Persistent behavioral, biological, and physiological sequelae in active-duty treatment-seeking U.S. special operations forces personnel: a cross-sectional study

Background The breadth and constellation of sequelae in U.S. special operations forces (SOF) are underrepresented in the literature, especially following multiple traumatic brain injuries (TBIs), musculoskeletal injuries, and chronic stress. This study used multimodal markers of behavioral, biological, and physiological symptoms to evaluate 1) the breadth of sequelae experienced in this population, 2) their symptom structure, and 3) differential responses across participants that may improve clinical practice. Methods Participants ( n = 222) included U.S. active-duty SOF seeking treatment for TBI-related sequelae, musculoskeletal injuries, and related comorbidities. Cross-sectional data included 31 variables across 17 subjective and objective measures. Symptom structure was evaluated using exploratory factor analysis (EFA). Differential symptom responses were evaluated using latent profile analysis (LPA) and latent class analysis (LCA). Findings Cardiometabolic (82.4%), pain (83.3%), cognitive (77.5%), endocrine (39.2%), headaches (80.2%), mental health (81.1%), sensory (73.4%), and sleep (92.8%) symptoms were common. Five factors were identified that accounted for 62.8% of the total variance in symptoms. One factor accounted for the most variance (23.2%) and included a broad reaction across multiple health domains. Two latent profiles were identified with 32.4% of the sample experiencing cumulative and global disruptions in pain, cognition, headaches, mental health, sensory function, and sleep. Dysphoric arousal (49.5%) was the predominant mental health phenotype, with fewer participants presenting with traditional forms of anxiety, depression, and PTSD. Interpretation This study provides emerging evidence of a cumulative and general burden of persistent posttraumatic behavioral, biological, and physiological sequelae in U.S. SOF personnel and provide insights into the differential experiences of these sequelae. Funding This study was not funded.