Levels Of Posttraumatic Stress Disorder Research Articles

Psychological Consequences of Dealing with Congenital Melanocytic Nevi- Case Study

This commentary is a follow-up to “Traumatic Stress Among Children After Surgical Intervention for Congenital Melanocytic Nevi: A Pilot Study” [1]. This study found that Children with CMN Show a high level of post-traumatic stress disorder after surgery and that distress affects their mental functioning. These finding semphasizes the importance of actions for prevention and early treatment of PMTS. It seems that since the long therapeutic process for CMN requires continued compliance from the children and their parents, implementing that preventive actions might influence the success of the whole surgical and reconstructive process. In this article we will present a case study of preventive care for a child with CMN who suffered from symptoms of post-traumatic stress disorder following her medical coping.

Dropout from evidence-based trauma treatment in a community mental health clinic serving victims of interpersonal violence.

Trauma-focused psychotherapies are increasingly offered in community-based mental health centers, but little is known about treatment dropout in these settings. The current study explored dropout at different stages of treatment in a treatment-seeking sample of 1,186 adults who experienced interpersonal violence and were offered trauma-focused and non-trauma-focused therapies. A total of 31.6% of participants dropped out before treatment initiation, 28.0% dropped out after treatment initiation and completed a mean of 4.02 (SD = 2.41) sessions, and 40.4% completed a full course of PTSD treatment. Being unemployed, p < .001, and scoring lower on measures of environment factors, p = .045, were significant predictors of pretreatment dropout. Being female, p < .001; Latinx, p = .032; and scoring higher on a measure of social relationships, p = .024, were independent predictors of postinitiation dropout. Individuals who completed nine sessions of treatment displayed significantly lower levels of posttraumatic stress disorder, depression, and anxiety symptoms. The present study provides preliminary evidence that survivors of interpersonal violence who seek therapy tend to drop out early during treatment, and most who complete treatment attain symptom reduction.

Health Professionals in a COVID-19 Reference Hospital: Post-traumatic Stress Disorder (PTSD) Levels and Their Associations With Psychological Resilience and Quality of Life.

IntroductionThe coronavirus disease 2019 (COVID-19) pandemic has affected the quality of life of both the general population and health professionals and has increased the levels of psychopathology among them. The present study aims to map the levels of post-traumatic stress disorder (PTSD), psychological resilience, and quality of life of healthcare professionals who work in a COVID-19 reference hospital in Athens, Greece, one year after the onset of the pandemic. Also, this study focuses on investigating the relationships among the study variables and demographics and examining possible mediating effects.MethodsThe sample consisted of 400 health professionals from Sotiria Hospital, of whom 102 were men. Participants were asked to complete the Post-Traumatic Stress Scale, Connor-Davidson Resilience Scale, and the WHO Quality of Life Questionnaire. The survey was conducted from May to July 2021.ResultsThe findings show statistical differences in resilience levels regarding marital status and employee education. Also, 13.5% of the staff reported significant PTSD levels, which relate to low levels of psychological resilience and every pillar of quality of life.ConclusionsThus, research findings indicate that resilience levels could have a protective effect on the development of PTSD symptoms. Therefore, the design of group interventions that aim at building health workers’ resilience will be discussed.

Measuring post-traumatic stress after childbirth: a review and critical appraisal of instruments

ABSTRACT Background Addressing psychological trauma after childbirth requires accurate measurement of its prevalence, risk factors, and outcomes using validated instruments that distinguish perceptions of traumatic birth, subclinical post-traumatic stress (PTS) symptoms, and symptoms meeting a diagnostic threshold. Objective The purpose of this study was to review literature on psychological trauma following childbirth and appraise instruments that measure postpartum PTS. Methods In January 2020, the authors searched for and evaluated peer-reviewed studies that quantitatively measured PTS following hospital-based live births in the United States, United Kingdom, Canada, Australia, Norway, Sweden, and Switzerland; 37 articles were selected and evaluated. Results Levels of post-traumatic stress disorder were most commonly measured, followed by PTS symptoms. Diagnostic instruments suggested lower PTS prevalence estimates than those screening for or assessing PTS symptoms. Community samples yielded lower prevalence estimates than samples recruited from the internet or settings specifically addressing mental health. Measurement sooner after birth yielded higher estimates. Conclusion Study design, sample characteristics, instruments, and timing of measurements likely impact postpartum PTS prevalence estimates. Variation in these characteristics make it difficult to draw conclusions on the prevalence of postpartum PTS. Researchers should consider the appraisal of measurement tools presented here and use rigorous study methodology when studying traumatic birth experiences and evaluating interventions.

Difference in Pandemic-Related Experiences and Factors Associated with Sickness Absence among Nurses Working in COVID-19 and Non-COVID-19 Departments.

Background: The aim of this study is to determine the main variables associated with nurses’ sickness absence (SA) and to improve the prediction of SA based on pandemic-related experiences. The second aim is to examine the differences between COVID-19 (CoV) and non-COVID-19 (non-CoV) nurses in levels of post-traumatic stress disorder (PTSD) symptoms, personality traits, coping strategies and professional stressors experienced. Methods: This historical prospective study enrolled 1305 nurses from the University Hospital of Split, Croatia. A total of 380 subjects participated in the study, 163 non-CoV and 217 CoV subjects. Nurses’ pandemic-related experience questionnaires, Big Five Inventory (BFI), Post-traumatic Stress Disorder Checklist (PCL-5), Coping Inventory for Stressful Situations (CISS) and Occupational Stress Questionnaire, were used for evaluation. Results: Non-CoV nurses felt more fear of infection, were more socially distanced, had more PTSD symptoms and neuroticism and felt more stress due to public criticism and job requirements compared to CoV nurses; p < 0.001. The groups of SA users and non-SA users could be distinguished based on predictor variables in CoV and non-CoV nurses, with a correct classification of 84.8% vs. 79.1%. Conclusions: It was possible to predict the probability of using SA among nurses due to pandemic professional experience, personality traits and coping strategies.

MEDIA TRAUMA AND POSTTRAUMATIC STRESS DISODER SYMPTOMS IN CHILDREN

The acute issue of the lack of high-quality diagnostic methods for assessing the level of post-traumatic stress disorder (PTSD) and its symptoms, especially psychodiagnostic scales of war traumatization for a child audience is discussed. Based on the analysis of international studies, a forecast was formulated regarding the 40–60% level of PTSD manifestations in Ukrainian children of the war, including among those who are Ukrainian refugees in different countries. Analysis of the symptoms used to diagnose PTSD and complex PTSD gives reason to suggest that the role of media traumatization is underestimated. Children receive media trauma as a result of exposition of the media content covering traumatic war events. It is necessary to take into account the age periodization of media risks to determine the role of media trauma in the complex assessment of exposure to stressors. An analysis of the sets of methods recommended by authoritative professional associations has been carried out, which increases the awareness of the urgent need to create domestic psychometric norms for children of different ages (a minimum of three age categories determined by various psychological mechanisms of media risks). Based on global analogues, which determine the loss of learning material by children with PTSD of about 60% due to cognitive problems (concentration of attention, reduced memory, difficulty in forming new skills), an approximate estimate of the expected socio-economic impact of PTSD on the educational system of Ukraine is given, which was an additional burden on the budget of about 5 billion hryvnias per year according to the most minimal level of expectation of PTSD among schoolchildren and students (10%) with a corresponding increase significantly when the national level of symptom manifestation will be more. It is proposed to consider the PTSD impact orientir as a basis for assessing the moral damage caused by the war to the educational system as a result of the change in children’s conditions due to the collective trauma of the war. The results of studies by Ukrainian scientists on the role of early diagnosis of PTSD and timely services show that the manifestation of PTSD symptoms reduces by 2 times. A conclusion was made about the urgent need to create remote technologies for the diagnosis of PTSD symptoms in children of different age categories, and the prospects for further research were outlined.

Posttraumatic stress disorder and its predictors in Kathmandu Valley residents after the 2015 Nepal Earthquake

After about six months from the 2015 Nepal Earthquake (Mw7.8, 25 April 2015), we conducted a survey to assess the level of posttraumatic stress disorder (PTSD) in disaster victims of Kathmandu Valley. Post-disaster surveys in many disaster-hit areas in the world indicate that the victims and affected people live a fearful life for certain period, so in this study we attempt to assess the state of mental health of the 2015 Nepal Earthquake victims in relatively heavy-hit areas of the Kathmandu Valley. We use a 17-item instrument for assessing PTSD containing three main types of PTSD symptoms: re-experiencing (5 items), avoidance (7 items), and hyperarousal symptoms (5 items). The survey results indicate that there was certain level of PTSD in the Kathmandu residents, and it can be associated not only with house damage and fatal loss but also the house repair work and livelihood revival. So, it is considered that delays in recovery and reconstruction may also lead to prevalence of PTSD.

Trauma exposure and PTSD among men entering jail: A comparative study with the general population

Research has consistently shown high levels of post-traumatic stress disorder (PTSD) in correctional settings. We aimed to compare the prevalences of trauma exposure, subthreshold PTSD, and full PTSD in incarcerated people with those observed in the general population. We used the Mini-International Neuropsychiatric Interview to screen for psychiatric disorders among men upon admission to jail (N = 630) and non-incarcerated men living in the same geographic area (the northern district of France; N = 5793). We utilized a multinomial regression model to assess the association between admission to jail and the prevalences of trauma exposure, subthreshold PTSD, and full PTSD. We employed logistic regression models to verify the interaction between admission to jail and PTSD status on the presence of psychiatric comorbidities. Full PTSD was overrepresented among men in jail after adjustment for all covariates (OR [95% CI] = 3.49 [1.55–7.85], p = 0.002). The association between PTSD status and the presence of at least one psychiatric comorbidity was also more important upon admission to jail than in the general population. Admission to jail was not associated with a higher prevalence of trauma exposure (OR [95% CI] = 1.12 [0.85–1.46], p = 0.419) or subthreshold PTSD (OR [95% CI] = 1.17 [0.81–1.68], p = 0.413). These results suggest higher prevalence rates of full PTSD and psychiatric comorbidities associated with PTSD symptoms in incarcerated people than in the general population. The provision of trauma-focused interventions tailored to these clinical specificities should be considered for the jail population.

Associations of Embeddedness and Posttraumatic Stress Disorder among 9/11 Survivors.

Following exposures to traumatic events on 9/11, survivors have reported heightened levels of posttraumatic stress disorder (PTSD). Multiple factors contribute to both the exacerbation and amelioration of PTSD symptoms, including social integration and support. This cross-sectional study aimed to understand and identify associations of embeddedness and psychosocial risk factors by PTSD status for survivors and first responders of 9/11. Results indicate that those with chronic PTSD had the lowest prevalence of both social and emotional embeddedness and many who reported no PTSD symptoms following 9/11 reported moderate levels of social and emotional embeddedness. Overall, our findings suggest those individuals who reported little to no PTSD also reported the most social/emotional embeddedness; whereas those individuals who report greater or chronic PTSD report the least social/emotional embeddedness. As such, it may be beneficial for clinicians across multiple care disciplines and contexts to consider and address the social lives and needs of those individuals experiencing symptoms of PTSD to ensure their emotional and physical needs are truly being met.

The prevalence, characteristics, and psychiatric correlates of traumatic brain injury in incarcerated individuals: an examination in two independent samples

ABSTRACT Primary Objective Identify the prevalence, characteristics, and psychological correlates of traumatic brain injury (TBI) among incarcerated individuals. Research Design Three aims: (1) Determine the prevalence and characteristics of TBI in 1469 adults incarcerated in Wisconsin state prisons (1064 men, 405 women); (2) Characterize the relationship between mild TBI and mental illness in a sub-sample of men and women; (3) Reproduce the findings from Aim 1 and Aim 2 in an independent sample of 1015 adults incarcerated in New Mexico state prisons (600 men, 415 women). Methods and Procedures Standardized TBI assessment with structured clinical interviews and self-report questionnaires. Main Outcomes and Results Rates of TBI were approximately five times greater than the general population, with a substantially higher rate of TBI caused by assault. In the Wisconsin sample, mild TBI was associated with greater levels of post-traumatic stress disorder (PTSD) among women (but not among men). In the New Mexico sample, TBI of any severity was associated with greater levels of major depressive disorder (MDD) among women (but not among men). Conclusions This study thus provides novel data on TBI and its correlates among individuals incarcerated in state prisons, and highlights a specific treatment need within the prison population.

Post-traumatic stress disorder among victims of great march of return in the Gaza Strip, Palestine: A need for policy intervention

This study aimed to assess the level of Post-Traumatic Stress Disorder (PSTD) and to examine the relationship between exposure to war stress and posttraumatic symptoms among people who were injured during the Great March of Return (GMR) in the Gaza Strip, Palestine. A sample of 264 adults who were injured during participation in the events of GMR completed the Impact Event Scale-Revised (IES-R). IES-R has three sub-scales; intrusion, avoidance, and hyper-arousal. Only 27.3% of the participants had two or more injuries and 38.4% of participants reported having disability due to their injuries. The results showed that 95.4% of the participants had severe posttraumatic symptoms. Total score of IES-R ranged between 29 and 88 (mean = 61.28). The most frequent symptoms of trauma subscales was “Intrusion” (mean = 2.90), followed by “Avoidance” (mean = 2.73), and then “Hyper-arousal” (mean = 2.70). Level of PTSD was affected by working status, need for hospitalization, need for a referral for treatment outside the Gaza Strip, disability and severity of injury. Such high level of PSTD will have negative consequences on participants' physical and mental status. Therefore, a need for special counseling programs is required to help them to survive with least consequences of PTSD on their wellbeing.

Embodiment-related risk factors for Posttraumatic Stress, Anxiety and Depression in female victims of intimate partner violence

ABSTRACT A central notion in the field of embodiment is that body sensorimotor processes and body mental representations influence emotion, cognition and behavior. By affecting the body, intimate partner violence (IPV) can leave victims with a fragile self, and significant physical and mental health problems. In this study, we aim to examine embodiment-related variables and mental health of female victims of IPV, as well as the impact of embodiment on mental health. A total of 38 female victims of IPV (mean age 40.3 ± 10.9 years) were recruited from shelters and the community. The study assessed the levels of Posttraumatic Stress Disorder (PTSD), Anxiety and Depression, and abilities of Movement Imagery, Interoceptive Accuracy, Interoceptive Sensibility, Body Ownership and Bodily Dissociation. Univariate, bivariate and binary regression analysis were used. PTSD, Anxiety and Depression were highly prevalent among our sample, alongside with altered values of body ownership and interoception. All three mental health disorders were significantly correlated with interoceptive self-regulation, interoceptive trusting, and bodily dissociation. For this group of women, each unit rise in the bodily dissociation scale increased two and six times the risk for developing Depression and Anxiety, respectively. The embodiment of female victims of IPV is altered, and higher bodily dissociation can be a risk factor for the development of mental health problems. Restoration of embodiment-related functions could be important for the victims to overcome the negative effects of violent relationships.

What Psychological and Sociodemographic Challenges are Linked to Criminal Justice Involvement among Veterans and Service Members with and without TBI? A LIMBIC-CENC Study

<h3>Research Objectives</h3> To examine sociodemographic and psychological factors associated with history of arrests and felony incarceration among Veterans and Service Members (V/SM) with and without history of mild traumatic brain injury (mTBI). <h3>Design</h3> Survey; Multicenter cohort study. <h3>Setting</h3> Eight Veteran Affairs and Department of Defense medical hospitals. <h3>Participants</h3> V/SM completed a baseline assessment for Chronic Effects of Neurotrauma Consortium (N=1,555). Participants were predominantly male (87%), white (72%), and 40 years old (SD=9.71). Most (83%) reported a history of at least one mTBI). <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> Self-report measure of lifetime arrest/felony incarceration history. <h3>Results</h3> Three groups were composed based on level of involvement with the criminal justice system: 1.) No history of arrests or incarcerations (65%), 2.) A lifetime history of arrest but no felony incarceration (32%), and 3.) A lifetime history of felony incarceration (3%). Chi-square and Kruskal-Wallis H tests revealed statistically significant differences between the groups in demographic factors including the incarcerated group having younger age, greater percentage of men, lower education, and greater percentage of never being married, followed by the arrest group and then the no arrest group (all p < .05). The incarcerated group also had the highest level of posttraumatic stress disorder (PTSD) symptoms, lowest social support, and greatest percentage of hazardous alcohol consumption, followed by the arrest and then the no arrest groups (all p < .05). No differences were found between groups for mTBI history. <h3>Conclusions</h3> The correlates of legal involvement among V/SM span demographic and psychological dimensions. Some correlates are modifiable, including social support, PTSD symptoms, and alcohol consumption. Addressing these modifiable risk factors is critical to lower the risk of future criminal justice involvement. <h3>Author(s) Disclosures</h3> This material is based upon work supported by the U.S. Army Medical Research and Material Command and from the U.S. Department of Veterans Affairs Chronic Effects of Neurotrauma Consortium under Award No. W81XWH-13-2-0095. The U.S. Army Medical Research Acquisition Activity, 820 Chandler Street, Fort Detrick MD 21702-5014 is the awarding and administering acquisition office. All authors denied any conflicts of interests.

A-108 Psychological and Sociodemographic Challenges, but Not History of Mild Traumatic Brain Injury, Is Associated with Criminal Justice Involvement among Veterans and Service Members

Abstract Objective Examine factors associated with history of arrests and felony incarceration among Veterans and Service Members (V/SM) with combat exposure. Method Participants were V/SM who completed a baseline assessment for the multicenter Chronic Effects of Neurotrauma Consortium study (N = 1555). Most were male (87%), white (72%), with a mean age of 40 years (SD = 9.71). The majority (83%) reported a history of ≥1 mild traumatic brain injury (mTBI), with thirty-five present of those experiencing 3+ mTBIs. Results Three groups were composed based on self-reported level of involvement with the criminal justice system: 1.) No history of arrests or incarcerations (65%), 2.) A lifetime history of arrest but no felony incarceration (32%), and 3.) A lifetime history of felony incarceration (3%). Chi-square and Kruskal-Wallis H tests revealed statistically significant differences between the groups in demographic factors including the incarcerated group having younger age, greater percentage of men, lower education, and greater percentage of never being married, followed by the arrest group and then the no arrest group (all p &amp;lt; 0.05). The incarcerated group also had the highest level of posttraumatic stress disorder (PTSD) symptoms, lowest social support, and greatest percentage of hazardous alcohol consumption, followed by the arrest and then the no arrest groups (all p &amp;lt; 0.05). No differences were found between groups for mTBI history or neuropsychological testing results. Conclusions Correlates of legal involvement among V/SM span demographic and psychological dimensions. Some correlates are modifiable, including social support, PTSD symptoms, and alcohol consumption. Addressing these modifiable risk factors is critical to lower the risk of future criminal justice involvement.

Disaster stressors and psychological well-being in older adults after a flood.

We examined the inoculation and stress sensitization explanations concerning mental health outcomes in 223 predominately middle-aged and older adults after a flood (M age = 49.6 years, SD = 17.7 years, range: 18-88 years). In multiple linear regression models, having flood damage was associated with higher levels of posttraumatic stress disorder (PTSD) and depressive symptoms, while social support was associated with fewer symptoms. Greater lifetime trauma and flood-related stress were associated with more symptoms of depression and PTSD, respectively. Older age was associated with more religious coping and fewer depressive and worry symptoms. Future directions for research on postdisaster vulnerabilities and resilience are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Prevalence of post-traumatic stress disorder and its predictors following coronary artery bypass graft surgery.

Cardiac surgery can be traumatic and stressful, and as a result many people experience psychological difficulties following treatment. To assess the level of post-traumatic stress disorder (PTSD) 1 month after coronary artery bypass graft (CABG) surgery among Jordanian patients, and to examine the predictors of PTSD after 1 month. A descriptive survey design was used. 149 patients participated in the study. Their mean age was 59 years (SD=10.2) and most were male (87%) and married (93%). Some 44% of patients had PTSD. Length of stay in hospital (c² (1)=6.598, P<0.05), and age (c² (1)=4.920, P<0.05), predicted the occurrence of PTSD after 1 month. Nurses, who are usually in the frontline with patients, should consider using a robust tool and clinical interview to assess and evaluate the presence and the risks of PTSD to promote early detection and optimal management. Follow-up studies after 6 and 12 months would be beneficial.

Event centrality and secondary traumatization among Holocaust survivors' offspring and grandchildren: A three-generation study

The present study examined the intergenerational transmission of the Holocaust trauma in relation to levels of secondary traumatization and event centrality across three generations in a cross-sectional survey. Participants included 92 Holocaust survivor-offspring-grandchild triads (Holocaust G1-G2-G3) and 67 comparison triads (Comparison G1-G2-G3). Holocaust G1 reported higher levels of post-traumatic stress disorder (PTSD) symptoms relative to Comparison G1. Holocaust G2 and G3 reported significantly higher secondary traumatization relative to Comparison G2 and G3, respectively. Holocaust G3 also reported significantly higher scores in event centrality relative to Comparison G3. In survivor families, the indirect effect of PTSD symptoms in Holocaust G1 predicted Holocaust G2's secondary traumatization, which subsequently predicted Holocaust G3's secondary traumatization. Moreover, PTSD symptoms in Holocaust G1 predicted Holocaust G3's event centrality through secondary traumatization in both Holocaust G2 and G3 and event centrality in Holocaust G2. In the comparison groups, trauma transmission was not observed in three generations. Findings elucidate unique intergenerational transmission of the Holocaust trauma in survivor families, which comprise both personal and societal constituents. Moreover, the findings show that event centrality is a distinctive mechanism in intergenerational transmission in survivor families.

Post-9/11 military veterans' adjustment to civilian life over time following separation from service.

US military veterans face many challenges in transitioning to civilian life; little information is available regarding veterans' reintegration experiences over time. The current study characterized veterans' postdeployment stressful life events and concurrent psychosocial wellbeing over one year and determined how stressors and wellbeing differ by demographic factors. Recent Post-911 veterans (n = 402) were assessed approximately every three months for 1 year. Participants were 60% men, primarily White (78%), and 12% Latinx; the average age was 36 years. The frequency of stressful events decreased over time but was higher for men and minority-race veterans (independent of time since separation). Veterans reported high mean levels of posttraumatic stress disorder, anxiety, and insomnia symptoms, which improved slightly over time. Minority-race and Latinx veterans had higher symptom levels and slower rates of symptom reduction. Veterans remain distressed in their overall transition to civilian life. Interventions to promote resilience and help veterans manage readjustment to civilian life appear urgently needed.

What is the level of post-traumatic stress disorder experienced by Italian University students during the Covid-19 pandemic? Result of an online survey

OBJECTIVE: To date, level of Post-Traumatic Stress Disorder (PTSD) symptoms experienced from university students during the peak of Covid-19 in Italy is until under investigated. Therefore, this study aims to describe PTDS related to the Covid-19 outbreak among Italian university students. METHODS: A multicentre cross-sectional study was conducted, involving convenience and consecutive sampling of Italians University students. A self-reported web questionnaire on the on-line platform Qualtrics®, was used to data collect, in March and April 2020. RESULTS: Overall, 720 Italian University students participated to this study. The sample are major male (80.7%) with an average mean of 23.52 years. The results of data analysis highlighted the important level of PTSD experienced from Italian University students during the Covid-19 outbreak, especially by female students that presented higher levels of PTSD. Additionally, no differences were found between students in healthcare field and not in healthcare field. CONCLUSION: The results showed, for the first time, the level of PTSD experienced by Italian Universities students, triggered by the psychological consequences of the health emergency Covid-19. This situation requires public health interventions aimed at preventing the early development of such mental disorders, which negatively affect the growth of future generations.

Post-mTBI Pain Interference in a U.S. Military Population: A Chronic Effects of Neurotrauma Consortium Study.

Chronic pain is a significant problem for service members and veterans with mild traumatic brain injury (mTBI). While the root cause of pain is not clearly understood, comorbidities may contribute to how their pain disrupts their functional status, a construct termed "pain interference." The purpose of this study is to examine the associations between mTBI, other comorbidities, and pain interference. The sample comprised participants with mTBI(s) from The Chronic Effects of Neurotrauma Consortium multicenter observational study. Potential concussive events were identified using a modified Ohio State University traumatic brain injury (TBI) Identification interview and then further with a structured interview. Pain interference was measured with the TBI quality-of-life pain interference score, which was categorized into insignificant, moderate, and high pain interference. Comorbidities of interest included anxiety, depression, post-traumatic stress disorder, insomnia, and arthritis. Multivariable relationships were analyzed using logistic regression. The analysis sample included 346 participants with mTBI(s). In adjusted analysis, those with high pain interference were more likely to have history of ≥ 3 TBIs (odds ratio (OR) 3.1, 95% confidence interval [CI] 1.4, 6.9) and to have clinical levels of post-traumatic stress disorder (OR 5.4, 95% CI 1.9, 15.7), depression (OR 2.5, 95% CI, 1.0, 6.1), anxiety (OR 4.9, 95% CI, 2.0, 11.7), and sleep disturbances (OR 6.1, 95% CI 2.0, 19.0) versus those with insignificant pain interference. These results identify clinical features of veterans and service members with mTBI(s) who are at highest risk for pain-related disability. These findings also demonstrate the need to consider mental health and sleep problems in their pain evaluation and treatment approach.