Blast exposure is common among service members, but the chronic psychiatric effects associated with blast exposure are not well-characterized independent of a resulting mild traumatic brain injury (TBI). This analysis evaluated whether blast exposure severity was independently associated with or exacerbated symptom report beyond posttraumatic stress disorder (PTSD) and mild TBI. Participants were Iraq and Afghanistan combat veterans (N = 275; 86.55% male), 71.27% with history of blast exposure, 29.82% current diagnosis of PTSD, and 45.45% with mild TBI. All participants completed diagnostic interviews for PTSD, lifetime TBI, and lifetime blast exposure. Self-reported psychiatric and health outcomes included posttraumatic stress symptoms, depressive symptoms, neurobehavioral symptoms, sleep quality, pain interference, and quality of life. Blast severity was associated with PTSD (B = 2.00), depressive (B = 0.76), and neurobehavioral (B = 1.69) symptoms beyond PTSD diagnosis and mild TBI history. Further, blast severity accounted entirely (i.e., indirect/mediation effect) for the association between TBI and posttraumatic stress (B = 1.62), depressive (B = 0.61), and neurobehavioral (B = 1.38) symptoms. No interaction effects were present. Exposure to blast is an independent factor influencing psychiatric symptoms in veterans beyond PTSD and mild TBI. Results highlight that blast exposure severity may be a more relevant risk factor than deployment mild TBI in combat veterans and should be considered in the etiology of psychiatric symptom presentation and complaints. Further, severity of psychological distress due to the combat environment may be an explanatory mechanism by which blast exposure mediates the relationship between mild TBI and symptom outcomes.

爆炸暴露在服役人员中很常见，但与爆炸暴露相关的慢性精神影响并没有得到很好的表征，独立于由此产生的轻度创伤性脑损伤 (TBI)。该分析评估了爆炸暴露的严重程度是否与创伤后应激障碍 (PTSD) 和轻度 TBI 之外的症状报告独立相关或加剧。参与者是伊拉克和阿富汗的战斗退伍军人（N = 275; 86.55% 男性），71.27% 有爆炸暴露史，29.82% 目前诊断为 PTSD，45.45% 有轻度 TBI。所有参与者都完成了 PTSD、终生 TBI 和终生爆炸暴露的诊断访谈。自我报告的精神和健康结果包括创伤后压力症状、抑郁症状、神经行为症状、睡眠质量、疼痛干扰和生活质量。爆炸严重程度与 PTSD ( B  = 2.00)、抑郁 ( B  = 0.76) 和神经行为 ( B  = 1.69) 症状有关，超出 PTSD 诊断和轻度 TBI 病史。此外，爆炸严重程度完全（即间接/中介效应）解释了 TBI 与创伤后应激（B  = 1.62）、抑郁（B = 0.61) 和神经行为 ( B  = 1.38) 症状。不存在交互作用。暴露于爆炸是影响 PTSD 和轻度 TBI 之外的退伍军人精神症状的独立因素。结果强调，与在战斗退伍军人中部署轻度 TBI 相比，爆炸暴露的严重程度可能是一个更相关的风险因素，应在精神症状表现和主诉的病因学中加以考虑。此外，由于战斗环境导致的心理困扰的严重程度可能是爆炸暴露介导轻度 TBI 与症状结果之间关系的一种解释机制。