AUGUST 22, 2024 – Safeguarding quality of life for service members and veterans is a multi-faceted task that looms large among the objectives of Navy Medicine, requiring an ever-evolving understanding of the many long-term health outcomes unique among wounded members of this population.
Naval Health Research Center (NHRC)’s Wounded Warrior Recovery Project (WWRP), part of NHRC’s Veteran & Active-Duty Longitudinal Outcomes Research (VALOR) Program, is dedicated to investigating the highly complex, multidimensional, and interrelated nature of the physical and mental health quality of life outcomes experienced by our wounded warriors. Led since 2012 by principal investigator Michael Galarneau and epidemiologist Troy Holbrook, WWRP has published 25 studies on the key factors contributing to long-term quality of life after deployment-related injury.
Galarneau and Holbrook began the project examining the status of wounded service members and the effectiveness of the therapies they were receiving. The WWRP uses an extensive research dataset, the Expeditionary Medical Encounter Database (EMED), which includes detailed clinical, tactical and personnel information about each combat casualty event that has occurred since October 2001. For each recorded injury, researchers can study the circumstances leading up to the event, the patient’s medical conditions and their treatment history both before and after the time of injury.
Among other findings, WWRP research has shown that mental health consequences, including posttraumatic stress disorder (PTSD) and depression, have long-term effects on quality of life.
“We’re seeing high rates of what we describe as negative health behaviors problems, such as alcohol use, poor sleep patterns, physical inactivity and tobacco use,” said Cameron McCabe, a research psychologist with NHRC. “Those are common among this population, and I think the takeaway in terms of identifying risk up front is that these are occurring years after the injury, and they’re ongoing.”
In its early days, the WWRP focused on the risks associated with service-related injuries. Now, researchers are working to identify treatments and interventions that contribute to better quality of life outcomes. One of the biggest recommendations to come out of the research has been a push for optimized care.
“Given the high level of comorbidities that we’re seeing—physical health problems, pain, mental health problems, behavioral health problems—we’d like to see [more] interdisciplinary care, addressing multiple facets of the individual simultaneously,” McCabe said.
When it comes to deployment-related injuries, mild traumatic brain injury (mTBI) is of particular concern to researchers. mTBIs are concerning in part due to their prevalence. Blast-related concussions are common in military-related environments, and concerns have been raised about the mTBI impact on long-term mental health—including PTSD, depression, and cognitive functioning.
A new study from WWRP, however, suggests that modifiable health behaviors like sleep and physical activity may have a greater overall impact on mental health and cognitive functioning than a history of mTBI. The study in question examined individuals who had been wounded on deployment—both with and without history of mTBI. Participants were asked to rate their own positive health habits (such as sleep and physical activity) and potentially harmful behaviors (such as unhealthy alcohol use).
Those with and without histories of mTBI reported similar levels of physical activity and alcohol use. Those with a history of mTBI, however, were less likely to get enough sleep, even years after the initial injury. Sleep duration was shown to have the most significant impact on cognitive functioning and mental health, followed by physical activity, then alcohol use.
“What we found is that health behaviors which are modifiable accounted for a much larger percentage of how well they rated their own cognitive and mental health functioning, compared to a history of mild TBI,” said Sarah Jurick, a research psychologist with NHRC.
The good news, according to Jurick, is that modifiable health behaviors can be improved with the right interventions. For instance, cognitive behavioral therapy, a common type of talk therapy you can do with a counselor or in a group session, has been shown to improve insomnia, as well as other mental health conditions commonly associated with mTBI.
“There’s no one-size-fits-all intervention to help all individuals with mild TBI,” said McCabe. “They’re going to be experiencing a variety of different issues. Having tailored interventions that can target multiple modifiable factors—that’s going to be the way we can get real, lasting, and sustained change.”
To learn more about the VALOR project and the research their team conducts, visit www.valorprogram.org.
NHRC’s mission is to optimize military operational readiness through cutting-edge research on warfighter, veteran, and family health. NHRC supports military mission readiness with research and development that delivers high-value, high-impact solutions to the health and readiness challenges our military population faces on the battlefield, at sea, on foreign shores and at home. NHRC’s team of distinguished scientists and researchers consists of active-duty service members, federal civil service employees and contractors, whose expertise includes physiology, microbiology, psychology, epidemiology, and biomedical engineering.
Story by Anne Malinoski
Naval Health Research Center