Mental health outcomes of male UK military personnel deployed to Afghanistan and the role of combat injury: analysis of baseline data from the ADVANCE cohort study

Dyball, Daniel; Bennett, Alexander N.; Schofield, Susan; Cullinan, Paul; Boos, Christopher J.; Bull, Anthony M.J.; Wessely, Simon; Stevelink, Sharon; Fear, Nicola T.

doi:10.1016/s2215-0366(22)00112-2

Cited by 26 publications

(28 citation statements)

References 29 publications

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“…We have previously reported a significant association between CRTI and resting HR, metabolic syndrome, arterial stiffness (central augmentation index) 2 and post-traumatic stress disorder (PTSD). 18 Moreover, metabolic syndrome, 5 increased arterial stiffness 20 and PTSD 6 have all been shown to be independently Original research linked to lower RMSSD and HRV, strengthening the plausible link between CRTI and its severity on lower HRV. Another potential reason for lower HRV among the injured versus uninjured, in our study, could be the effects of CRTI on systemic inflammation.…”

Section: Discussionmentioning

confidence: 96%

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Relationship between combat-related traumatic injury and ultrashort term heart rate variability in a UK military cohort: findings from the ADVANCE study

et al. 2023

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IntroductionCombat-related traumatic injury (CRTI) has been linked to an increased cardiovascular disease (CVD) risk. The long-term impact of CRTI on heart rate variability (HRV)—a robust CVD risk marker—has not been explored. This study investigated the relationship between CRTI, the mechanism of injury and injury severity on HRV.MethodsThis was an analysis of baseline data from the ArmeD SerVices TrAuma and RehabilitatioN OutComE (ADVANCE) prospective cohort study. The sample consisted of UK servicemen with CRTI sustained during deployment (Afghanistan, 2003–2014) and an uninjured comparison group who were frequency matched to the injured group based on age, rank, deployment period and role in theatre. Root mean square of successive differences (RMSSD) was measured as a measure of ultrashort term HRV via <16 s continuous recording of the femoral arterial pulse waveform signal (Vicorder). Other measures included injury severity (New Injury Severity Scores (NISS)) and injury mechanism.ResultsOverall, 862 participants aged 33.9±5.4 years were included, of whom 428 (49.6%) were injured and 434 (50.3%) were uninjured. The mean time from injury/deployment to assessment was 7.91±2.05 years. The median (IQR) NISS for those injured was 12 (6–27) with blast being the predominant injury mechanism (76.8%). The median (IQR) RMSSD was significantly lower in the injured versus the uninjured (39.47 ms (27.77–59.77) vs 46.22 ms (31.14–67.84), p<0.001). Using multiple linear regression (adjusting for age, rank, ethnicity and time from injury), geometric mean ratio (GMR) was reported. CRTI was associated with a 13% lower RMSSD versus the uninjured group (GMR 0.87, 95% CI 0.80–0.94, p<0.001). A higher injury severity (NISS ≥25) (GMR 0.78, 95% CI 0.69–0.89, p<0.001) and blast injury (GMR 0.86, 95% CI 0.79–0.93, p<0.001) were also independently associated with lower RMSSD.ConclusionThese results suggest an inverse association between CRTI, higher severity and blast injury with HRV. Longitudinal studies and examination of potential mediating factors in this CRTI-HRV relationship are needed.

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Section: Discussionmentioning

confidence: 96%

“…Rank at sampling was used as a proxy for the socioeconomic status of the participants as previously described 2 18. The ranks were classified as lower (junior non-commissioned officers and other lower ranks), middle (senior non-commissioned officers) and senior (commissioned officers).…”

Section: Methodsmentioning

confidence: 99%

Relationship between combat-related traumatic injury and ultrashort term heart rate variability in a UK military cohort: findings from the ADVANCE study

et al. 2023

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“…The consortium has previously reported on cardiovascular changes related to battlefield trauma, with higher rates of metabolic syndrome associated with injury, 27 and adverse effects of combat trauma on mental health. 28 ADVANCE-TBI, a substudy of ADVANCE, takes advantage of the unique opportunity to leverage recent scientific advances to clarify in detail the patterns of TBI arising from the Afghanistan campaign. It will describe the neurological and psychiatric outcomes of these patients over time, and relate these to head injury exposures.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

ADVANCE-TBI study protocol: traumatic brain injury outcomes in UK military personnel serving in Afghanistan between 2003 and 2014 – a longitudinal cohort study

Graham

Blissitt²,

Zimmerman³

et al. 2023

BMJ Open

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IntroductionOutcomes of traumatic brain injury (TBI) are highly variable, with cognitive and psychiatric problems often present in survivors, including an increased dementia risk in the long term. Military personnel are at an increased occupational risk of TBI, with high rates of complex polytrauma including TBI characterising the UK campaign in Afghanistan. The ArmeD SerVices TrAuma and RehabilitatioN OutComE (ADVANCE)-TBI substudy will describe the patterns, associations and long-term outcomes of TBI in the established ADVANCE cohort.Methods and analysisThe ADVANCE cohort comprises 579 military personnel exposed to major battlefield trauma requiring medical evacuation, and 566 matched military personnel without major trauma. TBI exposure has been captured at baseline using a standardised interview and registry data, and will be refined at first follow-up visit with the Ohio State Method TBI interview (a National Institute of Neurological Disorders and Stroke TBI common data element). Participants will undergo blood sampling, MRI and detailed neuropsychological assessment longitudinally as part of their follow-up visits every 3–5 years over a 20-year period. Biomarkers of injury, neuroinflammation and degeneration will be quantified in blood, and polygenic risk scores calculated for neurodegeneration. Age-matched healthy volunteers will be recruited as controls for MRI analyses. We will describe TBI exposure across the cohort, and consider any relationship with advanced biomarkers of injury and clinical outcomes including cognitive performance, neuropsychiatric symptom burden and function. The influence of genotype will be assessed. This research will explore the relationship between military head injury exposure and long-term outcomes, providing insights into underlying disease mechanisms and informing prevention interventions.Ethics and disseminationThe ADVANCE-TBI substudy has received a favourable opinion from the Ministry of Defence Research Ethics Committee (ref: 2126/MODREC/22). Findings will be disseminated via publications in peer-reviewed journals and presentations at conferences.

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“…The ADVANCE study has recently published the first analysis of mental health outcomes and the role of combat injury in Lancet Psychiatry 3. The authors compared 579 combat-injured participants to 565 matched non-injured personnel, achieving response rates of 59.6% and 56.3%, respectively, with a median time elapsed from Afghanistan deployment to baseline assessment of 8 years.…”

mentioning

confidence: 99%

Combat injury is associated with adverse mental health outcomes among deployed personnel, but not for amputees: is there a hierarchy of wounding?

Minshall¹

2022

BMJ Mil Health

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Mental health outcomes of male UK military personnel deployed to Afghanistan and the role of combat injury: analysis of baseline data from the ADVANCE cohort study

Cited by 26 publications

References 29 publications

Relationship between combat-related traumatic injury and ultrashort term heart rate variability in a UK military cohort: findings from the ADVANCE study

Relationship between combat-related traumatic injury and ultrashort term heart rate variability in a UK military cohort: findings from the ADVANCE study

ADVANCE-TBI study protocol: traumatic brain injury outcomes in UK military personnel serving in Afghanistan between 2003 and 2014 – a longitudinal cohort study

Combat injury is associated with adverse mental health outcomes among deployed personnel, but not for amputees: is there a hierarchy of wounding?

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