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Barczak-Scarboro NE, Roby PR, Kiefer AW, Bailar-Heath M, Burke RJ, DeLellis SM, Kane SF, Lynch JH, Means GE, Depenbrock PJ, Mihalik JP. The relationship between resilience and neurophysiological stress in Special Operations Forces combat service members. Eur J Neurosci 2021; 55:2804-2812. [PMID: 33432647 DOI: 10.1111/ejn.15109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/21/2020] [Accepted: 01/04/2021] [Indexed: 11/30/2022]
Abstract
Military resilience research is increasing due to the growing literature associating resilience with stress adaptation. This study aimed to investigate which physiological stress adaptation components were associated with resilience in Special Operations Forces combat service members. Special Operations Forces combat service members (n = 117) self-reported resilience (ER89) and lifetime clinician-confirmed mild traumatic brain injury history. Participants also underwent transcranial Doppler ultrasonography to measure middle cerebral artery velocity during rest and a breath-holding task. Neither resilience nor mild traumatic brain injury history was significantly associated with middle cerebral artery velocity percent increase following breath-holding; younger Special Operations Forces combat service members had a higher percent increase in middle cerebral artery velocity following a breath-holding task. Resilience was negatively associated with time to return to baseline middle cerebral artery velocity following peak velocity; whereas, mild traumatic brain injury history did not have a significant association. The Special Operations Forces combat service members that scored higher in resilience tended to return to baseline middle cerebral artery velocity following peak velocity faster than their less resilient counterparts. More resilient Special Operations Forces combat service members recovered faster from physiological stress (breath-holding) than less resilient counterparts. This is the first study to investigate resilience and cerebrovascular stress response and recovery in this population. Our initial findings indicated that the Ego Resiliency Scale may be an optimal resilience psychometric and should be used to evaluate effective military resilience trainings, which aim to improve performance and mental health.
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Affiliation(s)
- Nikki E Barczak-Scarboro
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Human Movement Science Curriculum, Department of Allied Health Sciences, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Patricia R Roby
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Human Movement Science Curriculum, Department of Allied Health Sciences, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Adam W Kiefer
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Human Movement Science Curriculum, Department of Allied Health Sciences, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Riley J Burke
- Air Force Special Operations Command, Fort Bragg, NC, USA
| | | | - Shawn F Kane
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Family Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - James H Lynch
- United States Army Special Operations Command, Fort Bragg, NC, USA
| | - Gary E Means
- United States Army Special Operations Command, Fort Bragg, NC, USA
| | | | - Jason P Mihalik
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Human Movement Science Curriculum, Department of Allied Health Sciences, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Winter L, Moriarty H, Robinson K. Employment Status Among U.S. Military Veterans With Traumatic Brain Injury: Mediation Analyses and the Goal of Tertiary Prevention. Front Neurol 2019; 10:190. [PMID: 30930830 PMCID: PMC6428699 DOI: 10.3389/fneur.2019.00190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 02/14/2019] [Indexed: 12/03/2022] Open
Abstract
For most individuals with traumatic brain injury (TBI), the ability to work is crucial to financial and psychological well-being. TBI produces a wide range of cognitive, physical, emotional, and interpersonal impairments that may undermine the ability to work. Employment is therefore a primary goal of TBI rehabilitation and has been the focus of extensive research. Although this literature has identified predictors of employment outcomes, few studies have examined the mechanisms that underlie these associations. Mediation analysis can identify these mechanisms, provide a more nuanced view of how predictors jointly affect rehabilitation outcomes, and identify predictors that, if treatable conditions, could be useful targets for tertiary prevention. Such efforts are aimed at reducing long-term impairments, disability, or suffering resulting from the injury. The study sample comprised 83 U.S. military veterans with TBI who had participated in a larger rehabilitation study and were interviewed in their homes. Bivariate tests revealed significant associations of employment with pain, cognitive functioning, self-rated health, depressive symptoms and physical functioning; the latter variable was operationalized in two ways—using the Patient Competency Rating Scale and the SF–36V physical functioning subscales. Because these physical functioning measures were highly intercorrelated (r = 0.69, p < 0.0001), separate regression models were conducted. In the hierarchical binary logistic regression models, predictors were entered in order of modifiability, with comorbidities (pain) entered in block 1, physical health/functioning sequelae in block 2, and depressive symptoms in block 3. In the regression using the SF-36V measure of physical functioning, pain's effect was mediated by the physical functioning/health predictors, with only physical functioning emerging as significant, but this effect was itself mediated by depressive symptoms. In the regression using the PCRS physical-function measure, only depressive symptoms emerged as a mediator of other effects. Findings underscore the central role of depression in the employment status of veterans with TBI, suggesting that negative effects of other problems/limitations could be mitigated by more effective treatment of depression. Thus, for many with chronic TBI who live with vocational limitations, outcomes may improve with lower depression. Findings argue for the wider use of mediation approaches in TBI research as a means of identifying targets for tertiary prevention of poor outcomes.
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Affiliation(s)
- Laraine Winter
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States
| | - Helene Moriarty
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States.,M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA, United States
| | - Keith Robinson
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States
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