Abstract
Abstract Objective Although emerging data suggest that women with traumatic brain injury (TBI) may suffer greater neurobehavioral dysfunction in both the post-acute and chronic phases of injury, sex differences have been severely understudied within the context of military TBI. Therefore, we examined sex differences on the Comprehensive Traumatic Brain Injury Evaluation (CTBIE) using a diverse sample of Iraq/Afghanistan-era Veterans enrolled in the VA’s Million Veteran Program. Method 14,378 Veterans (n = 1361 females [9.5%]) completed the CTBIE, a clinician-administered TBI interview. Chi-square analyses and logistic regressions (adjusting for age, race/ethnicity, and education) were used to explore associations between sex and CTBIE diagnostics, injury-related characteristics, neurobehavioral symptoms and other psychiatric comorbidities, and functional outcomes. Results Confirmed TBI diagnoses were more frequent among males than females (65% vs. 58%) and significant sex differences were observed across several CTBIE outcomes (p’s ≤ 0.001; $ \phi $/Cramer’s V = 0.03–0.14). Relative to females, a greater proportion of males experienced bullet and blast-related injuries and were employed. In contrast, a greater proportion of females experienced falls, reported clinically significant neurobehavioral symptoms (particularly cognitive and affective-related symptoms as well as symptom interference with daily life), failed symptom validity measures, and endorsed higher comorbid psychiatric symptoms. Conclusions Results indicate that males and females experience differential clinical and functional outcomes on the CTBIE, particularly with respect to injury-related characteristics, symptom endorsement, and employment. Findings underscore the need for female Veteran participation in TBI research in order to improve our understanding of sex-specific experiences with TBI and its sequelae, as well as to improve clinical care targeted to this vulnerable population.
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