuals aged ≥16 who identified as non-Hispanic White (1750 females, 4270 males), non-Hispanic Black (315 females, 1147 males), or Hispanic (314 females, 1065 males), and who completed a 1-year postinjury follow-up interview in the TBI Model Systems National Database.

Design: Secondary analysis of a longitudinal cohort study at 1-year postinjury.

Main measures: The Participation Assessment with Recombined Tools-Objective-17 (PART-O-17) Productivity items (ie, school, employment, and homemaking) and subscale, and total Summary scores were the primary outcomes used to assess societal participation. The covariates were age, years of education, and total score on the Functional Independence Measure (FIM).

Results: A significant sex × race/ethnicity interaction with homemaking was identified ( P = .047). Compared with Non-Hispanic White males, odds of not endorsing homemaking were 1.55 times greater for Non-Hispanic Black males and 1.71 times greater for Hispanic males. No significant sex × race/ethnicity interactions were found with employment ( P = .221) or school items ( P = .967). After adjusting for age, education, and FIM Total, a significant sex × race/ethnicity interaction on Productivity scores was found, F (28 852) = 10.3, P <.001, such that sex differences were observed for only Non-Hispanic Black and Hispanic participants compared to Non-Hispanic White participants. No significant interaction regarding sex differences across racial/ethnic groups was identified using the PART-O-17 Summary score.

Conclusions: Compared with non-Hispanic White males, non-Hispanic Black and Hispanic males were less likely to report engaging in homemaking activities, resulting in greater sex differences among Non-Hispanic Black and Hispanic males and females on the Productivity subscale than were observed on this scale among non-Hispanic White individuals. Current community participation measures may not accurately capture the experiences of diverse populations with TBI.

Objective: Many studies of concussion in adolescents include both sexes, but males are often overrepresented. Female adolescents may be more susceptible to concussion and greater symptom severity than males, potentially masking associations that may exist in concussed adolescent females between pre-existing/injury-related factors and persisting symptoms. To address these issues, our research objectives were to (1) determine what factors at initial clinical evaluation are predictive of persisting concussion symptoms, specifically in adolescent females using modern statistical approaches, and (2) identify the persisting symptoms potentially linked to these factors to inform best practices for the targeted treatment of adolescent females.

Setting: Specialty concussion clinics.

Participants: 732 adolescent females aged 12 to 18 years with a diagnosis of concussion ≤30 days from injury.

Design: Data from a prospective cohort study were obtained at 2 clinical time points, within 1 month following injury and 3 months later. Data were analyzed using machine learning techniques in logistic regression and random forest classification models.

Main measures: Demographic variables, pre-existing factors, and injury-related factors; Sport Concussion Assessment Tool 5 © (SCAT5) Symptom Evaluation, General Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-8 (PHQ-8), and Pittsburgh Sleep Quality Index (PSQI).

Results: In the machine learning analysis, the area under the curve (AUC) for the random forest model was 0.73 (SE = 0.014), and the AUC of the logistic regression model was 0.70 (SE = 0.0014). SCAT5 Symptom Severity Score, SCAT5 Emotional Cluster Symptom Severity, Number of SCAT5 Symptoms, GAD-7 Score, PHQ-8 Score, PSQI Score, and pre-existing/injury-related factors were predictive of persisting concussion symptoms. Specific persisting symptoms were also identified.

Conclusion: Adolescent females with greater initial post-concussion symptoms, especially emotional symptoms, were more likely to report persisting symptoms. Use of readily available screening tools can be utilized by providers to identify adolescent females who may be at risk for persisting symptoms and direct focused treatment for these symptoms.

Objectives: This retrospective study examined whether contact sport participation, repetitive head impact (RHI) exposure, and concussion history were associated with cognitive and emotional symptoms in former collegiate female athletes.

Setting: Archival data from the College Level Aging Athlete Study, a hybrid survey of over 1,000 former collegiate athletes aged 50 and older.

Participants: Female athletes ( n = 567) were categorized into contact (e.g., soccer, lacrosse, ice hockey, and rugby) and non-contact (e.g., golf, diving, swimming, and gymnastics) groups based on their primary collegiate sport.

Design and main measures: Analyses of covariance, controlling for age and education, compared subjective cognitive decline (Cognitive Functioning Index), objective cognitive performance (Telephone Interview for Cognitive Status-40 Item Version), depression (Patient Health Questionnaire-8), anxiety (Generalized Anxiety Disorder Scale-7), and emotional dysregulation (Neurological Quality of Life Emotional and Behavioral Dyscontrol). Additional ANCOVAs assessed interactions between contact sport status and RHI variables (self-reported concussions, age of first participation, and years played). A post hoc model examined whether emotional symptoms attenuated cognitive complaints using an emotional symptom index (aggregate of depression, anxiety, and emotional dysregulation measures). Models adjusted standard errors using a heteroskedasticity-consistent method, with significance corrected via the Holm-Bonferroni method.

Results: Contact and non-contact athletes showed similar cognitive and emotional profiles. Concussion history was associated with greater subjective cognitive and emotional symptoms but not objective cognitive decline. Emotional symptoms predicted cognitive concerns better than concussion history.

Conclusions: In this sample of aging female athletes, RHI exposure and concussions were not associated with objective cognitive impairment. Subjective concerns were greater in those with more reported concussions but were strongly influenced by emotional symptoms.

Objective: Sex, fatigue and subjective sleep disruption have been shown to be associated with poor subjective recovery after mild traumatic brain injury (mTBI). This study aimed to determine whether the relationship between these factors and post-concussion symptom (PCS) reporting are unique to individuals who have incurred an mTBI. Setting, Participants, Design and Main Measures: In this observational study, a group of 208 pre-morbidly healthy adults was assessed with measures of fatigue (Multi-dimensional Fatigue Inventory), subjective sleep disturbance (Pittsburgh Sleep Quality Index), depression (Inventory of Depressive Symptomatology) and anxiety (Beck Anxiety Inventory) symptomatology, and PCS endorsement (Rivermead Post-Concussion Symptoms Questionnaire).

Results: Individuals who were admitted to hospital approximately 8-weeks prior with systemic traumatic injury and mTBI (mTBI; n = 86) and with systemic traumatic injury without head injury (TC; n = 46) had equivalent and elevated levels of fatigue, subjective sleep disturbance and PCS endorsement relative to a healthy community-based control sample (HC; n = 76). Female sex ( P = .028) and an elevated sense of general tiredness ( P = .037) independently explained significant variance in global PCS endorsement in the mTBI group, but sex did not independently explain variance in PCS reporting in either control group. Psychological status was the only variable that independently explained variance in PCS reporting in all groups.

Conclusions: This study indicates that the vulnerability of females to report elevated PCS in the post-acute period after traumatic injury is specific to those who have incurred a concomitant mTBI. Further, only some subcomponents of fatigue independently explain variance in PCS reporting, with the groups showing variability in these associations. Further work is needed to understand whether it is the "biological" and/or "socio-environmental" aspect of being female that increases the risk of higher PCS endorsement after mTBI.