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Article: Considerations for the assessment of blast exposure in service members and veterans.

Rowland, Jared A / Martindale, Sarah L

2024 Volume 15, Page(s) 1383710

Abstract: Introduction: Blast exposure is an increasingly present occupational hazard for military service members, particularly in modern warfare scenarios. The study of blast exposure in humans is limited by the lack of a consensus definition for blast exposure ...

Abstract	Introduction: Blast exposure is an increasingly present occupational hazard for military service members, particularly in modern warfare scenarios. The study of blast exposure in humans is limited by the lack of a consensus definition for blast exposure and considerable variability in measurement. Research has clearly demonstrated a robust and reliable effect of blast exposure on brain structure and function in the absence of other injury mechanisms. However, the exact mechanisms underlying these outcomes remain unclear. Despite clear contributions from preclinical studies, this knowledge has been slow to translate to clinical applications. The present manuscript empirically demonstrates the consequences of variability in measurement and definition across studies through a re-analysis of previously published data from the Chronic Effects of Neurotrauma Study 34. Methods: Definitions of blast exposure used in prior work were examined including Blast TBI, Primary Blast TBI, Pressure Severity, Distance, and Frequency of Exposure. Outcomes included both symptom report and cognitive testing. Results: Results demonstrate significant differences in outcomes based on the definition of blast exposure used. In some cases the same definition was strongly related to one type of outcome, but unrelated to another. Discussion: The implications of these results for the study of blast exposure are discussed and potential actions to address the major limitations in the field are recommended. These include the development of a consensus definition of blast exposure, further refinement of the assessment of blast exposure, continued work to identify relevant mechanisms leading to long-term negative outcomes in humans, and improved education efforts.
Language	English
Publishing date	2024-04-15
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2564214-5
ISSN	1664-2295
ISSN	1664-2295
DOI	10.3389/fneur.2024.1383710
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Article ; Online: Subjective cognitive complaints and objective cognitive functioning in combat veterans: Effects of PTSD and deployment mild TBI.

Ord, Anna S / Martindale, Sarah L / Jenks, Elizabeth R / Rowland, Jared A

Applied neuropsychology. Adult

2023 , Page(s) 1–7

Abstract: Objectives: (1) Examine the relationship between subjective cognitive complaints and objective cognitive functioning in combat veterans; and (2) evaluate conditional effects of posttraumatic stress disorder (PTSD) and deployment-related mild traumatic ... ...

Abstract	Objectives: (1) Examine the relationship between subjective cognitive complaints and objective cognitive functioning in combat veterans; and (2) evaluate conditional effects of posttraumatic stress disorder (PTSD) and deployment-related mild traumatic brain injury (TBI) within that relationship. Method: Combat veterans ( Results: All correlations between subjective cognitive complaints and objective cognitive measures were not statistically significant. Hierarchical linear regression indicated that cognitive performance was not significantly related to cognitive complaints, but both PTSD diagnosis and history of deployment mild TBI explained a significant amount of unique variance in self-reported cognitive symptoms. Interactions between the studied variables were not significant. Conclusions: PTSD and history of deployment mild TBI were uniquely related to cognitive complaints, but cognitive test performance was not. No confounding effects of PTSD or deployment mild TBI were observed in the relationship between cognitive performance and cognitive complaints. This provides support that symptom distress may be a better explanatory factor for perception of lower cognitive functioning than actual cognitive performance.
Language	English
Publishing date	2023-11-22
Publishing country	United States
Document type	Journal Article
ZDB-ID	2673736-X
ISSN	2327-9109 ; 2327-9095
ISSN (online)	2327-9109
ISSN	2327-9095
DOI	10.1080/23279095.2023.2280807
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Article ; Online: Validation of Military Occupational Specialty as a Proxy for Blast Exposure Using the Salisbury Blast Interview.

Martindale, Sarah L / Belding, Jennifer N / Crawford, Cameron D / Rowland, Jared A

Journal of neurotrauma

2023 Volume 40, Issue 21-22, Page(s) 2321–2329

Abstract: ... ...

Abstract	Abstract
MeSH term(s)	Humans ; Male ; Female ; Blast Injuries/complications ; Military Personnel ; Veterans ; Brain Injuries, Traumatic/diagnosis ; Brain Injuries, Traumatic/complications ; Explosions
Language	English
Publishing date	2023-06-02
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	645092-1
ISSN	1557-9042 ; 0897-7151
ISSN (online)	1557-9042
ISSN	0897-7151
DOI	10.1089/neu.2023.0067
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Article ; Online: Distress tolerance mitigates effects of posttraumatic stress, traumatic brain injury, and blast exposure on psychiatric and health outcomes.

Martindale, Sarah L / Vujanovic, Anka A / Ord, Anna S / Cary, Amanda / Rowland, Jared A

Rehabilitation psychology

2023 Volume 68, Issue 4, Page(s) 385–395

Abstract: 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 ... ...

Abstract	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. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
MeSH term(s)	Humans ; Male ; Female ; Stress Disorders, Post-Traumatic/epidemiology ; Quality of Life ; Brain Injuries, Traumatic/complications ; Brain Concussion/complications ; Veterans ; Outcome Assessment, Health Care ; Iraq War, 2003-2011 ; Afghan Campaign 2001- ; Military Personnel
Language	English
Publishing date	2023-05-22
Publishing country	United States
Document type	Journal Article
ZDB-ID	224747-1
ISSN	1939-1544 ; 0090-5550
ISSN (online)	1939-1544
ISSN	0090-5550
DOI	10.1037/rep0000502
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Article ; Online: Comparing effectiveness of residential versus intensive virtual treatment for veterans with posttraumatic stress disorder.

Craig, Katherine M / Bryan, Brandon C / O'Connor, Victoria L / Richard, Kevin W / Landwehr, Amanda E / Martindale, Sarah L

Psychological trauma : theory, research, practice and policy

2024

Abstract: Objective: During the COVID-19 pandemic, restrictions imposed on residential treatment programs necessitated rapid implementation of virtual treatment delivery. Posttraumatic stress disorder (PTSD) Residential Rehabilitation Treatment Programs (P-RRTP) ... ...

Abstract	Objective: During the COVID-19 pandemic, restrictions imposed on residential treatment programs necessitated rapid implementation of virtual treatment delivery. Posttraumatic stress disorder (PTSD) Residential Rehabilitation Treatment Programs (P-RRTP) are a key mental health treatment for Veterans with PTSD who require more intensive interventions than outpatient care. During the pandemic, the W. G. (Bill) Hefner VA Healthcare System developed and implemented a Virtual Intensive Outpatient Program for PTSD (VIOPP) to meet the needs of the Veteran population. The purpose of this analysis was to compare the effectiveness of VIOPP to P-RRTP. Method: Analyses included Results: Results indicated a significant decrease in PCL-5 scores regardless of treatment modality, Conclusion: These analyses suggest that intensive virtual treatment has similar effectiveness to residential treatment for PTSD. This supports the development of intensive virtual interventions as viable alternatives to residential treatments and a valuable component within the continuum of PTSD care. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
Language	English
Publishing date	2024-04-04
Publishing country	United States
Document type	Journal Article
ZDB-ID	2497028-1
ISSN	1942-969X ; 1942-9681
ISSN (online)	1942-969X
ISSN	1942-9681
DOI	10.1037/tra0001681
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Article ; Online: Influence of affective instability on suicidal ideation beyond traumatic brain injury and posttraumatic stress disorder in veterans.

Martinez, Brandy S / Rowland, Jared A / Shura, Robert D / Magnante, Anna T / Morey, Rajendra A / Martindale, Sarah L

Journal of psychiatric research

2024 Volume 172, Page(s) 411–419

Abstract: Objective: Mild traumatic brain injury (TBI) is associated with long-term consequences, including greater risk for posttraumatic stress disorder (PTSD) and suicidal ideation. Affective instability is also independently related to PTSD and suicidality, ... ...

Abstract	Objective: Mild traumatic brain injury (TBI) is associated with long-term consequences, including greater risk for posttraumatic stress disorder (PTSD) and suicidal ideation. Affective instability is also independently related to PTSD and suicidality, which may explain why some individuals continue to experience chronic psychiatric complaints following mild TBI. The purpose of the present study was to evaluate affective instability as a key factor for PTSD and suicidal ideation among Veterans with and without TBI. Method: Participants (N = 299 Veterans; 86.96% male) completed the Personality Assessment Inventory (PAI) and structured clinical interviews for TBI and psychiatric diagnoses. Hierarchical linear regression was used to evaluate main and interaction effects. Results: There were no significant differences in affective instability (p = 0.140) or suicidal ideation (p = 0.453) between Veterans with or without TBI. Individuals with TBI were more likely to have a PTSD diagnosis (p = 0.001). Analyses evaluating PTSD diagnosis as an outcome indicated a main effect of affective instability (p < 0.001), but not TBI (p = 0.619). Analyses evaluating suicidal ideation as an outcome demonstrated an interaction effect between PTSD and affective instability beyond the effects of TBI (p = 0.034). Conclusions: Severe Affective instability appears to be a key factor in suicidal ideation among Veterans beyond TBI or PTSD history. PTSD was more strongly associated with suicidality at lower and moderate levels of affective instability. At severe levels of affective instability, however, Veterans with and without PTSD experienced suicidal ideation at similar rates. Findings suggests that high levels of affective instability not better explained by other psychiatric conditions confers similar suicidality risk to that of PTSD in a Veteran population.
MeSH term(s)	Humans ; Male ; Female ; Veterans/psychology ; Suicidal Ideation ; Stress Disorders, Post-Traumatic/psychology ; Brain Injuries, Traumatic/complications ; Brain Injuries, Traumatic/epidemiology ; Violence ; Brain Concussion
Language	English
Publishing date	2024-02-28
Publishing country	England
Document type	Journal Article
ZDB-ID	3148-3
ISSN	1879-1379 ; 0022-3956
ISSN (online)	1879-1379
ISSN	0022-3956
DOI	10.1016/j.jpsychires.2024.02.058
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Article ; Online: Influence of blast exposure on cognitive functioning in combat veterans.

Martindale, Sarah L / Ord, Anna S / Rowland, Jared A

Neuropsychology

2020 Volume 34, Issue 7, Page(s) 735–743

Abstract: Objective: We evaluated the contribution of blast-pressure severity to cognitive functioning beyond posttraumatic stress disorder (PTSD) severity and traumatic brain injury (TBI).: Method: Post-9/11 veterans (: Results: Veterans with mild ... ...

Abstract	Objective: We evaluated the contribution of blast-pressure severity to cognitive functioning beyond posttraumatic stress disorder (PTSD) severity and traumatic brain injury (TBI). Method: Post-9/11 veterans ( Results: Veterans with mild deployment TBI had overall significantly lower Conclusion: Blast-pressure severity exacerbated the effects of mild TBI on a simple attention task, such that participants with TBI had gradual decrements in attention as blast severity increased. Veterans who incur a TBI and are exposed to blasts during deployment may experience persisting difficulties with cognitive functioning as a result of alterations in basic attention abilities. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
Language	English
Publishing date	2020-07-16
Publishing country	United States
Document type	Journal Article
ZDB-ID	1042412-x
ISSN	1931-1559 ; 0894-4105
ISSN (online)	1931-1559
ISSN	0894-4105
DOI	10.1037/neu0000672
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Article ; Online: Effects of blast exposure on psychiatric and health symptoms in combat veterans.

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

Journal of psychiatric research

2021 Volume 143, Page(s) 189–195

Abstract: Blast exposure is common among service members, but the chronic psychiatric effects associated with blast exposure are not well-characterized independent of a resulting mild traumatic brain injury (TBI). This analysis evaluated whether blast exposure ... ...

Abstract	Blast exposure is common among service members, but the chronic psychiatric effects associated with blast exposure are not well-characterized independent of a resulting mild traumatic brain injury (TBI). This analysis evaluated whether blast exposure severity was independently associated with or exacerbated symptom report beyond posttraumatic stress disorder (PTSD) and mild TBI. Participants were Iraq and Afghanistan combat veterans (N = 275; 86.55% male), 71.27% with history of blast exposure, 29.82% current diagnosis of PTSD, and 45.45% with mild TBI. All participants completed diagnostic interviews for PTSD, lifetime TBI, and lifetime blast exposure. Self-reported psychiatric and health outcomes included posttraumatic stress symptoms, depressive symptoms, neurobehavioral symptoms, sleep quality, pain interference, and quality of life. Blast severity was associated with PTSD (B = 2.00), depressive (B = 0.76), and neurobehavioral (B = 1.69) symptoms beyond PTSD diagnosis and mild TBI history. Further, blast severity accounted entirely (i.e., indirect/mediation effect) for the association between TBI and posttraumatic stress (B = 1.62), depressive (B = 0.61), and neurobehavioral (B = 1.38) symptoms. No interaction effects were present. Exposure to blast is an independent factor influencing psychiatric symptoms in veterans beyond PTSD and mild TBI. Results highlight that blast exposure severity may be a more relevant risk factor than deployment mild TBI in combat veterans and should be considered in the etiology of psychiatric symptom presentation and complaints. Further, severity of psychological distress due to the combat environment may be an explanatory mechanism by which blast exposure mediates the relationship between mild TBI and symptom outcomes.
MeSH term(s)	Afghan Campaign 2001- ; Brain Concussion/epidemiology ; Female ; Humans ; Iraq War, 2003-2011 ; Male ; Quality of Life ; Self Report ; Stress Disorders, Post-Traumatic/epidemiology ; Veterans
Language	English
Publishing date	2021-09-03
Publishing country	England
Document type	Journal Article
ZDB-ID	3148-3
ISSN	1879-1379 ; 0022-3956
ISSN (online)	1879-1379
ISSN	0022-3956
DOI	10.1016/j.jpsychires.2021.09.021
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Article: Time doesn't heal all: PTSD symptoms exacerbate the relationship between age and pain intensity.

O'Connor, Victoria / Rowland, Jared A / Naylor, Jennifer C / Magnante, Anna T / Craig, Katherine M / Miskey, Holly M / Martindale, Sarah L

Frontiers in psychiatry

2023 Volume 14, Page(s) 1221762

Abstract: Objective: Posttraumatic stress disorder (PTSD) symptoms and pain interfere with daily functioning and quality of life for many combat Veterans. As individuals age, pain symptoms tend to increase whereas PTSD symptoms tend to decrease. PTSD symptoms ... ...

Abstract	Objective: Posttraumatic stress disorder (PTSD) symptoms and pain interfere with daily functioning and quality of life for many combat Veterans. As individuals age, pain symptoms tend to increase whereas PTSD symptoms tend to decrease. PTSD symptoms exacerbate pain, but the nature of this relationship across the aging process is unclear. The purpose of this study was to determine how PTSD symptoms affect the association between age and pain intensity. Methods: Participants in this cross-sectional study included 450 Veterans (80% male) who served after September 11, 2001. PTSD and pain intensity ratings were assessed by the PTSD Checklist for DSM-5 (PCL-5) and the Brief Pain Inventory (BPI), respectively. Hierarchical multiple linear regression evaluated main and interaction effects between age, PTSD symptoms, and pain intensity. Results: Age ( Conclusion: Results of these analyses suggests that age is important when considering the effects of PTSD symptoms on pain intensity ratings. Specifically, pain intensity ratings are higher in older Veterans with PTSD symptoms. These findings underscore the importance for clinical providers to evaluate trauma history and PTSD symptoms in older Veterans reporting pain symptoms.
Language	English
Publishing date	2023-07-27
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2564218-2
ISSN	1664-0640
ISSN	1664-0640
DOI	10.3389/fpsyt.2023.1221762
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Article ; Online: Symptom validity indices in the Posttraumatic Stress Disorder Checklist for DSM-5.

Shura, Robert D / Rowland, Jared A / Miskey, Holly M / Ord, Anna S / Magnante, Anna T / Martindale, Sarah L

Journal of traumatic stress

2023 Volume 36, Issue 5, Page(s) 919–931

Abstract: The use of symptom validity tests (SVTs) is standard practice in psychodiagnostic assessments. Embedded measures are indices within self-report measures. To date, no embedded SVTs have been identified in the Posttraumatic Stress Disorder Checklist for ... ...

Abstract	The use of symptom validity tests (SVTs) is standard practice in psychodiagnostic assessments. Embedded measures are indices within self-report measures. To date, no embedded SVTs have been identified in the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5). This research aimed to develop and validate PCL-5 SVTs in two samples of veterans. Participants completed one of two prospective research studies that included cognitive and psychological tests. Participants in Study 1 were veterans (N = 464) who served following the September 11, 2001, terrorist attacks; participants in Study 2 were veterans or service members (N = 338) who had been deployed to Iraq and/or Afghanistan. Both studies included the PCL-5 and the Structured Inventory of Malingered Symptomatology (SIMS), the latter of which served as the criterion for identifying PCL-5 SVTs. For Study 1, two separate SVTs were developed: the PCL-5 Symptom Severity scale (PSS), based on the PCL-5 total score, and the PCL-5 Rare Items scale (PRI), based on PCL-5 items infrequently endorsed at the highest item ratings. At the most conservative SIMS cutoff score, the PSS achieved excellent discrimination for both the Study 1, AUC = .840, and Study 2 samples, AUC = .858, with specific cutoff scores of ≥ 51 and ≥ 56 maximizing sensitivity while maintaining a specificity of .90. The PRI achieved good discrimination, AUCs = .760 and.726, respectively, with a cutoff score of 2 or higher indicated by both studies. The results of these two studies provide provisional support for these two embedded SVTs in the PCL-5.
Language	English
Publishing date	2023-07-18
Publishing country	United States
Document type	Journal Article
ZDB-ID	639478-4
ISSN	1573-6598 ; 0894-9867
ISSN (online)	1573-6598
ISSN	0894-9867
DOI	10.1002/jts.22957
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