Exploring the Relationship between mTBI Exposure and the Presence and Severity of Postconcussive Symptoms among Veterans Deployed to Iraq and Afghanistan

● Exploring the Relationship between mTBI Exposure and the Presence and Severity of Postconcussive Symptoms among Veterans Deployed to Iraq and Afghanistan. ● The effect of perceived burdensomeness and thwarted belongingness on therapists' assessment of patients' suicide risk. ● The therapeutic alliance as a predictor of outcome in dialectical behavior therapy versus nonbehavioral psychotherapy by experts for borderline personality disorder. Objective To describe the association between mild Traumatic Brain Injury (mTBI) and persisting postconcussive symptoms according to symptom category, number and severity. Design Observational. Participants Veterans (ages 18+) deployed in Operation Enduring and Iraqi Freedom (OEF/OIF) conflicts who had not received any treatment for mTBI in the 30 days preceding study enrollment. Methods Veterans were interviewed and completed testing in a single day. The Standard TBI Diagnostic Interview and the Clinician Administered PTSD Scale were used. Testing included the Neurobehavioral Symptom Inventory and a full neuropsychological battery. Gold standard classification methods were utilized to determine presence/absence of mTBI. For each of the five symptom outcomes, an adjusted multiple linear regression model (negative binomial count models) accounting for effects of socio-demographic variables and behavioral health conditions was used. Main Outcome Measurements Self-reported neurobehavioral symptoms categorized as affective, cognitive, somatic and vestibular symptoms. Results OEF/OIF Veterans with mTBI, relative to Veterans with no mTBI, have 30% more symptoms overall (p< .001), 34% more somatic symptoms (p< .001), 22% more cognitive symptoms (p= .008), 15% more affective symptoms (p= .017), and 59% more vestibular symptoms (p< .001). For adjusted models, variables significantly related to number of symptoms across all four symptom categories are anxiety (all p values p< .001) and insomnia (all p values p< .001). For the adjusted models, variables significantly related to symptom severity across all four symptom categories are insomnia (all p values p< .001), depression (p values range from p< .001to .05) and anxiety (all p values p< .001). Conclusions OEF/OIF Veterans with mTBI, relative to Veterans with no mTBI, have significantly more and significantly more severe persisting symptoms with vestibular symptoms reported with the greatest frequency. After accounting for behavioral health conditions and socio-demographic factors, OEF/OIF Veterans with mTBI compared to Veterans without mTBI, had significantly more cognitive, affective, vestibular and somatic symptoms persisting 4.8 years after the mTBI event(s). Objective: The interpersonal theory of suicide posits that perceived burdensomeness and thwarted belongingness are two causal interactive suicidal risk factors. The aim of this study was to examine …