Mild Traumatic Brain Injury in UK Military Personnel Returning From Afghanistan and Iraq

King's Centre for Military Health Research, King's College London, London, United Kingdom.
The Journal of head trauma rehabilitation (Impact Factor: 2.92). 12/2011; 27(1):33-44. DOI: 10.1097/HTR.0b013e318212f814
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: To assess (a) the prevalence of mild traumatic brain injury (mTBI) in UK military personnel deployed to Iraq and/or Afghanistan, (b) the risk factors associated with mTBI, and (c) the association between mTBI and subsequent postconcussion symptoms (PCS).
: A total of 4620 personnel deployed to Iraq and/or Afghanistan who completed a questionnaire between 2007 and 2009, of whom 2333 were also studied in 2005, participated in the study.
: Mild traumatic brain injury during deployment, as identified using a modified version of the Brief Traumatic Brain Injury Screen questionnaire; symptoms associated with PCS in the month before questionnaire completion.
: The prevalence of mTBI was 4.4%, and the prevalence in those with a combat role was 9.5%. Having an mTBI was associated with current symptoms of posttraumatic stress disorder (adjusted odds ratio (AOR), 5.2; 95% confidence interval [CI], 2.3-11.4), alcohol misuse (AOR, 2.3; 95% CI, 1.4-3.7), and multiple physical symptoms (AOR, 2.6; 95% CI, 1.3-5.2). Only 3 of 9 symptoms remained associated with mTBI after adjustment. Psychological distress and alcohol misuse recorded before deployment were associated with subsequent mTBI.
: The prevalence of mTBI in UK military is lower than that in the US military. Symptoms of current posttraumatic stress disorder and alcohol misuse are associated with mTBI. Symptoms of mental disorder predated occurrence of mTBI. The majority PCS were not associated with mTBI.

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Available from: Matthew Hotopf, Sep 30, 2015
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    • "per 1,000 for UK troops). Thus since 2006 fatality rates have been similar (Rona, Jones, Fear, et al., 2012). "
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    ABSTRACT: A substantial amount of research has been conducted into the mental health of the UK military in recent years. This article summarises the results of the various studies and offers possible explanations for differences in findings between the UK and other allied nations. Post-traumatic stress disorder (PTSD) rates are perhaps surprisingly low amongst British forces, with prevalence rates of around 4% in personnel who have deployed, rising to 6% in combat troops, despite the high tempo of operations in recent years. The rates in personnel currently on operations are consistently lower than these. Explanations for the lower PTSD prevalence in British troops include variations in combat exposures, demographic differences, higher leader to enlisted soldier ratios, shorter operational tour lengths and differences in access to long-term health care between countries. Delayed-onset PTSD was recently found to be more common than previously supposed, accounting for nearly half of all PTSD cases; however, many of these had sub-syndromal PTSD predating the onset of the full disorder. Rates of common mental health disorders in UK troops are similar or higher to those of the general population, and overall operational deployments are not associated with an increase in mental health problems in UK regular forces. However, there does appear to be a correlation between both deployment and increased alcohol misuse and post-deployment violence in combat troops. Unlike for regular forces, there is an overall association between deployment and mental health problems in Reservists. There have been growing concerns regarding mild traumatic brain injury, though this appears to be low in British troops with an overall prevalence of 4.4% in comparison with 15% in the US military. The current strategies for detection and treatment of mental health problems in British forces are also described. The stance of the UK military is that psychological welfare of troops is primarily a chain of command responsibility, aided by medical advice when necessary, and to this end uses third location decompression, stress briefings, and Trauma Risk Management approaches. Outpatient treatment is provided by Field Mental Health Teams and military Departments of Community Mental Health, whilst inpatient care is given in specific NHS hospitals.
    European Journal of Psychotraumatology 08/2014; 5. DOI:10.3402/ejpt.v5.23617 · 2.40 Impact Factor
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    • "As a consequence, there is an increase of TBI-related chronic illnesses such as memory impairments and, neuropsychological disabilities including depression, anxiety, and post-traumatic stress disorder (PTSD), which impedes quality of life and contributes to a high cost of disability annually [4], [5]. These TBI-induced neuropsychological disabilities either persist or develop late in life and may precipitate anxiety disorders and PTSD in veterans and civilians [6], [7], [8], [9]. However, there is no clear evidence on how these psychiatric morbidities interact with chronic TBI [6]. "
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    ABSTRACT: Long-term consequences of traumatic brain injury (TBI) are closely associated with the development of severe psychiatric disorders, such as post-traumatic stress disorder (PTSD), yet preclinical studies on pathological changes after combined TBI with PTSD are lacking. In the present in vivo study, we assessed chronic neuroinflammation, neuronal cell loss, cell proliferation and neuronal differentiation in specific brain regions of adult Sprague-Dawley male rats following controlled cortical impact model of moderate TBI with or without exposure to PTSD. Eight weeks post-TBI, stereology-based histological analyses revealed no significant differences between sham and PTSD alone treatment across all brain regions examined, whereas significant exacerbation of OX6-positive activated microglial cells in the striatum, thalamus, and cerebral peduncle, but not cerebellum, in animals that received TBI alone and combined TBI-PTSD compared with PTSD alone and sham treatment. Additional immunohistochemical results revealed a significant loss of CA3 pyramidal neurons in the hippocampus of TBI alone and TBI-PTSD compared to PTSD alone and sham treatment. Further examination of neurogenic niches revealed a significant downregulation of Ki67-positive proliferating cells, but not DCX-positive neuronally migrating cells in the neurogenic subgranular zone and subventricular zone for both TBI alone and TBI-PTSD compared to PTSD alone and sham treatment. Comparisons of levels of neuroinflammation and neurogenesis between TBI alone and TBI+PTSD revealed that PTSD did not exacerbate the neuropathological hallmarks of TBI. These results indicate a progressive deterioration of the TBI brain, which, under the conditions of the present approach, was not intensified by PTSD, at least within our time window and within the examined areas of the brain. Although the PTSD manipulation employed here did not exacerbate the pathological effects of TBI, the observed long-term inflammation and suppressed cell proliferation may evolve into more severe neurodegenerative diseases and psychiatric disorders currently being recognized in traumatized TBI patients.
    PLoS ONE 12/2013; 8(12):e81585. DOI:10.1371/journal.pone.0081585 · 3.23 Impact Factor
    • "These include litigation status, lower levels of education, lower levels of intellectual ability, female gender, prior head injury, poor social support, lower socioeconomic status, alcohol abuse, social difficulties, stress, negative perceptions of mild TBI, physical injuries, and multiple traumas (Binder & Rohling, 1996; Gouvier, Cubic, Jones, Brantley, & Cutlip, 1992; Hou et al., 2012; Kibby & Long, 1996; Luis, Vanderploeg , & Curtiss, 2003; Meares et al., 2011; Rona et al., 2012; Wood, Novak, & Long, 1984). Psychiatric difficulties also are important moderators of PCS (Fann, Katon, Uomoto, & Esselman, 1995; Hoge et al., 2008; Hou et al., 2012; King, 1996; Luis et al., 2003; Meares et al., 2011; Ponsford et al., 2012; Rona et al., 2012). Finally, pain and sleep problems are significantly associated with postconcussive symptoms (Meares et al., 2011; Nicholson, 2000; Perlis, Artiola, & Giles, 1997; Ponsford et al., 2012). "
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    ABSTRACT: The purpose of this study was to examine the relationship between postconcussion symptom complaint (PCS) severity and positive coping factors (knowledge, self-efficacy, and attributions) in a sample of individuals who have sustained a mild TBI, above and beyond the demographic and psychiatric predictors that have been most commonly examined. Ninety-one people with a history of reported mild TBI were surveyed. Hierarchical regression analyses revealed that demographic variables and psychiatric symptom severity predicted PCS severity. Consistent with our hypotheses, knowledge, self-efficacy, and attributions, when taken together, made an independent and significant contribution to prediction of PCS severity (21% of additional variance). The most potent factor was attribution, or the extent to which one attributes symptoms to mild TBI versus other causes. Those who attribute their symptoms to TBI are more likely to report greater symptom severity overall. Taken together, knowledge, self-efficacy, and attributions contribute independently to PCS severity. Additional research is needed to determine if these factors are amenable to intervention.
    The Clinical Neuropsychologist 03/2013; 27(3). DOI:10.1080/13854046.2013.774438 · 1.72 Impact Factor
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