Page 76 - JSOM Winter 2024

Chronicity of Posttraumatic Stress Disorder Symptoms
Following Traumatic Brain Injury

A Comparison of Special Operators and Conventional Forces

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Shannon R. Miles, PhD *; Daniel Klyce, PhD ; Amanda Garcia, PhD ; Alexandra R. Thelan, PhD ;
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Xinyu Tang, PhD ; Rachel Wallace, PhD ; Raj G. Kumar, PhD ; Risa Nakase-Richardson, PhD 8
ABSTRACT
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Background: Special Operations Forces (SOF) have become military challenges around the globe. The types of missions
the solution to many of the United States’ military challenges USSOCOM leads are varied, including direct action, counter-
due to their ability to conduct time sensitive, clandestine, and terrorism, foreign internal defense, irregular warfare, and civil
high-risk missions. Historically, SOF were assumed to be resil- affairs. Even after expanding from 29,500 personnel in 1999
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ient to the psychological sequelae of war, including posttrau- to almost 70,000 in 2023, Special Operations Forces (SOF)
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matic stress disorder (PTSD). However, the objective burden of only constitute about 5% of all joint military forces. SOF are
PTSD in SOF, particularly after traumatic brain injury (TBI), constrained by the limited number of Service Members who
remains unknown. This study compared average PTSD symp- can meet stringent selection requirements and the significant
toms over time between SOF and Conventional Forces (CF) amount of time dedicated to training them. Because reliance
who had sustained a TBI. Methods: This prospective cohort on SOF has grown, their health status impacts military readi-
study examined Servicemembers and Veterans admitted to one ness for future deployments and is a critical national concern.
of five Veterans Affairs Polytrauma Rehabilitation Centers for
TBI. Propensity score matching created matched samples of Posttraumatic stress disorder (PTSD) can impair psychological
205 SOF and 205 CF. The PTSD Checklist-Civilian version and physical health. It is related to negative subjective cog-
(PCL-C) measured PTSD symptoms at admission and 1, 2, 5, nitive (attention, verbal memory, and processing speed) and
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and 10 years post TBI. Results: In a longitudinal mixed-effects affective (ability to engage in activities without emotions inter-
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model of PTSD symptoms over time grouped by TBI severity, fering) health and performance. PTSD is also associated with
SOF and CF had similar severity and patterns of PTSD symp- medically related discharge. Unfortunately, PTSD is often co-
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toms. SOF and CF with mild TBI had more PTSD symptoms morbid with traumatic brain injury (TBI), and the combina-
across all time points compared to those with moderate and tion is related to greater severity of PTSD. Given assumptions
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severe TBI. Conclusion: The evolution and severity of PTSD about the psychological resilience of SOF, there are mixed
symptoms after TBI in SOF and CF were similar. While SOFs opinions about their likelihood of developing PTSD relative
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had higher resilience compared to CFs in previous work, SOFs to Conventional Forces (CF). Specifically, it is unknown how
are not impervious to trauma exposure and PTSD. Increasing PTSD symptoms following TBI in SOF may differ from those
awareness of PTSD prevalence and consequences is needed experienced by CF.
to serve SOF. Identifying those needing care and providing
evidence-based PTSD treatments can have the downstream Contrary to the limited literature on the SOF community, a
effects of reducing attrition from the service and maintaining large body of literature has examined PTSD after TBI in CF
military readiness. Servicemembers and Veterans (SM/Vs). 9,11,12 Nearly 25% of a
sample of CF who deployed in support of the wars in Afghan-
Keywords: posttraumatic stress disorder; traumatic brain injury; istan and/or Iraq met the criteria for PTSD 5 years after their
special operation forces; veterans; military last deployment. SM/Vs who sustained a TBI were up to 4.2
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times more likely to develop PTSD than those without a TBI.
Without treatment, PTSD symptoms generally increase over
time. It is unclear whether these findings among CF will gen-
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Introduction
eralize to SOF.
Warfighters assigned to the United States Special Operations
Command (USSOCOM), such as Delta Force, Green Berets, Part of the challenge of comparing outcomes for SOF to out-
Rangers, Special Tactics Airmen, SEALs, and Marine Raid- comes for CF is that there are objective mean differences be-
ers, have become the United States’ solution of choice to tween the groups. Psychological resilience is defined as having
*Correspondence to Shannon Miles, JAHVH, 13000 Bruce B. Downs Blvd (117), Tampa, FL 33612 or shannon.miles@va.gov
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1 Dr. Shannon R. Miles, Dr. Amanda Garcia, and Dr. Alexandra R. Thelan are affiliated with the Mental Health and Behavioral Sciences Service
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at James A. Haley Veterans’ Hospital, Tampa, FL. Dr. Shannon R. Miles is an Associate Professor in the Department of Psychiatry & Behavioral
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Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL. Dr. Daniel Klyce and Dr. Rachel Wallace are affiliated with the
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Mental Health Service, Central Virginia VA Health Care System, Richmond, VA. Dr. Daniel Klyce is affiliated with the Department of Physical
Medicine and Rehabilitation, Virginia Commonwealth University, and Psychology Service, Sheltering Arms Institute, Richmond, VA. Dr. Xinyu
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Tang is affiliated with the Tampa VA Research and Education Foundation, Inc., Temple Terrace, FL. Dr. Raj G. Kumar is affiliated with the
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Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY. Dr. Risa Nakase-Richardson
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is the Associate Chief of Staff for Research at the James A. Haley Veterans’ Hospital, affiliated with the Traumatic Brain Injury Center of Excel-
lence, Defense Health Agency, and is a professor in the Pulmonary and Sleep Medicine Division, Department of Internal Medicine, University of
South Florida, Tampa, FL.
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