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Conclusion 4. USSOCOM Office of Communication. Factbook 2023 United
States Special Operations Command. Accessed January 3, 2024.
In summary, this study represents the first investigation to https://www.socom.mil/latest-factbook
critically examine the longitudinal symptom burden of PTSD 5. Scott JC, Matt GE, Wrockleage KM, et al. A qualitative meta-anal-
symptoms after TBI among SOF. The large sample allowed us ysis of neurocognitive functioning in posttraumatic stress disor-
to compare SOF (n=205) and CF (n=205) who have received der. Psychol Bull. 2015;141(1):105–40. doi:10.1037/a0038039
rehabilitation for TBI. Creating matched samples of CF and 6. Garcia A, Miles SR, Reljic T, et al. Neurobehavioral symptoms in
SOF was important, as previous literature has demonstrated U.S. Special Operations Forces in rehabilitation after traumatic
brain injury: a TBI model systems study. Mil Med. 2022;187(11–
that there are objective differences between these groups at the 12):1417–1421. doi:10.1093/milmed/usab347
beginning of their careers that need to be considered when un- 7. Miles SR, Sharp C, Tharp AT, et al. Emotion dysregulation as an
derstanding PTSD symptoms. In a longitudinal mixed-effects underlying mechanism of impulsive aggression: reviewing empir-
model of PTSD symptoms over time grouped by TBI severity, ical data to inform treatments for veterans who perpetrate vio-
SOF and CF had similar severity and patterns of PTSD symp- lence. Aggress Violent Behav. 2017;34:147–153. doi:10.1016/j.
avb.2017.01.017.
toms. SOF and CF with mild TBI had more PTSD symptoms 8. Boulos D, Zamorski MA. Do shorter delays to care and mental
across all timepoints compared to those with moderate and health system renewal translate into better occupational outcome
severe TBI. Resilience should no longer be assumed to be pro- after mental disorder diagnosis in a cohort of Canadian military
phylactic or a natural solution to PTSD among SOF who have personnel who returned from an Afghanistan deployment? BMJ
experienced high levels of trauma exposure. Simply, while Open. 2015;5(12):e008591. doi:10.1136/bmjopen-2015-008591
10
SOF are resilient, they are not impervious to PTSD. 9. Loignon A, Ouellet MC, Belleville G. A systematic review and me-
ta-analysis on PTSD following TBI among military/Veteran and
civilian populations. J Head Trauma Rehabil. 2020;35(1):E21–
Author Contributions E35. doi:10.1097/htr:0000000000000514
SM, DK, and AG contributed to the study’s conceptualization 10. Rocklein Kemplin K, Paun O, Godbee DC, Brandon JW. Resil-
and methodology. SM, DK, and RW wrote the original draft. ience and suicide in Special Operations Forces: state of the science
AG, RK, and RN-R reviewed and edited the manuscript. AT via integrative review. J Spec Oper Med. 2019;19(2):57–66. doi:
wrote portions of the original draft and edited the manuscript. 10.55460/bques-am8h
XT participated in data curation, formal analysis, and visual- 11. Hoge CW, McGurk D, Thomas JL, Cox AL, Engel CC, Castro CA.
ization. RN-R was involved in funding acquisition, investiga- Mild traumatic brain injury in U.S. soldiers returning from Iraq.
N Engl J Med. 2008;358(5):453–63. doi:10.1056/nejmoa072972
tion, and project administration. 12. Yurgil KA, Barkauskas DA, Vasterling JJ, et al. Association between
traumatic brain injury and risk of posttraumatic stress disorder in
Disclosures active-duty Marines. JAMA Psychiatry. 2014;71(2):149–57. doi:
The authors have no conflicts of interest to report. The funders 10.1001/jamapsychiatry.2013.3080
had no say in the design of this study or the results. XT had full 13. Vasterling JJ, Aslan M, Proctor SP, et al. Longitudinal examina-
access to all the data in the study and takes responsibility for tion of posttraumatic stress disorder as a long-term outcome of
Iraq war deployment. Am J Epidemiol. 2016;184(11):796–805.
the integrity of the data and the accuracy of the data analysis. doi:10.1093/aje/kww151
14. Orcutt HK, Erickson DJ, Wolfe J. The course of PTSD symp-
Disclaimer toms among Gulf War veterans: a growth mixture modeling
The views expressed in this manuscript are those of the au- approach. J Trauma Stress. 2004;17(3):195–202. doi:10.1023/b:-
thors and do not necessarily represent the official policy or jots.0000029262.42865.c2
position of the Defense Health Agency, Department of De- 15. Bartone PT, Roland RR, Picano JJ, Williams TJ.Psychological har-
diness predicts success in US Army Special Forces candidates. Int
fense, or any other U.S. government agency. Per Title 17 J Sel Assess. 2008;16(1):78–81. doi:10.1111/j.1468-2389.2008.
U.S.C.§105, copyright protection is not available for any work 00412.x
of the U.S. Government. For more information, please contact 16. Greene CH. Coaching military Special-Operations Forces. Con-
dha.TBICOEinfo@health.mil.UNCLASSIFIED sult Psychol J. 2019;71(2):107–119. doi:10.1037/cpb0000131
17. Cooper AD, Warner SG, Rivera AC, et al. Mental health, phys-
Funding ical health, and health-related behaviors of U.S. Army Special
This material is the result of work supported with resources Forces. PLoS One. 2020;15(6):e0233560. doi:10.1371/journal.
pone.0233560
and the use of facilities at the James A. Haley Veterans’ Hospi- 18. Dhabhar FS. The short-term stress response - Mother Nature’s
tal and Richmond VA Medical Center. This work was prepared mechanism for enhancing protection and performance under con-
under Contract HT0014-22-C-0016 with DHA Contracting ditions of threat, challenge, and opportunity. Front Neuroendo-
Office (CO-NCR) HT0014 and, therefore, is defined as U.S. crinol. 2018;49:175–192. doi:10.1016/j.yfrne.2018.03.004
Government work under Title 17 U.S.C.§101. 19. Barczak-Scarboro NE, Cole WR, DeLellis SM, et al. Mental health
symptoms are associated with mild traumatic brain injury history
in active Special Operations Forces (SOF) combat and combat
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