Comparative analysis of depressive, anxiety and post-traumatic symptoms in patients with a history of combat traumatic brain injury depending on its severity and duration

Relevance. Over the past decade, the number of combat-related traumatic brain injury (CRBI) cases has increased significantly in Ukraine, the consequences of which affect the mental state of military personnel and civilians, causing a constant state of stress, the psychological consequences of which are very dangerous [1, 4]. Mental health problems may arise under martial law: changes in the state of mental health due to suffering, acute reactions to stress, exacerbation of mental illness, alcohol and drug abuse, development of depression and anxiety. Purpose – of this study was to analyze psychopathological (depressive, anxiety and post-traumatic) symptoms in patients with a history of combat traumatic brain injury, depending on its severity and duration, to determine the principles of personalization of therapeutic approaches to the management of this category of patients. Materials and methods. We studied the severity of psychopathological symptoms, including depressive, anxiety, and posttraumatic symptoms, in 350 patients with different severity of TBI due to blast exposure, taking into account the time that has passed since the injury. To do this, we divided each TBI severity group into three subgroups (mild (145 patients), moderate (125 patients), and severe (80 patients)). Thus, the following groups of subjects were formed in the study: patients with mild TBI and duration from the moment of injury to our examination from 6 to 12 months, numbering 35 patients; patients with mild TBI and duration from the moment of injury from 1 to 3 years, numbering 60 patients; patients with mild TBI and duration from the moment of injury from 4 to 7 years, numbering 50 patients; patients with moderate TBI and duration from the moment of injury from 6 to 12 months, numbering 30 patients; patients with moderate TBI and duration of injury from 1 to 3 years, numbering 45 patients; patients with moderate TBI and duration of injury from 4 to 7 years; patients with severe TBI and duration from 6 to 12 months since the injury, numbering 20 patients; patients with severe TBI and duration from 1 to 3 years since the injury, numbering 30 patients; patients with severe TBI and duration from 4 to 7 years since the injury. The study of anxiety, depressive, and posttraumatic symptoms was carried out using the Symptom Check List-90-Revised (SCL-90-R) [7, 8], the DASS-21 Depression, Anxiety, and Stress Scale [9], and the military version of the Mississippi Posttraumatic Stress Scale [6]. Results. The severity of psychopathological symptoms in patients with mild CT increases with the duration of the posttraumatic period, however, this increase is uneven for individual psychopathological manifestations and for different duration of the posttraumatic period. When comparing the indicators of patients with different severity of TBI and the same duration of the posttraumatic period, the most significant differences were found in the group with a duration of 1–3 years after the injury, as well as in the group with a duration of 6–12 months, while in the group with a duration of 4–7 years, the differences were less significant. indicators of depression, anxiety and stress increased with the increase in the posttraumatic period, however, this increase was uneven in groups with different severity of TBI. In patients with mild CT, there was a clear tendency for depression to increase with the duration of the disease. Anxiety scores were also highest in patients in the 4–7 year group, lower in the 1–3 year group, and lowest in the 6–12 month group, however, the differences between the first two groups were not statistically significant (p > 0.05). The stress score was the lowest in the 6–12 months group, significantly higher in the 1–3 years group, and the highest in the 4–7 years group. In patients with moderate CT, while maintaining the general trend of increasing the severity of depression, anxiety and stress with increasing duration of the disease, the differences between the groups were significantly smaller, and were most pronounced for stress symptoms. Other patterns were found in TBI. The severity of depression according to the DASS-21 was highest in patients with the longest duration of the disease (4–7 years), and in patients with a duration of 6–12 months and 1–3 years it was not significantly different (p > 0.05). The anxiety score increased most significantly in the middle period (1–3 years), and then the increase was not statistically significant (p > 0.05). The stress score was the lowest in the group with a disease duration of 6–12 months, and the highest in the group of 4–7 months, however, the differences between the groups were not statistically significant (p > 0.05). Conclusions. It can be said that the severity of psychopathological symptoms in individuals with mild CT increases with the duration of the posttraumatic period, with the most significant increase in the late period (4–7 years). Among patients with moderate CT the total severity index of psychopathological symptoms and the index of current symptomatic distress were significantly higher in individuals with 1–3 years of posttraumatic period compared to the 6–12 months group and the 4–7 years group. In the TBI group, there was a clear tendency to increase the index of depression and interpersonal sensitivity with increasing time after TBI.