MULTILAYERED STRATEGY FOR TREATMENT AND REHABILITATION TO ENHANCE CLINICAL EFFECTIVENESS IN MANAGING MILITARY PERSONNEL WITH COMORBID POST-TRAUMATIC STRESS DISORDER AND BLAST-RELATED INJURY (WITH ACOUSTIC BAROTRAUMA)

Abstract

The article presents a comprehensive multilayered strategy for the treatment and rehabilitation of military personnel with comorbid post-traumatic stress disorder (PTSD) and blast-related injuries, including acoustic barotrauma, which represents a critical challenge in contemporary military psychiatry and rehabilitation medicine. The escalation of combat operations and widespread use of explosive devices have led to a dramatic increase in cases where psychological trauma coexists with physical injuries, particularly traumatic brain injury (TBI) and hearing loss. This comorbidity creates a complex clinical picture that significantly impairs treatment outcomes and worsens long-term prognosis. The study examines current diagnostic frameworks, including DSM-5 and ICD-11 criteria for PTSD, and analyzes the evidence base regarding the association between PTSD and blast-related injuries. Epidemiological data indicate that among Ukrainian veterans of the Anti-Terrorist Operation, PTSD prevalence may reach 27–40%, while in U.S. veterans of Iraq and Afghanistan conflicts, the rate is approximately 11–20% annually. Research demonstrates that mild TBI significantly increases PTSD risk, with 43.9% of soldiers who experienced loss of consciousness developing PTSD compared to only 9.1% of uninjured personnel. Similarly, bilateral hearing loss following blast exposure nearly triples the likelihood of PTSD development. The proposed multilayered strategy integrates trauma-focused psychotherapy, pharmacotherapy with selective serotonin reuptake inhibitors, neurorehabilitation including cognitive training and transcranial magnetic stimulation, audiological rehabilitation, physical rehabilitation, social and occupational support, and innovative technologies such as virtual reality exposure therapy and telemedicine. The article presents results from a simulated effectiveness study involving 60 participants divided into standard care and multilayered intervention groups. Assessments were conducted using validated instruments including the Clinician-Administered PTSD Scale, Connor-Davidson Resilience Scale, and SF-36 Health Survey. After six months of treatment, the multilayered approach demonstrated superior outcomes with PTSD symptom reduction of 54.6% compared to 22.5% in the standard group, while 77% achieved remission versus 40% in standard care. Resilience scores increased substantially in the intervention group, and quality of life improvements were significantly greater. Furthermore, 80% of participants receiving comprehensive care returned to active duty or employment, compared to 50% in the standard treatment group. These findings underscore the critical importance of multidisciplinary coordination, individualized treatment planning, and integration of evidence-based psychological, pharmacological, neurorehabilitation, and social interventions for effective management of comorbid PTSD and blast injuries.