Loss of Consciousness, Depression, Posttraumatic Stress Disorder, and Suicide Risk Among Deployed Military Personnel With Mild Traumatic Brain Injury.
ABSTRACT OBJECTIVE:: To identify clinical variables associated with suicidality in military personnel with mild traumatic brain injury (mTBI) while deployed to Iraq. SETTING:: Outpatient TBI clinic on a US military base in Iraq. PARTICIPANTS:: Military personnel (N = 158) referred to an outpatient TBI clinic for a standardized intake evaluation, 135 (85.4%) who had a diagnosis of mTBI and 23 (14.6%) who did not meet criteria for TBI. MAIN MEASURES:: Suicidal Behaviors Questionnaire-Revised, Depression subscale of the Behavioral Health Measure-20, Posttraumatic Stress Disorder Checklist-Military Version, Insomnia Severity Index, self-report questionnaire, and clinical interview addressing TBI-related symptoms. RESULTS:: Among patients with mTBI, increased suicidality was significantly associated with depression and the interaction of depression with posttraumatic stress disorder symptoms. Longer duration of loss of consciousness was associated with decreased likelihood for any suicidality. CONCLUSION:: Assessment after TBI in a combat zone may assist providers in identifying those at risk for suicidality and making treatment recommendations for service members with mTBI.
Full-textDOI: · Available from: Craig J Bryan, Feb 11, 2014
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ABSTRACT: Sleep disturbance is very common following traumatic brain injury (TBI), which may initiate or exacerbate a variety of co-morbidities and negatively impact rehabilitative treatments. To date, there are paradoxical reports regarding the associations between inherent characteristics of TBI and sleep disturbance in TBI population. The current study was designed to explore the relationship between the presence of sleep disturbance and characteristics of TBI and identify the factors which are closely related to the presence of sleep disturbance in TBI population. 98 TBI patients (72 males, mean age ± SD, 47 ± 13 years, range 18-70) were recruited. Severity of TBI was evaluated based on Glasgow Coma Scale (GCS). All participants performed cranial computed tomography and were examined on self-reported sleep quality, anxiety, and depression. TBI was mild in 69 (70%), moderate in 15 (15%) and severe in 14 (15%) patients. 37 of 98 patients (38%) reported sleep disturbance following TBI. Insomnia was diagnosed in 28 patients (29%) and post-traumatic hypersomnia in 9 patients (9%). In TBI with insomnia group, 5 patients (18%) complained of difficulty falling asleep only, 8 patients (29%) had difficulty maintaining sleep without difficulty in initial sleep and 15 patients (53%) presented both difficulty falling asleep and difficulty maintaining sleep. Risk factors associated with insomnia were headache and/or dizziness and more symptoms of anxiety and depression rather than GCS. In contrast, GCS was independently associated with the presence of hypersomnia following TBI. Furthermore, there was no evidence of an association between locations of brain injury and the presence of sleep disturbance after TBI. Our data support and contribute to a growing body of evidence which indicates that TBI patients with insomnia are prone to suffer from concomitant headache and/or dizziness, report more symptoms of anxiety and depression and severe TBI patients are likely to experience hypersomnia.PLoS ONE 10/2013; 8(10):e76087. DOI:10.1371/journal.pone.0076087 · 3.53 Impact Factor
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ABSTRACT: Wars in Iraq and Afghanistan have highlighted the problems of diagnosis and treatment of mild traumatic brain injury (mTBI). MTBI is a heterogeneous injury that may lead to the development of neurological and behavioral disorders. In the absence of specific diagnostic markers, mTBI is often unnoticed or misdiagnosed. In this study, mice were induced with increasing levels of mTBI and microRNA (miRNA) changes in the serum were determined. MTBI was induced by varying weight and fall height of the impactor rod resulting in four different severity grades of the mTBI. Injuries were characterized as mild by assessing with the neurobehavioral severity scale-revised (NSS-R) at day 1 post injury. Open field locomotion and acoustic startle response showed behavioral and sensory motor deficits in 3 of the 4 injury groups at day 1 post injury. All of the animals recovered after day 1 with no significant neurobehavioral alteration by day 30 post injury. Serum microRNA (miRNA) profiles clearly differentiated injured from uninjured animals. Overall, the number of miRNAs that were significantly modulated in injured animals over the sham controls increased with the severity of the injury. Thirteen miRNAs were found to identify mTBI regardless of its severity within the mild spectrum of injury. Bioinformatics analyses revealed that the more severe brain injuries were associated with a greater number of miRNAs involved in brain related functions. The evaluation of serum miRNA may help to identify the severity of brain injury and the risk of developing adverse effects after TBI.PLoS ONE 11/2014; 9(11):e112019. DOI:10.1371/journal.pone.0112019 · 3.53 Impact Factor
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ABSTRACT: Abstract Introduction: mTBI has been termed the 'signature injury' of recent conflicts in Afghanistan and Iraq. Most mTBI research uses retrospective accounts of exposure and point of injury symptoms; mTBI is reportedly less common among UK than US Forces. Methods: This study examined the rate of mTBI exposure and symptoms in 1363 UK military personnel deployed in Afghanistan in 2011 using a self-report questionnaire. Data were collected in the operational location during the 5th month of a 6-month deployment. Personnel reported injuries and symptoms related to six events including fragmentation, blast, bullet, fall, motor vehicle accident and 'other' exposure. Results: Eighty (5.9%) reported at least one potential mTBI exposure during the current deployment and 1.6% (n = 22) reported injury and one or more mTBI symptoms (1 year incidence rate = 3.2%). Higher PTSD symptom scores were significantly associated with reporting potential mTBI (p ≤ 0.001) and mTBI with symptoms (p ≤ 0.001). Conclusion: This study used contemporaneous data gathered in the deployed location which are subject to less memory distortion than studies using post-deployment recall. The incidence of mTBI was substantially lower than those reported in both US and UK post-deployment studies which is consistent with inflated reporting of symptoms when measured post-deployment.Brain Injury 06/2014; 28(7):896-9. DOI:10.3109/02699052.2014.888479 · 1.86 Impact Factor