Abstract
Objective. Veterans' mental health has been the subject of extensive research in many parts of the world. Particular attention is paid to PTSD, including in combination with trauma. Such comorbid conditions have a significant negative psychosocial impact, reducing the possibility of successful adaptation and resocialization of veterans. Certain features of socio-demographic and medical-anamnestic characteristics of veterans with PTSD, comorbid with TBI, as well as their problematic perception of certain areas of their lives may affect the formation of mental disorders, the course, and prognosis, success of therapy and rehabilitation, as well as recovery and quality of life. Thus, there is a need to study the characteristics of socio-demographic and medical-anamnestic characteristics of veterans with PTSD, especially in combination with CHD, to optimize pharmacological treatment and psychosocial therapy.
Purpose: to investigate the socio-demographic, medical, and anamnestic characteristics of veterans with PTSD and CHD.
Methods and materials. 329 combatants (members of the Armed Forces, the National Guard, and "volunteer battalions") in Eastern Ukraine who suffered from PTSD and LCHMT were examined. The socio-demographic and medical-anamnestic examination was performed using the Unified map of patient research developed by us.
Results. Analysis of the socio-demographic characteristics of patients with PTSD and TBI shows that about a third of those surveyed gained primary adult life experience in a military conflict. Stay in the combat zone affected the work history: before entering the service in the ATO, most of the surveyed persons worked full time in the civilian sphere, and after being in the ATO, these figures decreased by more than 3 times due to redistribution in the category of those who continued to serve. The large number of people who continued to serve despite receiving PTSD, TBI, or a combination of these can be partly explained by the desire to maintain "fraternal unity" as a surrogate family. Most of the subjects were premorbidly psychosomatically healthy despite periodic alcohol consumption; somatic vulnerability was unique to TBI individuals.
Conclusions. The socio-demographic, medical, and anamnestic features of veterans with PTSD and LCHMT identified by us were further used to form targets for psychosocial therapy and optimize pharmacological treatment.
Background
Modern macro- and micro-social factors related to the military conflict in eastern Ukraine have led to the transformation of public consciousness and changes in the lives and values of millions of people, which is essentially a collective trauma [1-3]. Mental maladaptation as a result of the influence of these factors leads to the development of social stress disorders, which in ICD-10 are defined under the diagnostic heading "Neurotic, stress-related and somatoform disorders" (F40-F49) [1,3-5]. Among them, the clinical manifestations of PTSD most pronouncedly affect the psychological and social side of the individual's life, the level of their adaptive capabilities, the use of psychological resources to overcome stress, the functional level of psychological homeostasis [1,5,6].
The study of various aspects of the relationship between traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) in patients injured by military trauma has become particularly relevant because these disorders often coexist clinically, both individually and collectively, are considered as significant factors of health disorders in people affected by emergencies [2,7-12].
Occurrence and severity of adaptation disorders and post-traumatic stress development caused by social stress factors due to personal, neurobiological, and social factors: individual thinking, level of education, previous traumatic experience, psychophysical education, social and family status, social and family somatic diseases in the past [1,4,5].
Military trauma has a significantly destructive impact on the individual life of a citizen and the functioning of the society in which one is and brings socio-economic disruption at the state level. The most pressing issues of social rehabilitation of victims of military trauma are the restoration of civilian status, the implementation of social contacts in peace, the constructive overcoming of socio-economic difficulties, correction of alcohol and psychoactive substance abuse, replacement of destructive behavioral strategies with more socially desirable and individually useful [1-3,5,12-14].
Veterans' mental health has been the subject of extensive research in many parts of the world. Particular attention is paid to PTSD, including in combination with TBI. Such comorbid conditions have a significant negative psychosocial impact, reducing the possibility of successful adaptation and resocialization of veterans. Certain features of socio-demographic and medical-anamnestic characteristics of veterans with PTSD comorbid with slight traumatic brain injury, as well as their problematic perception of certain areas of their lives may affect the formation of mental disorders, the course, and prognosis, success of therapy and rehabilitation, as well as recovery and quality of life [1-3,5,12-14].
Thus, there is a need to study the characteristics of socio-demographic and medical-anamnestic characteristics of veterans with PTSD, especially in combination with slight traumatic brain injury (STBI), their relationship with the clinical characteristics of victims in order to optimize pharmacological treatment and psychosocial therapy.
Aim
The aim of the study is to investigate the socio-demographic, medical, and anamnestic characteristics of veterans with PTSD and slight traumatic brain injury (STBI).
Methods and materials
329 combatants (members of the Armed Forces, the National Guard, and "volunteer battalions") in eastern Ukraine who suffered from PTSD and STBI were examined. The study was conducted on the basis of the Municipal Non-Commercial Enterprise "Ternopil Regional Clinical Psychoneurological Hospital" of the Ternopil Regional Council, where this contingent underwent treatment and/or rehabilitation.
The examination was conducted using our Unified Patient Study Card, which included the collection of information on certain socio-demographic and medical-social indicators, namely: age, gender, marital status, education, employment status, disability, living conditions, stay in the ATO area, duration of direct stay in the combat zone, duration of demobilization, military rank.
Results
The study material was structured within three research groups (Table 1): groups of veterans diagnosed with post-traumatic stress disorder (PTSD group) - 109 people (33.1% of the surveyed contingent); groups of veterans with the consequences of traumatic brain injury (group TBI) - 112 people (34.0%); groups of veterans with PTSD with comorbid consequences of traumatic brain injury (group of CTBI) - 108 people (32.8%).
Group | Total | φ* | |
---|---|---|---|
Indicator | abs. | % | |
PTSD | 109 | 33.1 | 0.7238 |
TBI | 112 | 34.0 | 0.4439 |
CTBI | 108 | 32.8 | 0.3219 |
Total | 329 | 100.0 | - |
According to the results of the comparison of the volumes of the selected groups, performed using the calculation of the coefficient Fisher's φ * - angular transformation (Table 1), no statistical difference in the number of respondents who made up the research groups was found (φ * ≤0.723; p> 0.1). Thus, research groups can be considered representative and statistically comparable.
The studied contingent consisted of persons aged 19 to 64 years. The structuring of research groups by age intervals at 10 years was unreliable (φ * ≤1,623; p> 0,1), which indicates the harmony of the distribution of respondents in the research groups by age and the irrationality of the use of age in further research (Table 2).
At the same time, we can testify that about a third of the surveyed persons significantly gained primary adult life experience in the conditions of military conflict (37.98% of representatives of all research groups were under the age of 30).
Group | PTSD | TBI | CTBI | ||||||
---|---|---|---|---|---|---|---|---|---|
Indicator | abs. | % | φ* | abs. | % | φ* | abs. | % | φ* |
Age characteristics | |||||||||
<20 | 3 | 2.75 | 1.482 | 3 | 2.67 | 1.623 | 3 | 2.77 | 1.592 |
21-30 | 36 | 33.03 | - | 41 | 36.61 | 0.331 | 39 | 36.11 | 0.335 |
31-40 | 36 | 33.03 | 0.406 | 37 | 33.04 | 0.478 | 35 | 32.41 | 0.326 |
>40 | 31 | 28.44 | 1.309 | 31 | 27.68 | 1.623 | 31 | 28.7 | 1.592 |
Was brought up in childhood | |||||||||
By full family | 51 | 46.79 | 0.716 | 51 | 45.54 | 0.443 | 58 | 53.7 | 1.797 |
By 1 of the parents | 43 | 39.45 | 2.115 | 46 | 41.07 | 2.129 | 38 | 35.19 | 1.559 |
By grandmother, grandfather | 10 | 9.174 | 0.428 | 6 | 5.35 | 0.134 | 3 | 2.77 | 0.069 |
By other relatives | 3 | 2.752 | 0.067 | 4 | 3.57 | 0.067 | 4 | 3.71 | 0.069 |
By orphanage | 2 | 1.835 | 1.713 | 5 | 4.46 | 2.252 | 5 | 4.63 | 2.599 |
Education | |||||||||
Secondary | 13 | 11.93 | 2.643 | 12 | 10.71 | 2.477 | 12 | 11.11 | 2.667 |
Secondary-special | 52 | 47.71 | 0.722 | 50 | 44.64 | - | 52 | 48.15 | 0.728 |
Higher | 44 | 40.37 | 2.127 | 50 | 44.64 | 2.477 | 44 | 40.74 | 2.164 |
Work before the anti-terrorist operation | |||||||||
Did not work | 29 | 26.61 | 0.159 | 33 | 29.46 | 0.079 | 28 | 25.93 | 0.239 |
Part-time employment | 31 | 28.44 | 0.654 | 32 | 28.57 | 0.401 | 31 | 28.7 | 0.659 |
Full employment | 39 | 35.78 | 1.881 | 37 | 33.04 | 1.733 | 39 | 36.11 | 1.893 |
Continued to serve | 10 | 9.174 | 1.277 | 10 | 8.92 | 1.497 | 10 | 9.25 | 1.222 |
Work after the anti-terrorist operation | |||||||||
Did not work | 33 | 30.28 | 0.081 | 34 | 30.36 | 0.079 | 32 | 29.63 | - |
Part-time employment | 32 | 29.36 | 1.384 | 33 | 29.46 | 1.425 | 32 | 29.63 | 1.393 |
Full employment | 12 | 11.01 | 1.384 | 12 | 10.71 | 1.425 | 12 | 11.11 | 1.393 |
Continued to serve | 32 | 29.36 | 0.081 | 33 | 29.46 | 0.079 | 32 | 29.63 | - |
Marital status | |||||||||
Single | 36 | 33.03 | 1.935 | 37 | 33.04 | 1.998 | 35 | 32.41 | 2.026 |
Married | 58 | 53.21 | 3.021 | 60 | 53.57 | 3.093 | 58 | 53.7 | 3.042 |
Divorced | 15 | 13.76 | 1.511 | 15 | 13.39 | 1.552 | 15 | 13.89 | 1.45 |
The vast majority of surveyed persons in childhood were brought up in complete families, but this predominance is significant only for the CTBI group - 53.7% (φ * = 1,797; р≤0,036). A significant majority of people raised in single-parent families were in the PTSD group - 39.5% (φ * = 2.115; p≤0.016), in the TBI group - 41.1% (φ * = 2.129; p≤0.016). A statistically significant minority of respondents from all research groups were brought up in orphanages as children (φ * ≥1,713; р≤0,044).
In all three research groups, the share of people with secondary education was significantly the lowest (respectively in the PTSD group - 11.9% (φ * = 2,643; р≤0,003), in the TBI group - 10.7% (φ * = 2,477; р≤ 0.02), in the CTBI group - 11.1% (φ * = 2.667; p≤0.002) there were relatively significantly more people with higher education, they were respectively in the group of PTSD - 40.1% (φ * = 2.127; p≤0,017), in the group of TBI - 44.6% (φ * = 2,477; p≤0,005), in the group of CTBI - 40.7% (φ * = 2,164; p≤0,015). The rest of the persons had secondary special education. Thus, we can attest to a fairly high level of education of individuals in all groups studied.
Prior to joining the anti-terrorist operation, most of the surveyed persons worked full-time in the civilian sphere (respectively in the PTSD group - 35.8% (φ * = 1.881; p≤0.03), in the TBI group - 33.04% * = 1,733; р≤0,042), in the CTBI group - 36.11% (φ * = 1,893; р≤0,029). After being in the ATO, these figures decreased by more than 3 times due to the redistribution in the category of those who continued to serve.
According to a marital status, about half of the surveyed persons were married (respectively in the group of PTSD - 53.2% (φ * = 3,021; p <0,0001), in the group of TBI - 53.6% (φ * = 3,093; p <0, 0001), in the group of CTBI - 53.7% (φ * = 3,042; p <0,0001). However, the second half of the respondents did not have a relevant family, and in all groups, more than 2/3 were singles, and 1/3 – divorced. Thus, we can attest that the unexpectedly large number of people who continued to serve despite receiving PTSD, TBI, or a combination of these can be partly explained by the desire to maintain "fraternal unity" as a surrogate family.
According to military ranks, the structure of all research groups was homogeneous (φ * ≤0.663; p> 0.1): private soldiers, sergeants, and officers accounted for one-third of the surveyed contingent (Table 3).
Group | PTSD | TBI | CTBI | ||||||
---|---|---|---|---|---|---|---|---|---|
Indicator | abs. | % | φ* | abs. | % | φ* | abs. | % | φ* |
Military rank | |||||||||
Private soldier | 41 | 37.61 | 0.502 | 45 | 40.18 | 0.906 | 42 | 38.89 | 0.754 |
Sergeant | 35 | 32.11 | 0.163 | 34 | 30.36 | 0.079 | 33 | 30.56 | - |
Officer | 33 | 30.28 | 0.663 | 33 | 29.46 | 0.984 | 33 | 30.56 | 0.754 |
General conscription or contract service | |||||||||
General conscription | 71 | 65.14 | 3.061 | 68 | 60.71 | 2.232 | 78 | 72.22 | 4.288 |
Contract service | 38 | 34.86 | 3.061 | 44 | 39.29 | 2.232 | 30 | 27.78 | 4.288 |
Length of stay in the combat zone | |||||||||
up to 1 week | 19 | 17.43 | 1.055 | 11 | 9.82 | 0.826 | 19 | 17.59 | 0.986 |
up to 1 month | 33 | 30.28 | 0.627 | 23 | 20.54 | 0.761 | 32 | 29.63 | 0.552 |
up to 3 months | 25 | 22.94 | 0.304 | 33 | 29.46 | - | 25 | 23.15 | 0.306 |
up to 6 months | 21 | 19.27 | 0.704 | 33 | 29.46 | 1.425 | 21 | 19.44 | 0.708 |
up to 1 year | 11 | 10.09 | 0.567 | 12 | 10.71 | 0.071 | 11 | 10.19 | 0.57 |
The vast majority of respondents in all research groups during hostilities served in the conscription (φ * ≥3,042; р≤0,013): 71 people (65.14%) in the PTSD group; 68 people (60.71%) in the TBI group and 78 people (72.22%) in the CTBI group.
The duration of the stay in the combat zone was structured as follows: up to 1 week; up to 1 month; up to 3 months; up to 6 months and up to 1 year. When comparing groups of percentages of the number of respondents in the research groups within these terms using the calculation of the coefficient Fisher's φ * - angular transformation, no statistically significant difference was found (φ * ≤1,425; p≥0,078), which indicates a harmonious distribution research material and this important factor.
The analysis of additional medical and anamnestic characteristics of the respondents of the studied groups gave the following results (Table 4).
Group | PTSD | TBI | CTBI | ||||||
---|---|---|---|---|---|---|---|---|---|
Indicator | abs. | % | φ* | abs. | % | φ* | abs. | % | φ* |
Treatment by a psychiatrist before service in the anti-terrorist operation | |||||||||
no | 86 | 78.9 | 5.250 | 88 | 78.57 | 5.282 | 86 | 79.63 | 5.31 |
yes | 23 | 21.1 | 5.250 | 24 | 21.43 | 5.282 | 22 | 20.37 | 5.31 |
Chronic somatic diseases before service in the anti-terrorist operation | |||||||||
no | 49 | 44.95 | 1.05 | 45 | 40.18 | 2.051 | 67 | 62.04 | 2.45 |
yes | 60 | 55.05 | 1.05 | 67 | 59.82 | 2.051 | 41 | 37.96 | 2.45 |
Disability group | |||||||||
yes | 34 | 31.19 | 3.731 | 84 | 75.0 | 4.798 | 39 | 36.11 | 2.81 |
no | 75 | 68.81 | 3.731 | 28 | 25.0 | 4.798 | 69 | 63.89 | 2.81 |
Alcohol consumption | |||||||||
Does not use | 14 | 12.84 | 2.231 | 18 | 16.07 | 2.036 | 20 | 18.52 | 2.141 |
Several times/year | 46 | 42.2 | 1.168 | 46 | 41.07 | 1.144 | 48 | 44.44 | 1.5 |
1 time/month | 32 | 29.36 | 1.337 | 32 | 28.57 | 1.315 | 30 | 27.78 | 1.405 |
2 times/month | 13 | 11.93 | 0.559 | 13 | 11.61 | 0.572 | 8 | 7.41 | 0.352 |
1 time/week | 4 | 3.67 | 0.613 | 3 | 2.67 | 0.795 | 2 | 1.85 | 0.832 |
Cannabinoid use | |||||||||
Does not use | 66 | 60.55 | 3.341 | 68 | 60.71 | 3.507 | 69 | 63.89 | 3.767 |
Several times/year | 25 | 22.94 | 0.918 | 23 | 20.54 | 0.707 | 21 | 19.44 | 0.708 |
1 time/month | 12 | 11.01 | 0.459 | 13 | 11.61 | 0.512 | 11 | 10.19 | 0.449 |
2 times/month | 5 | 4.587 | 0.218 | 5 | 4.464 | 0.132 | 4 | 3.70 | 0.069 |
1 time/week | 1 | 0.917 | 1.579 | 3 | 2.679 | 2.471 | 3 | 2.77 | 2.573 |
Use of other psychoactive substances | |||||||||
Did not use | 65 | 59.63 | 3.104 | 97 | 86.61 | 5.375 | 69 | 63.89 | 3.709 |
Opiates | 28 | 25.69 | 1.201 | 10 | 8.92 | 0.398 | 23 | 21.3 | 0.994 |
Psychostimulants | 3 | 2.752 | 0.068 | 1 | 0.89 | - | 8 | 7.407 | 0.206 |
Hallucinogens | 4 | 3.67 | 0.136 | 1 | 0.89 | 0.064 | 5 | 4.63 | 0.22 |
Barbiturates | 6 | 5.505 | 0.198 | 2 | 1.78 | 0.064 | 1 | 0.926 | - |
Tranquilizers | 3 | 2.752 | 2.423 | 1 | 0.89 | 2.191 | 1 | 0.926 | - |
Others | - | - | - | - | - | - | 1 | 0.926 | 1.648 |
In all groups, a significant majority of respondents (φ * ≥5.25; p <0.0001) never sought psychiatric care before being in the combat zone: 86 people (78.9%) in the PTSD group; 88 people (78.57%) in the TBI group and 86 people (79.63%) in the CTBI group.
A completely different picture was observed with anamnestic data on chronic somatic diseases. In the PTSD group, there was no statistically significant difference between the number of people treated for these diseases before participating in the anti-terrorist operation and those who had not previously suffered from chronic somatic diseases (φ * = 1.05; p> 0.1), while in the group of TBI the majority was treated for these diseases (φ * = 2,051; p <0,02), and in the group of CTBI, on the contrary, the majority was treated for chronic somatic diseases (φ * = 2,45; p < 0.005).
At the time of the survey, a significant majority of the disability group did not have (φ * ≥2.81; p≤0.001) respondents from the PTSD group (75 people - 68.81%) and CTBI (69 people - 63.89%), while in the group of TBI, on the contrary, the majority was with a disability group (φ * = 4.798; p <0.0001) (84 people - 75.0%).
The results of the survey on alcohol use indicate that a significant minority of all study groups abstain from alcohol consumption (φ * ≥2,036; р≤0,021). However, statistically significant differences in the rhythm of alcohol consumption (Table 4) were not detected (φ * ≤1,405; p≥0,081).
The analysis of the results of the survey of the second, most popular psychoactive substance among the participants of the armed conflict in eastern Ukraine - the group of cannabinoids, gave opposite results - a statistically significant majority of respondents did not use them (φ * ≥3,341; p <0,0001). Among cannabinoid users, as in the case of alcohol, it was not possible to identify a group with one or another rhythm of drug use (φ * ≤1,579; p≥0,056) except for members of the TBI group - the rhythm of use "once a week and more often" was found in the significant (φ * = 2,471; p <0,006) minority of respondents (3 persons - 2.68%).
Other psychoactive substances according to the results of the survey were also never used by the majority of all research groups (φ * ≥3.104; p <0.0001). Among respondents who used other surfactants, opiate users predominated (28 people - 25.69% in the PTSD group; 10 people - 8.92% in the TBI group; 23 people - 21.3% in the CTBI group), although the statistical significance of this the advantage is not acceptable (φ * ≤1,201; p> 0,1).
To check the differences in the percentages of the number of respondents of individual research groups, which are characterized by the above-described social and anamnestic factors, we also calculated the coefficient Fisher's φ * - angular transformation (Table 5-6), based on the analysis of which to state that there is no statistically significant difference between patients who made up the groups of PTSD, TBI and CTBI (φ * ≤1.559898; p> 0.61). The only exception is the number of people who did not use other surfactants - there were significantly more of them in the group significantly more among the TBI group (φ * ≥3.429138; p <0.0001), while between the number of such persons in the PTSD and CTBI groups no significant difference was found (φ * ≥0.507329; p> 0.1).
Group | PTSD-TBI | PTSD-CTBI | TBI - CTBI |
---|---|---|---|
Age characteristics | |||
<20 | 0.006034 | 0.001495 | 0.00753 |
21-30 | 0.329111 | 0.280263 | 0.04647 |
31-40 | 0.000908 | 0.055668 | 0.056944 |
>40 | 0.066598 | 0.022659 | 0.089257 |
Was brought up in childhood | |||
By full family | 0.12662 | 0.720519 | 0.851142 |
By 1 of the parents | 0.155735 | 0.395756 | 0.552648 |
By grandmother, grandfather | 0.287783 | 0.426895 | 0.187251 |
By other relatives | 0.061341 | 0.071129 | 0.010572 |
By orphanage | 0.183849 | 0.193604 | 0.012905 |
Education | |||
Secondary | 0.096219 | 0.064168 | 0.031429 |
Secondary-special | 0.310956 | 0.04491 | 0.355424 |
Higher | 0.418008 | 0.035346 | 0.381552 |
Work before the anti-terrorist operation | |||
Did not work | 0.249356 | 0.058318 | 0.307155 |
Part-time employment | 0.011427 | 0.022659 | 0.011411 |
Full employment | 0.25136 | 0.030369 | 0.281327 |
Continued to serve | 0.0198 | 0.005876 | 0.025676 |
Work after the anti-terrorist operation | |||
Did not work | 0.007122 | 0.057197 | 0.064682 |
Part-time employment | 0.008846 | 0.023683 | 0.015019 |
Full employment | 0.023619 | 0.00781 | 0.031429 |
Continued to serve | 0.008846 | 0.023683 | 0.015019 |
Marital status | |||
Single | 0.000908 | 0.055668 | 0.056944 |
Married | 0.039191 | 0.052901 | 0.014157 |
Divorced | 0.029584 | 0.010315 | 0.039898 |
Group | PTSD-TBI | PTSD-CTBI | TBI - CTBI |
---|---|---|---|
Military rank | |||
Private soldier | 0.244205 | 0.119969 | 0.122979 |
Sergeant | 0.156827 | 0.137726 | 0.017783 |
Officer | 0.072777 | 0.024722 | 0.097499 |
General conscription or contract service | |||
General conscription | 0.54077 | 0.932009 | 1.474477 |
Contract service | 0.414331 | 0.625943 | 1.033198 |
Length of stay in the combat zone | |||
up to 1 week | 0.590949 | 0.012976 | 0.602061 |
up to 1 month | 0.827066 | 0.057197 | 0.769899 |
up to 3 months | 0.560188 | 0.017631 | 0.54138 |
up to 6 months | 0.854564 | 0.013943 | 0.839149 |
up to 1 year | 0.048662 | 0.007769 | 0.040726 |
Alcohol consumption | |||
Does not use | 0.258134 | 0.449979 | 0.199501 |
Several times / year | 0.109938 | 0.219111 | 0.330212 |
1 time / month | 0.069666 | 0.137638 | 0.069105 |
2 times / month | 0.025317 | 0.342581 | 0.320482 |
1 time / week | 0.074962 | 0.13008 | 0.060687 |
Cannabinoid use | |||
Does not use | 0.018953 | 0.400205 | 0.384082 |
Several times / year | 0.201452 | 0.289564 | 0.091138 |
1 time / month | 0.047327 | 0.063825 | 0.111279 |
2 times / month | 0.009356 | 0.06644 | 0.057619 |
1 time / week | 0.118661 | 0.123502 | 0.006846 |
Use of other psychoactive substances | |||
Didn’t use | 3.916171 | 0.507329 | 3.429138 |
Opiates | 1.239097 | 0.368309 | 0.931477 |
Psychostimulants | 0.125022 | 0.321928 | 0.341589 |
Hallucinogens | 0.175815 | 0.071871 | 0.223453 |
Barbiturates | 0.252345 | 0.260076 | 0.061135 |
Tranquilizers | 0.125022 | 0.121735 | 0.002684 |
Others | - | 1.559898 | - |
There were also significant differences when comparing the number of respondents in the PTSD and CTBI groups who suffered from chronic somatic diseases before serving in the ATO - in the CTBI group there were significantly more (φ * ≥1,168; p <0,046) of them. There were significantly more people with a disability group in the TBI group than in the PTSD and CTBI groups (φ * ≥3.593094; p <0.0001), with no differences in the number of respondents with disabilities in the PTSD and CTBI groups (φ * ≤0.624587; p> 0.1) (Table 7).
Group | PTSD-TBI | PTSD-CTBI | TBI - CTBI |
---|---|---|---|
Treatment by a psychiatrist before service in the anti-terrorist operation | |||
no | 0.053188 | 0.118081 | 0.171946 |
yes | 0.027639 | 0.060383 | 0.088331 |
Chronic somatic diseases before service in the anti-terrorist operation | |||
no | 0.467438 | 1.831987 | 2.287443 |
yes | 0.542994 | 1.699506 | 2.223479 |
Disability group | |||
yes | 4.47343 | 0.444048 | 4.154993 |
no | 4.105761 | 0.624587 | 3.593094 |
Discussion
Acquisition of about a third of the surveyed persons in primary adult life experience in a military conflict (37.98% of all research groups were under the age of 30) can be considered an aggravating factor, potentially negatively affecting the process of returning to civilian life, with additional restrictions resilience due to PTSD and/or TBI. The study of van der Naalt J. et al. (2017) [15] and Haarbauer-Krupa J. et al. (2017)[16] also noted the aggravating role of younger age in the further course and effective recovery of patients with TBI and PTSD.
The redistribution of professional employment of the surveyed persons due to being in the combat zone is noteworthy: before entering the service in the anti-terrorist operation most of the surveyed persons worked in full employment in the civilian sphere (respectively in the PTSD group - 35.8% (φ * = 1,881; p ≤0.03), in the TBI group - 33.04% (φ * = 1,733; p≤0,042), in the CTBI group - 36.11% (φ * = 1,893; p≤0,029). After staying at ATO as mentioned above, these figures have more than tripled due to the redistribution of those who continued to serve. The unexpectedly large number of people who continued to serve despite receiving PTSD, TBI, or a combination of these can be partly explained by the desire to continue applying the acquired skills [15] and to a greater extent the preservation of "fraternal unity" as a surrogate family [16]. The latter phenomenon certainly plays a positive role in the psychological state of servicemen and volunteers under the battle, but mentally "keeps" veterans at war, slowing their adaptation to civilian life [1,3,4].
The anamnesis of alcohol consumption indicates that a significant minority of all study groups abstain from alcohol consumption (φ * ≥2,036; р≤0,021), while the use of other surfactants is much lower. There has been pointed out the predominance of alcohol use/abuse compared to other psychoactive substances by other researchers [17]. However, in some clinical groups, there were no statistically significant differences in the rhythm of alcohol consumption.
Almost 80% of those surveyed in all groups (φ * ≥5.25; p <0.0001) had never sought psychiatric care before being in the combat zone, while in the traumatic brain injury group the majority had been treated for chronic somatic diseases (φ * = 2,051; p <0,02), which was due to the participation in the fighting of volunteer battalions, which included older people with somatic burden [18].
Conclusion
1. Analysis of the socio-demographic characteristics of patients with PTSD and TBI shows that about a third of the surveyed persons gained primary adult life experience in a military conflict.
2. Staying in the combat zone affected the occupational anamnesis: before entering the service in the anti-terrorist operation most of the surveyed persons worked in full employment in the civilian sphere, and after being in the anti-terrorist operation these indicators decreased more than 3 times due to redistribution in the category of those continued to serve. The large number of people who continued to serve despite receiving PTSD, TBI, or a combination of these, can be partly explained by the desire to maintain "fraternal unity" as a surrogate family.
3. Most of the surveyed persons were premorbid psychosomatically healthy despite periodic alcohol consumption; somatic vulnerability was unique to individuals with TBI.
Additional information
Conflict of interests
The authors declare no competing interests exist.
References
- Matyash M, Khudenko L. Social stress disorders in the structure of ukrainian syndrome. UMJ. 2016;3(113):118-21.
- Smashna O, Khaustova O. Features posttraumatic stress disorder diagnosis in patients with mild traumatic brain injury. Archiv psychiatrii. 2017;23(4):225-32.
- Fang S, Schnurr P, Kulish A, et al. Psychosocial Functioning and Health-Related Quality of Life Associated with Posttraumatic Stress Disorder in Male and Female Iraq and Afghanistan War Veterans: The VALOR Registry. J Womens Health (Larchmt). 2015;24(12):1038-46. doi:https://doi.org/10.1089/jwh.2014.5096
- Nichter B, Norman S, Haller M, Pietrzak R. Psychological burden of PTSD, depression, and their comorbidity in the U. S veteran population: Suicidality, functioning, and service utilization J Affect Disord. 2019;256:633-640. doi:https://doi.org/10.1016/j.jad.2019.06.072
- Wang Y, Karstoft K, Nievergelt C. Post-traumatic stress following military deployment: Genetic associations and cross-disorder genetic correlations. J Affect Disord. 2019;252:350-357.
- Smashna O. Cognitive-behavioral therapy of the insomnia in posttraumatic stress disorders. Archiv psychiatrii. 2014;20(4):91-5.
- Khaustova O, Smashna O. Comorbidity of PTSD and TBI: multifactor model of interaction Archiv psychiatrii. 2016;22(1):22-7.
- DePalma R, Hoffman S. Combat blast related traumatic brain injury (TBI): decade of recognition; promise of progress. Behav Brain Res. 2018;340:102-5. doi:https://doi.org/10.1016/j.bbr.2016.08.036
- Vasterling J, Jacob S, Rasmusson A. Traumatic Brain Injury and Posttraumatic Stress Disorder: Conceptual, Diagnostic, and Therapeutic Considerations in the Context of Co-Occurrence. J Neuropsychiatry Clin Neurosci. 2018;30(2):91-100. doi:https://doi.org/10.1176/appi.neuropsych.17090180
- Dieter J, Engel S. Traumatic Brain Injury and Posttraumatic Stress Disorder: Comorbid Consequences of War. Neurosci Insights. 2019;14. doi:https://doi.org/10.1177/1179069519892933
- Pietrzak R, Johnson D, Goldstein M, Malley J, Southwick S. Posttraumatic stress disorder mediates the relationship between mild traumatic brain injury and health and psychosocial functioning in veterans of Operations Enduring Freedom and Iraqi Freedom. J Nerv Ment Dis. 2009;197(10):748-753.
- Shandera-Ochsner A, Berry D, Harp J, et al. Neuropsychological effects of self-reported deployment-related mild TBI and current PTSD in OIF/OEF veterans. Clin Neuropsychol. 2013;27(6):881-907.
- Dieter J, Engel S. The efficacy of a transdisciplinary intensive outpatient program for treating active duty service members with TBI and associated disorders. в: FY17 Prevention, Mitigation, and Treatment of Blast Injuries Report to the Executive Agent. US Department of Defense Blast Injury Research Program Coordinating Office.
- Smashna O. , Khaustova O. Diagnostic Approach to the Mild Traumatic Brain Injury Verification in Patients with Posttraumatic Stress Disorder Psychiatry, psychotherapy and clinical psychology. 2019;3:408-16.
- Matthieu M, Meissen M, Scheinberg A, Dunn E. Reasons why post–9/11 era veterans continue to volunteer after their military service. Journal of Humanistic Psychology. 2019;1(1).
- Hinojosa R, Hinojosa M. Using military friendships to optimize postdeployment reintegration for male Operation Iraqi Freedom/Operation Enduring Freedom veterans. J Rehabil Res Dev. 2011;48(10):1145-1158.
- Burnett-Zeigler I, Ilgen M, Valenstein M. Prevalence and correlates of alcohol misuse among returning Afghanistan and Iraq veterans. Addictive behaviors. 2011;36(8):801-806.
- Cymbaljuk V, Serdjuk A. Medychne Zabezpechennja antyterorystychnoi’ operacii’: Naukovo-Organizacijni Ta Medyko-social’ni Aspekty. NVC «Priorytety»; 2016.
- Sukyasjan S, Tadevosjan M. Rol’ cherepno-mozgovoj travmy v dynamyke boevogo posttravmatycheskogo stressovogo rasstrojstva. Zhurnal nevrologyy y psyhyatryy Korsakova. 2014;114(4):16-24.
- van der Naalt J, Timmerman M, de Koning M. Early predictors of outcome after mild traumatic brain injury (UPFRONT): an observational cohort study. Lancet Neurol. 2017;16(7):532-540.
- Haarbauer-Krupa J, Taylor C, Yue J. Screening for Post-Traumatic Stress Disorder in a Civilian Emergency Department Population with Traumatic Brain Injury. J Neurotrauma. 2017;34(1):50-58.