OBJECTIVE This study examined cognitive functioning in post-9/11 Veterans with the deployment trauma phenotype (DTP), comprised of co-occurring diagnoses of depressive disorder (major depressive disorder and or persistent depressive disorder/dysthymia), posttraumatic stress disorder (PTSD), and mild traumatic brain injury (mTBI), using objective neuropsychological measures. METHOD Participants included a cross-sectional sample of 399 post-9/11 Veterans who completed clinical interviews and neuropsychological tests as part of a larger study at VA Boston Healthcare System. Confirmatory factor analysis identified four cognitive domains: attention, cognitive control/processing speed, episodic memory, and cognitive flexibility. Veterans with DTP and its constituent diagnoses in isolation, two-way diagnostic combinations, and no constituent diagnoses were compared. RESULTS Veterans with DTP had a twofold increased prevalence for below average performance in cognitive control/processing speed compared with those with no constituent diagnoses (prevalence ratios [PRs] = 2.04; 95% confidence interval [CI]: 1.03-4.05). The PTSD + depressive disorder group also had a twofold increased prevalence for below average performance in episodic memory (PR = 2.16; 95% CI: 1.05-4.43). CONCLUSIONS The deployment trauma phenotype is associated with clinically significant decrease in cognitive control/processing speed in post-9/11 Veterans. Comorbid PTSD and depressive disorder negatively impacted performances in episodic memory. Mild TBI alone showed no cognitive deficits. Clinical interventions should target psychiatric symptoms with a transdiagnostic approach to address this multimorbid population.

中文翻译：

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9/11 后多病态退伍军人认知表现的促成因素：部署创伤表型。

目的 本研究检查了 9/11 事件后具有部署创伤表型 (DTP) 的退伍军人的认知功能，包括同时诊断的抑郁症（重度抑郁症和/或持续性抑郁症/心境恶劣）、创伤后应激障碍 (PTSD)和轻度创伤性脑损伤 (mTBI)，使用客观的神经心理学措施。方法参与者包括 399 名 9/11 后退伍军人的横断面样本，他们完成了临床访谈和神经心理学测试，作为 VA Boston Healthcare System 一项更大规模研究的一部分。验证性因素分析确定了四个认知领域：注意力、认知控制/处理速度、情景记忆和认知灵活性。具有 DTP 的退伍军人及其独立诊断、双向诊断组合，并且没有比较成分诊断。结果 与没有成分诊断的退伍军人相比，患有 DTP 的退伍军人在认知控制/处理速度方面表现低于平均水平的患病率增加了两倍（患病率 [PRs] = 2.04；95% 置信区间 [CI]：1.03-4.05）。PTSD + 抑郁症组在情景记忆方面表现低于平均水平的患病率也增加了两倍（PR = 2.16；95% CI：1.05-4.43）。结论 部署创伤表型与 9/11 后退伍军人的认知控制/处理速度的临床显着下降相关。共病 PTSD 和抑郁症对情景记忆的表现产生负面影响。仅轻度 TBI 没有表现出认知缺陷。