Recent-era U.S. veterans are clinically complex, with a high prevalence of co-occurring mild traumatic brain injury (mTBI), psychiatric conditions, and behavioral dysfunction. The current study examined the direct and indirect associations between mTBI and persistent neurobehavioral, psychiatric, and functional disability symptoms among recent-era U.S. veterans and service members (n = 648). We evaluated the postconcussive syndrome (PCS) potential causal model with two network analysis modeling approaches. Separate analyses were conducted for military mTBI and lifetime mTBI. An exploratory factor analysis was conducted to limit topological overlap in the network analysis. The most influential symptoms (i.e., the unique variables most strongly associated with the rest of the network) in the military mTBI network were behavioral disengagement, expected influence (EI) = 1.10; cognitive difficulties, EI = 1.08; agitation/irritability, EI = 1.05; and PTSD-related reexperiencing and avoidance symptoms, EI = 0.98. After accounting for other symptoms, mTBI was only minimally informative, EI = 0.34. Additionally, military mTBI did not moderate the association between symptoms or the overall connectivity of the network. The results for lifetime mTBI were consistent with those for military mTBI. The present analyses identified a variety of behavioral, cognitive, and emotional symptoms that play an important role in understanding comorbidity and daily functioning among recent-era U.S. veterans. Associations between cumulative mTBI that occurred in civilian or military settings were indirect and relatively small in magnitude. The current results add to a growing literature raising doubts about the PCS model.

中文翻译：

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近代美国退伍军人轻度创伤性脑损伤、持续性神经行为和精神症状以及功能障碍的网络分析

近代美国退伍军人的临床情况很复杂，同时发生轻度创伤性脑损伤 (mTBI)、精神疾病和行为功能障碍的患病率很高。目前的研究调查了近代美国退伍军人和服役人员中 mTBI 与持续性神经行为、精神和功能障碍症状之间的直接和间接关联（n= 648）。我们使用两种网络分析建模方法评估了脑震荡后综合征 (PCS) 的潜在因果模型。对军用 mTBI 和终生 mTBI 进行了单独分析。进行探索性因素分析以限制网络分析中的拓扑重叠。军事 mTBI 网络中最具影响力的症状（即与网络其余部分关联最密切的独特变量）是行为脱离，预期影响 (EI) = 1.10；认知困难，EI = 1.08；激动/烦躁，EI = 1.05；和 PTSD 相关的再体验和回避症状，EI = 0.98。考虑到其他症状后，mTBI 仅提供最少的信息，EI = 0.34。此外，军用 mTBI 并未缓和症状之间的关联或网络的整体连通性。终生 mTBI 的结果与军事 mTBI 的结果一致。目前的分析确定了各种行为、认知和情绪症状，这些症状在了解近代美国退伍军人的合并症和日常功能方面发挥着重要作用。在民用或军事环境中发生的累积 mTBI 之间的关联是间接的，并且幅度相对较小。目前的结果增加了越来越多的文献，对 PCS 模型提出了质疑。在民用或军事环境中发生的累积 mTBI 之间的关联是间接的，并且幅度相对较小。目前的结果增加了越来越多的文献，对 PCS 模型提出了质疑。在民用或军事环境中发生的累积 mTBI 之间的关联是间接的，并且幅度相对较小。目前的结果增加了越来越多的文献，对 PCS 模型提出了质疑。