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Differences in quality-of-life scores across injury categories by mental health status among injured U.S. military service members and veterans

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Abstract

Purpose

Posttraumatic stress disorder (PTSD) and depression are strong predictors of poor health-related quality of life (HRQOL) among injured U.S. military service members (SMs). Patterns of HRQOL between injury categories and injury categories stratified by mental health (MH) symptoms have not been examined. Among deployment-injured SMs and veterans (n = 4353), we examined HRQOL and screening data for PTSD and/or depression within specific injury categories.

Methods

Participants included those enrolled in the Wounded Warrior Recovery Project with complete data for HRQOL (SF-36) from June 2017 to May 2020. Injuries were categorized using the Barell Injury Diagnosis Matrix (Barell Matrix). Mean physical component summary (PCS) and mental component summary (MCS) scores were calculated for each injury category and stratified by the presence or absence of probable PTSD and/or depression.

Results

The average follow-up time that participants were surveyed after injury was 10.7 years. Most participants were male, non-Hispanic White, served in the Army, and enlisted rank. Mechanism of injury for 77% was blast-related. Mean PCS and MCS scores across the entire sample were 43.6 (SD = 10.3) and 39.5 (SD = 13.3), respectively; 50% screened positive for depression and/or PTSD. PCS and MCS scores were significantly lower within each injury category among individuals with probable PTSD and/or depression than those without.

Conclusion

Among deployment-injured SMs, those with probable PTSD and/or depression reported significantly lower HRQOL within injury categories and HRQOL component (i.e., physical or mental) than those without. Findings are consistent with prior reports showing mental health symptoms to be strongly associated with lower HRQOL and suggest integration of mental health treatment into standard care practices to improve long-term HRQOL.

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Acknowledgements

Disclaimer

I am a military service member or employee of the U.S. Government. This work was prepared as part of my official duties. Title 17, U.S.C. §105 provides that copyright protection under this title is not available for any work of the U.S. Government. Title 17, U.S.C. §101 defines a U.S. Government work as work prepared by a military service member or employee of the U.S. Government as part of that person’s official duties. Report No. 22-14 was supported by the U.S. Navy Bureau of Medicine and Surgery Wounded, Ill, and Injured program under work unit no. 60808. The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, nor the U.S. Government. The study protocol was approved by the Naval Health Research Center Institutional Review Board in compliance with all applicable Federal regulations governing the protection of human subjects. Research data were derived from an approved Naval Health Research Center Institutional Review Board Protocol, Number NHRC.2009.0014.

Funding

This study was funded by the U.S. Navy Bureau of Medicine and Surgery under work Unit No. 60808. The funder had no role in study design; data collection, analysis, or interpretation; or writing of this manuscript.

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Authors and Affiliations

  1. Leidos, Inc., San Diego, CA, USA

    Judith Harbertson, Cameron T. McCabe, Susan L. Eskridge, Sarah M. Jurick & Jessica R. Watrous

  2. Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106-3521, USA

    Judith Harbertson, Andrew J. MacGregor, Cameron T. McCabe, Susan L. Eskridge, Sarah M. Jurick & Jessica R. Watrous

  3. Axiom Resource Management, Inc., San Diego, CA, USA

    Andrew J. MacGregor

  4. Operational Readiness Research Directorate, Naval Health Research Center, San Diego, USA

    Michael R. Galarneau

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Contributions

All authors contributed to study design conception and interpretation of analysis and provided a critical review/revision of the manuscript. JH created, cleaned, and coded the data set, conducted analysis, and drafted the manuscript. AM and SE provided injury and epidemiological methods subject matter expertise. CM provided assistance with data set creation, coding, and processing support and provided mental health and quality-of-life subject matter expertise. JW and SJ provided mental health subject matter expertise. MG provided assistance with data sources and historical research/context knowledge.

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Correspondence to Judith Harbertson.

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The authors have no relevant financial or nonfinancial interests to disclose.

Ethical approval

All procedures were approved by the Naval Health Research Center Institutional Review Board (Protocol Number: NHRC.2009.0014).

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Participation in the WWRP is voluntary and informed consent was obtained from all participants included in the study.

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Harbertson, J., MacGregor, A.J., McCabe, C.T. et al. Differences in quality-of-life scores across injury categories by mental health status among injured U.S. military service members and veterans. Qual Life Res 32, 461–472 (2023). https://doi.org/10.1007/s11136-022-03263-3

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