{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T01:59:11Z","timestamp":1780624751466,"version":"3.54.1"},"reference-count":45,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2018,2,14]],"date-time":"2018-02-14T00:00:00Z","timestamp":1518566400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Worldviews Ev Based Nurs"],"published-print":{"date-parts":[[2018,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Understanding the complex interrelationships between combat injuries, physical health, and mental health symptoms is critical to addressing the healthcare needs of wounded military personnel and veterans. The relationship between injury characteristics, pain, posttraumatic stress disorder (PTSD), and depression among combat\u2010injured military personnel is unique to modern conflicts and understudied in the nursing literature.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>This integrative review synthesizes clinical presentations and relationships of combat injury, PTSD, depression, and pain in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) United States military service members and veterans.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A literature search was conducted using relative key terms across databases to identify peer\u2010reviewed publications between 2001 and 2016 that examined health outcomes of combat\u2010injured persons in OEF and OIF. The quality of evidence was evaluated and results synthesized to examine the association of combat injury as a risk factor for PTSD, the relationship of PTSD and depression pre\u2010 and postinjury, and pain management throughout care.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Twenty\u2010two articles were included in this review. Greater injury and pain severity poses risks for developing PTSD following combat injury, while early symptom management lessens risks for PTSD. Depression appears to be both a contributing risk factor to postinjury PTSD, as well as a comorbidity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Linking Evidence to Action<\/jats:title><jats:p>Findings demonstrate a compelling need for improvements in standardized assessment of pain and mental health symptoms across transitions in care. This integrative review informs nurse researchers and providers of the clinical characteristics of pain, PTSD, and depression following combat injury and offers implications for future research promoting optimal surveillance of symptoms.<\/jats:p><\/jats:sec>","DOI":"10.1111\/wvn.12274","type":"journal-article","created":{"date-parts":[[2018,2,14]],"date-time":"2018-02-14T16:42:44Z","timestamp":1518626564000},"page":"113-126","source":"Crossref","is-referenced-by-count":23,"title":["Complexity of the Relationships of Pain, Posttraumatic Stress, and Depression in Combat\u2010Injured Populations: An Integrative Review to Inform Evidence\u2010Based Practice"],"prefix":"10.1111","volume":"15","author":[{"given":"Nicholas A.","family":"Giordano","sequence":"first","affiliation":[{"name":"PhD Student, Hillman Scholar in Nursing Innovation University of Pennsylvania School of Nursing  Philadelphia PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Bader","sequence":"additional","affiliation":[{"name":"PhD Student, Robert Wood Johnson Foundation Future of Nursing Scholar (Independence Blue Cross Foundation) University of Pennsylvania School of Nursing  Philadelphia PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Therese S.","family":"Richmond","sequence":"additional","affiliation":[{"name":"Andrea B. Laporte Professor of Nursing, Associate Dean for Research &amp; Innovation University of Pennsylvania School of Nursing  Philadelphia PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosemary C.","family":"Polomano","sequence":"additional","affiliation":[{"name":"Professor of Pain Practice, University of Pennsylvania School of Nursing, and Professor of Anesthesiology and Critical Care (Secondary) University of Pennsylvania Perelman School of Medicine  Philadelphia PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,2,14]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.5435\/00124635-200600001-00003"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.7205\/MILMED-D-03-3808"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005373-197403000-00001"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1526-4637.2009.00731.x"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1526-4637.2012.01382.x"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-006-0101-4"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1682\/JRRD.2006.05.0057"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1526-4637.2009.00590.x"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000000403"},{"issue":"4","key":"e_1_2_7_11_1","first-page":"277","article-title":"PASTOR\/PROMIS\u00ae pain outcomes system: What does it mean to pain specialists","volume":"4","author":"Cook K. 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