Traumatic Brain Injury, Posttraumatic Stress Disorder, and Postconcussive Symptom Reporting Among Troops Returning From Iraq

VA VISN 19 Mental Illness Research Education and Clinical Center, Denver, Colorado, USA.
The Journal of head trauma rehabilitation (Impact Factor: 2.92). 11/2009; 25(5):307-12. DOI: 10.1097/HTR.0b013e3181cada03
Source: PubMed


Analyze the contribution of mild traumatic brain injury (mTBI) and/or posttraumatic stress disorder (PTSD) to the endorsement of postconcussive (PC) symptoms during Post Deployment Health Assessment. Determine whether a combination of mTBI and PTSD was more strongly associated with symptoms than either condition alone.
Cross-sectional study design where both the exposure, mTBI and/or PTSD, and the outcomes of interest, PC symptoms, were ascertained after return from deployment. Subjects were injured soldiers (n = 1247) from one Fort Carson Brigade Combat Team (n = 3973).
Positive history of PC symptoms.
PTSD and mTBI together were more strongly associated with having PC symptoms (adjusted prevalence ratio 6.27; 95% CI: 4.13-9.43) than either mTBI alone (adjusted prevalence ratio = 4.03; 95% CI: 2.67-6.07) or PTSD alone (adjusted prevalence ratio = 2.74; 95% CI: 1.58-4.74) after adjusting for age, gender, education, rank, and Military Occupational Specialty.
In soldiers with histories of physical injury, mTBI and PTSD were independently associated with PC symptom reporting. Those with both conditions were at greater risk for PC symptoms than those with either PTSD, mTBI, or neither. Findings support the importance of continued screening for both conditions with the aim of early identification and intervention.


Available from: Karen Schwab
    • "It is important to note that depression and PTSD share several overlapping symptoms and often co-occur among Iraq/Afghanistan veterans. A diagnosis of PTSD and/or depression among these war veterans is associated with functional difficulties including occupational and social impairment, physical health problems, and substance use (Brenner et al., 2010; Hoge et al., 2004; Thomas et al., 2010). These disorders are further complicated by co-occurring traumatic brain injuries (TBIs) commonly incurred through blast exposures . "
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    ABSTRACT: We examined the prospective influence of the resilient, undercontrolled, and overcontrolled personality prototypes on depression and posttraumatic stress disorder (PTSD) symptoms among Iraq/Afghanistan war veterans. After accounting for the possible influence of combat exposure, we expected that the resilient prototype would predict lower depression and PTSD over time and would be associated with adaptive coping strategies, higher social support, lower psychological inflexibility, and higher self-reported resilience relative to overcontrolled and undercontrolled prototypes, independent of traumatic brain injury (TBI) status. One hundred twenty-seven veterans (107 men, 20 women; average age = 37) participated in the study. Personality was assessed at baseline, and PTSD and depression symptoms were assessed 8 months later. Path analysis was used to test the direct and indirect effects of personality on distress. No direct effects were observed from personality to distress. The resilient prototype did have significant indirect effects on PTSD and depression through its beneficial effects on social support, coping and psychological inflexibility. TBI also had direct effects on PTSD. A resilient personality prototype appears to influence veteran adjustment through its positive associations with greater social support and psychological flexibility, and lower use of avoidant coping. Low social support, avoidant coping, and psychological inflexibility are related to overcontrolled and undercontrolled personality prototypes, and these behaviors seem to characterize veterans who experience problems with depression and PTSD over time. A positive TBI status is directly and prospectively associated with PTSD symptomology independent of personality prototype. Implications for clinical interventions and future research are discussed. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
    Rehabilitation Psychology 08/2015; 60:263-276. DOI:10.1037/rep0000050 · 1.91 Impact Factor
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    • "Similarly, in a longitudinal survey of 953 National Guard soldiers who had deployed to Iraq, mild TBI history did not predict other outcomes, after accounting for PTSD (Polusny et al., 2011). In contrast, other investigators have found that PTSD alone does not fully account for cognitive, affective, and physical symptoms in combat veterans who also have TBI (Brenner et al., 2010; Schneiderman et al., 2008; Vanderploeg, Belanger, & Curtiss, 2009). Vanderploeg and colleagues (2012) argued that it is not surprising that controlling for PTSD and depression minimizes the association between TBI and postconcussive symptoms , given that PTSD, depression, and postconcussive symptoms are all health outcomes with symptom overlap. "
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    ABSTRACT: Although the majority of combat veterans reintegrate into civilian life without long-lasting problems, a sizable minority return from deployment with psychiatric or physical injuries that warrant medical attention. Even in the absence of diagnosable disorders, many experience functional problems that impede full reintegration into civilian life. Considerable resources have been allocated to studying, diagnosing, treating, and compensating combat-related disorders. This important work has resulted in significant improvements in healthcare for those with deployment-related difficulties. Nevertheless, many service members and veterans with reintegration difficulty may not receive needed help. Based on our review, we argue that in addition to treatment and compensation for diagnosable postdeployment problems, a comprehensive approach to reintegration is needed that includes partnership between the government, private sector, and the public.
    Social Issues and Policy Review 01/2014; 8(1). DOI:10.1111/sipr.12001
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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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