Do Sleep Problems Mediate the Relationship Between Traumatic Brain Injury and Development of Mental Health Symptoms After Deployment?

摘要

Military service members who screen positive for traumatic brain injury (TBI) may subsequently screen positive for posttraumatic stress disorder (PTSD) and/or depression. The objective of this study was to explore the role of sleep as a mediating factor in the development of mental health symptoms postdeployment. A total of 29,640 Navy and Marine Corps men who returned from deployment to Iraq, Afghanistan, or Kuwait during 2008 and 2009 were prospectively evaluated for TBI, sleep problems, PTSD, and depression at two time points. Among those who did not screen positive for PTSD at baseline (n = 29,019), the adjusted odds of receiving a positive PTSD screen at follow-up decreased from 1.61 (95% confidence interval [CI] 1.21-2.14) to 1.32 (95% CI 0.99-1.77) for a subject screening positive for TBI relative to a subject screening negative. Likewise, after controlling for sleep problems, the adjusted odds of receiving a positive depression screen decreased from 1.41 (95% CI 1.11-1.80) to 1.15 (95% CI 0.90-1.47) among service members screening negative for depression at baseline (n = 27,702). Based on these findings, sleep problems mediated 26% of TBI's effect on PTSD and 41% of TBI's effect on depression. Results suggest that sleep problems may be an early indicator of risk for PTSD and depression.