Effects of blast exposure on psychiatric and health symptoms in combat veterans

Martindale, Sarah L.; Ord, Anna S.; Rule, Lakeysha G.; Rowland, Jared A.

doi:10.1016/j.jpsychires.2021.09.021

Cited by 22 publications

(23 citation statements)

References 37 publications

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“…All variables were assessed for nonnormality and were within acceptable ranges of skewness and kurtosis. Results from hierarchical regression models evaluating the independent effects of PTSD diagnosis, mild deployment TBI, and blast pressure have been reported previously and the present analyses were consistent (Martindale et al, 2021). First, bivariate correlations were conducted between potential covariates of interest (i.e., age, sex, years of education, race, ethnicity, years since deployment, and combat exposure) and functional indicators to determine appropriateness of inclusion in analyses.…”

Section: Methodssupporting

confidence: 90%

“…There is a relative paucity of literature evaluating DT in military veterans with regard to its association with psychological conditions, particularly among combat veterans with mild TBI or those exposed to blast (Akbari et al, 2022; Vujanovic & Zegel, 2020). Therefore, the purpose of this investigation was to build upon our previous work (Martindale et al, 2021) to evaluate interactive effects of DT with (a) PTSD diagnosis, (b) mild TBI history, and (c) blast exposure on functional indicators (i.e., posttraumatic stress symptom severity, depressive symptom severity, neurobehavioral symptom severity, sleep quality, pain interference, and quality of life) among combat veterans who served in Iraq or Afghanistan after September 11, 2011. We have previously demonstrated that PTSD and blast are independently associated with these functional indicators beyond mild TBI (Martindale et al, 2021).…”

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confidence: 99%

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Distress tolerance mitigates effects of posttraumatic stress, traumatic brain injury, and blast exposure on psychiatric and health outcomes.

Martindale¹,

Vujanovic²,

Ord³

et al. 2023

Rehabilitation Psychology

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Background: Exposure to blasts is common among service members and history of these exposures has been associated with chronic psychiatric and health outcomes. Evidence suggests that distress tolerance (DT) may moderate this relationship and be a valuable treatment target in this population. The purpose of this manuscript was to evaluate DT as a modifying factor in the association between posttraumatic stress disorder (PTSD), mild traumatic brain injury (TBI), blast exposure, and functional indicators. Method: Participants were 275 (86.55% male) combat veterans who served in Iraq or Afghanistan after September 11, 2001. Clinical interviews for PTSD diagnosis, TBI history, and blast exposure were administered, and participants completed self-report questionnaires (DT, PTSD symptom severity, depressive symptom severity, neurobehavioral symptom severity, sleep quality, pain interference, and quality of life). Results: DT was significantly associated with all functional indicators beyond PTSD diagnosis, mild TBI, and blast severity. There were significant interaction effects between DT and PTSD diagnosis for posttraumatic stress symptom severity, sleep quality, and quality of life. Specifically, there were significant differences in these reported functional indicators between individuals with and without a PTSD diagnosis as DT increases, such that reported symptoms were lower (quality of life better) for individuals without PTSD as DT improved. Conclusion: Our results demonstrate that DT might be a key factor in postdeployment function for military service members. Treatments targeting DT may be particularly effective in individuals who attribute psychiatric symptoms to history of blast exposure. Impact and ImplicationsDistress tolerance (DT) mitigated the relationship between posttraumatic stress disorder (PTSD) and functional outcomes of posttraumatic stress symptoms, sleep quality, and quality of life. Effects of DT were exacerbated in veterans without a PTSD diagnosis, suggesting that DT may be a key protective factor against the development of PTSD, and individuals with a higher baseline level of DT may be less likely to develop clinical symptomology in response to stressors. Addressing DT in treatment may lead to better functional outcomes, especially in veterans without a PTSD diagnosis and/or subclinical PTSD symptoms.

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Section: Methodssupporting

confidence: 90%

mentioning

confidence: 99%

Distress tolerance mitigates effects of posttraumatic stress, traumatic brain injury, and blast exposure on psychiatric and health outcomes.

Martindale¹,

Vujanovic²,

Ord³

et al. 2023

Rehabilitation Psychology

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“…In assessing blast exposure, it is challenging to disentangle recollections of prior blast exposures versus experiences. Martindale et al [ 27 ] highlighted that psychological stress associated with blast experiences (i.e., hearing/seeing a blast) during deployment mediates symptom reporting, potentially resulting in reporting of symptoms similar to TBI regardless of whether a TBI or other physical trauma has occurred [ 27 , 28 ]. A second interrelated issue is the reliance on TBI as a proxy for blast overpressure wave impact on the pulmonary system.…”

Section: Discussionmentioning

confidence: 99%

“…A second interrelated issue is the reliance on TBI as a proxy for blast overpressure wave impact on the pulmonary system. Recent evidence suggests that TBI symptomatology is not necessarily indicative of blast exposure severity [ 27 ], prompting calls to update TBI classification schemes to better align with physiological outcomes [ 23 ]. Third, patients’ recollections of blasts and/or clinical documentation may be biased towards more memorable blast experiences.…”

Section: Discussionmentioning

confidence: 99%

Relationship between clinician documented blast exposure and pulmonary function: a retrospective chart review from a national specialty clinic

Therkorn

Sotolongo

et al. 2022

Respir Res

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Background Service member exposure to explosive blast overpressure waves is common with considerable attention to traumatic brain injury (TBI) and neuropsychological sequalae. Less is known about the impacts on the respiratory system, particularly long-term effects, despite vulnerability to overpressure. Using a national registry, we previously observed an independent relationship between self-reported blast exposure and respiratory symptoms; however, the impact on objective measures of pulmonary function is poorly understood. Methods 307 Veterans referred to our national specialty center for post-deployment health concerns underwent a comprehensive multi-day evaluation that included complete pulmonary function testing (PFT), occupational and environmental medicine history, neuropsychological or psychological evaluation. We developed an a priori chart abstraction process and template to classify Veterans into blast exposure groups: (1) none, (2) single-mild, or (3) multiple-mild. This template focused primarily on clinician documented notes of blast related TBI that were used as proxy for blast overpressure injury to thorax. PFT variables characterizing flow (FEV1%; %∆FEV1), volume (TLC%), diffusion (DLCO%) and respiratory mechanics (forced oscillometry) were selected for analysis. Results Veterans (40.5 ± 9.7 years; 16.3% female) were referred 8.6 ± 3.6 years after their last deployment and presented with considerable comorbid conditions and health problems (e.g., 62% post-traumatic stress, 55% dyspnea). After chart abstraction, Veterans were assigned to none (n = 208), single mild (n = 52) and multiple mild (n = 47) blast exposure groups. Among the blast exposed, clinicians documented 73.7% were < 50 m from the blast and 40.4% were physically moved by blast. PFT outcome measures were similar across all groups (p value range: 0.10–0.99). Conclusions In this referred sample of deployed Veterans, PFT measures of flow, volume, diffusion, and respiratory mechanics were not associated with clinician documented blast exposure per the retrospective chart abstraction methodology applied. Yet, these clinical findings suggest future research should determine and assess distinction between Veteran recollections of perceived blast experiences versus overpressure wave exposure to the respiratory system.

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“…Early recognition and appropriate triage for CRBNE casualties are needed to minimize secondary contamination [ 13 ]. Furthermore, blast exposure has recently been identified as an independent factor influencing psychiatric symptoms other than post-traumatic stress disorder and mild traumatic brain injury [ 14 ]. In this respect, the long-term impact of a blast injury cannot be underestimated.…”

Section: Discussionmentioning

confidence: 99%

Blast Injuries by an Improvised Explosive Device in Japan: A Case Report

Kujirai¹,

Fujii²,

Kaito³

et al. 2022

Cureus

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Blast injuries caused by an improvised explosive device (IED) are becoming more common in civilian settings. However, physicians may not be familiar with the treatment and management of blast-injured victims. To the best of our knowledge, this is the first case report of a blast injury caused by an IED in Japan.A 64-year-old man was admitted to our hospital's emergency department after sustaining a blast injury. His vital signs were stable, but he had multiple small wounds with embedded foreign bodies that were consistent with injuries sustained by IED victims. The patient was treated for his injuries and was moved to another hospital on day 37. Knowledge about blast injuries caused by IEDs and management strategies for mass casualties are both necessary.

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Effects of blast exposure on psychiatric and health symptoms in combat veterans

Cited by 22 publications

References 37 publications

Distress tolerance mitigates effects of posttraumatic stress, traumatic brain injury, and blast exposure on psychiatric and health outcomes.

Distress tolerance mitigates effects of posttraumatic stress, traumatic brain injury, and blast exposure on psychiatric and health outcomes.

Relationship between clinician documented blast exposure and pulmonary function: a retrospective chart review from a national specialty clinic

Blast Injuries by an Improvised Explosive Device in Japan: A Case Report

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