Posttraumatic Stress Disorder Mediates the Relationship Between Mild Traumatic Brain Injury and Health and Psychosocial Functioning in Veterans of Operations Enduring Freedom and Iraqi Freedom

Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
The Journal of nervous and mental disease (Impact Factor: 1.69). 10/2009; 197(10):748-53. DOI: 10.1097/NMD.0b013e3181b97a75
Source: PubMed


This study evaluated whether posttraumatic stress disorder (PTSD) mediated the relationship between mild traumatic brain injury (MTBI) and general health ratings, psychosocial functioning, and perceived barriers to receiving mental healthcare 2 years following return from deployment in veterans of Operations Enduring Freedom and Iraqi Freedom (OEF/OIF). A total of 277 OEF/OIF veterans completed the Connecticut OEF/OIF Veterans Needs Assessment Survey; 18.8% of the sample screened positive for MTBI. Compared with respondents who screened negative for MTBI, respondents who screened positive for MTBI were younger, more likely to have PTSD, more likely to report fair/poor overall health and unmet medical and psychological needs, and scored higher on measures of psychosocial difficulties and perceived barriers to mental healthcare. Injuries involving loss of consciousness were associated with greater work-related difficulties and unmet psychological needs. PTSD mediated the relationship between MTBI and all of these outcomes. These results underscore the importance of assessing PTSD in OEF/OIF veterans who screen positive for MTBI.

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    • "Approximately 2.4 million United States military personnel have been deployed to Iraq and Afghanistan since September 11, 2001. Military deployment and combat has historically shown to result in medical [1] [2] [3] [4], psychological [5] [6] [7] [8], and social problems [9] [10] [11] [12] [13], all of which affect veterans' post-deployment health across the life course [13] [14] [15] [16]. "
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    ABSTRACT: OBJECTIVE To describe returning veterans’ transition experience from military to civilian life and to educate health care providers about culture-centered communication that promotes readjustment to civilian life. METHODS Qualitative, in-depth, semi-structured interviews with 17 male and 14 female Iraq and Afghanistan veterans were audio recorded, transcribed verbatim, and analyzed using Grounded Practical Theory. RESULTS Veterans described disorientation when returning to civilian life after deployment. Veterans’ experiences resulted from an underlying tension between military and civilian identities consistent with reverse culture shock. Participants described challenges and strategies for managing readjustment stress across three domains: intrapersonal, professional/educational, and interpersonal. CONCLUSIONS To provide patient-centered care to returning Iraq and Afghanistan veterans, health care providers must be attuned to medical, psychological, and social challenges of the readjustment experience, including reverse culture shock. Culture-centered communication may help veterans integrate positive aspects of military and civilian identities, which may promote full reintegration into civilian life. PRACTICE IMPLICATIONS Health care providers may promote culture-centered interactions by asking veterans to reflect about their readjustment experiences. By actively eliciting challenges and helping veterans’ to identify possible solutions, health care providers may help veterans integrate military and civilian identities through an increased therapeutic alliance and social support throughout the readjustment process.
    Patient Education and Counseling 06/2014; 95(3). DOI:10.1016/j.pec.2014.03.016 · 2.20 Impact Factor
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    • "Concussed SMs reported an increase in concussion-related symptoms from the baseline which persisted over time and had not resolved by the second post-deployment assessment. These results are also consistent with studies which have reported that symptoms are present six months or longer following deployment in SMs with mTBI [29]-[32] and/or emerge over time following deployment [33], [35], [36]. One study has reported that symptoms associated with self-reported mTBI were present one year post-deployment [34]. "
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    ABSTRACT: Computerized neurocognitive testing (NCAT) has been proposed to be useful as a screening tool for post-deployment cognitive deficits in the setting of mild traumatic brain injury (mTBI). We assessed the clinical utility of post-injury/post-deployment Automated Neurocognitive Assessment Metric (ANAM) testing, using a longitudinal design to compare baseline ANAM tests with two post-deployment ANAM tests in a group of Marines who experienced combat during deployment. Post-deployment cognitive performance and symptom recovery were compared in a subsample of 1324 U.S. Marines with high rates of combat exposure during deployment. Of the sample, 169 Marines had available baseline and twice repeated post-deployment ANAM results. A retrospective analysis of the ANAM data, which consisted of a self-report questionnaire about deployment-related blast exposure, recent history of mTBI, current clinical symptoms, and cognitive performance. Self-reported concussion sustained anytime during deployment was associated with a decrease in cognitive performance measured between 2-8 weeks post-deployment. At the second post-deployment test conducted on average eight months later, performance on the second simple reaction time test, in particular, remained impaired and was the most consistent and sensitive indicator of the cognitive decrements. Additionally, post-concussive symptoms were shown to persist in injured Marines with a self-reported history of concussion for an additional five months after most cognitive deficits resolved. Results of this study showed a measurable deployment effect on cognitive performance, although this effect appears to resolve without lasting clinical sequelae in those without history of deployment-related concussion. These results highlight the need for a detailed clinical examination for service members with history of concussion and persistent clinical symptoms. Reliance solely upon computerized neurocognitive testing as a method for identifying service members requiring clinical follow-up post-concussion is not recommended, as cognitive functioning only slowly returned to baseline levels in the setting of persistent clinical symptoms.
    PLoS ONE 11/2013; 8(11):e79595. DOI:10.1371/journal.pone.0079595 · 3.23 Impact Factor
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    • "Therefore, this pilot project describes HCU in a sample of OEF/OIF veterans with closed TBI who use VA primary care services and received care for closed TBI. Informed by previous research (Homaifar et al., 2009; Pietrzak et al., 2009; Taylor et al., 2012), we hypothesized that OEF/OIF veterans with a history of closed TBI would have higher rates of service utilization than those without TBI, and that PTSD diagnosis would have an additive effect on rates and likelihood of HCU. "
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    ABSTRACT: Traumatic brain injury (TBI) is a prevalent and costly condition among U.S. veterans. We used a case-controlled review of Veterans Affairs (VA) administrative data to describe outpatient health care utilization (HCU) in a sample of 780 veterans with history of closed TBI and an equivalent number of controls. Results suggest higher rates of HCU in veterans with TBI, plus an additive effect of TBI and post-traumatic stress disorder (PTSD) in behavioral health utilization. Veterans with TBI history and current PTSD used many times more behavioral health appointments than veterans with TBI alone, and about 1.5 times as many behavioral health appointments as veterans with PTSD alone.
    05/2013; 1:74-80. DOI:10.1080/21635781.2012.759168
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