Peculiarities of affective and posttraumatic response in patients with a history of combat traumatic brain injury depending on its severity: analysis of symptoms and principles of therapy

Background. Since 2014, as a result of hostilities in the Anti-Terrorist Operation – Joint Forces Operation (ATO-JFO) area and the full-scale invasion of Ukraine by the Russian Federation, cases of combat-related traumatic brain injury (cTBI) have become much more frequent, with consequences that significantly affect the daily life of civilians, fundamentally destroying the sense of security, causing constant stress, the psychological consequences of which are dangerous for both the patient and others. The internal stress and discomfort they cause exceed human capabilities. We can distinguish socio-psychological, physical, economic and medical factors that affect the health of the population in wartime. During the war, social problems arise that are directly related to the emergency situation, namely: family separation, lack of security, loss of livelihoods, breakdown of social ties, low level of trust, lack of resources, children growing up without parents, etc. As a result, mental health problems arise, including exacerbation of existing mental illnesses, changes in mental health due to suffering, acute reactions to stress, alcohol and drug abuse, and the development of depression and anxiety. Purpose – the study was to determine the peculiarities of psychopathological symptoms, namely, depression, anxiety and post-traumatic disorders, in servicemen with TBI due to blast exposure. Materials and methods. We examined 350 servicemen with combat-related traumatic brain injury, who were divided into three groups depending on its severity: 145 people had mild TBI, 125 people had moderate TBI, and 80 people had severe TBI. The study of the features of affective and posttraumatic symptoms was carried out using the Symptom Check List-90-Revised (SCL-90-R), the DASS-21 depression, anxiety and stress scale and the military version of the Mississippi Posttraumatic Stress Scale. Results. The index of obsessive-compulsive symptoms (OCS), which reflects the presence of obsessive thoughts or actions that are subjectively perceived by the individual as violent, insurmountable, and arising against his or her will, was naturally high in servicemen who took part in combat operations and suffered TBI. In the surveyed contingent, it reflects, first of all, the symptoms of post-traumatic stress disorder. In patients with mild TBI, the index of ACS was significantly higher than normal (1.98±0.49 points), in patients with moderate TBI it was significantly higher (2.12 ± 0.39 points), and in patients with TBI it was the highest (2.37 ± 0.45 points). Differences in the indicators of obsessive-compulsive symptoms between all groups by the severity of TBI were statistically significant (p < 0.01). Interpersonal sensitivity, manifested by feelings of personal inferiority and inadequacy when comparing oneself with other people, was low in patients with mild TBI (0.81 ± 0.76 points). In patients with moderate TBI, the score on this scale was also within the normal range, although significantly (p < 0.05) higher than in patients with mild TBI (1.17 ± 1.02 points). In the group with TBI, the interpersonal sensitivity score was significantly (p < 0.01) higher than in the other two groups (1.48 ± 0.76 points) and exceeded the norm, which, in our opinion, can be explained by the influence of the main symptoms of TBI, which significantly worsens the state of health, cognitive and socio-psychological functioning, and the influence of posttraumatic stress symptoms. Conclusions. Thus, we have identified significant differences in the state of the psychoemotional sphere of patients with TBI due to blast exposure. Patients with mild TBI have the lowest severity of psychopathological (depressive, anxiety, post-stress, psychosomatic) symptoms. This gives us grounds to recommend the widespread use of psychocorrection, psychotherapy and social and psychological adaptation measures in such patients. The presence of sufficient psychological resources in such patients in the form of minimal severity of psychopathological symptoms will significantly reduce the psychopathological consequences of TBI, stabilise the state of the psycho-emotional sphere and ensure full recovery of mental and social functioning.