Psychiatric diagnoses among Iraq and Afghanistan War veterans screened for deployment-related traumatic brain injury

Center for Chronic Disease Outcomes Research, VA Medical Center, and Department of Medicine, University of Minnesota Medical School, Minneapolis, MN 55417, USA.
Journal of Traumatic Stress (Impact Factor: 2.72). 02/2010; 23(1):17-24. DOI: 10.1002/jts.20483
Source: PubMed


The authors examined psychiatric diagnoses in administrative records for 13,201 United States military veterans who were screened for traumatic brain injury (TBI) in Department of Veterans Affairs facilities. Over 80% of the veterans with positive TBI screens had psychiatric diagnoses. Compared to veterans with negative TBI screens, those with positive screens, but without confirmed TBI status, were three times more likely to have a posttraumatic stress disorder (PTSD) diagnosis and were two times more likely to have depression and substance-related diagnoses. Among veterans with positive TBI screens, those with clinically confirmed TBI status were more likely than those without confirmed TBI status to have diagnoses for PTSD, anxiety, and adjustment disorders. These findings have implications for health care delivery and provider education.

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    • "The symptoms shared among mild TBI, PTSD and depression include, for example , headache, insomnia, fatigue, irritability, cognitive dysfunction , and chronic pain (Hoge et al. 2008; Iverson 2005), all which can be considered independently existing clinical processes or as components of a complex syndrome (Scholten et al. 2012). These symptoms and conditions also frequently co-occur, which further complicates clinical understanding and may ultimately impede treatment and recovery (Carlson et al. 2010, 2011; Hill et al. 2009; Schneiderman et al. 2008; Vanderploeg et al. 2012; Vanderploeg 2007; Walker et al. 2012). Despite the complex comorbidity of these conditions, the current clinical practice guideline for treatment of mild TBI (concussion) calls for single disease focused treatment and symptom-based management (Management of Concussion/ mTBI Working Group 2009). "
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    ABSTRACT: U. S. veterans of Iraq and Afghanistan are known to have a high prevalence of traumatic brain injury (TBI), posttraumatic stress disorder (PTSD), and depression, which are often comorbid and share many symptoms. Attempts to describe this cohort by single diagnoses have limited our understanding of the complex nature of this population. The objective of this study was to identify subgroups of Iraq and Afghanistan veterans (IAVs) with distinct compositions of symptoms associated with TBI, PTSD, and depression. Our cross-sectional, observational study included 303,716 IAVs who received care in the Veterans Health Administration in 2010-2011. Symptoms and conditions were defined using International Classification of Diseases, Ninth Revision codes and symptom-clusters were identified using latent class analysis. We identified seven classes with distinct symptom compositions. One class had low probability of any condition and low health care utilization (HCU) (48 %). Other classes were characterized by high probabilities of mental health comorbidities (14 %); chronic pain and sleep disturbance (20 %); headaches and memory problems (6 %); and auditory problems (2.5 %). Another class had mental health comorbidities and chronic pain (7 %), and the last had high probabilities of most symptoms examined (3 %). These last two classes had the highest likelihood of TBI, PTSD, and depression and were identified as high healthcare utilizers. There are subgroups of IAVs with distinct clusters of symptom that are meaningfully associated with TBI, PTSD, depression, and HCU. Additional studies examining these veteran subgroups could improve our understanding of this complex comorbid patient population.
    Brain Imaging and Behavior 05/2015; 9(3). DOI:10.1007/s11682-015-9402-8 · 4.60 Impact Factor
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    • "After experiencing mTBI, soldiers typically return to full duty status immediately after clinical signs begin to disappear, but returning prematurely can increase the risk for repeat injury (MacGregor et al., 2011). Previous studies have shown that mTBI patients experience complications associated with post-concussive syndrome (PCS) (Schneiderman et al., 2008; Belanger et al., 2010; Bryant et al., 2010) or post-traumatic stress disorder (PTSD) (Hoge et al., 2008; Carlson et al., 2010; Levin et al., 2010; Carlson et al., 2011). The underlying mechanisms of these symptoms warrants further investigation and has significant clinical implications (Budde et al., 2011). "
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    ABSTRACT: We induced mild blunt and blast injuries in rats using a custom-built device and utilized in-house diffusion tensor imaging (DTI) software to reconstruct 3-D fiber tracts in brains before and after injury (1, 4, and 7 days). DTI measures such as fiber count, fiber length, and fractional anisotropy (FA) were selected to characterize axonal integrity. In-house image analysis software also showed changes in parameters including the area fraction (AF) and nearest neighbor distance (NND), which corresponded to variations in the microstructure of Hematoxylin and Eosin (H&E) brain sections. Both blunt and blast injuries produced lower fiber counts, but neither injury case significantly changed the fiber length. Compared to controls, blunt injury produced a lower FA, which may correspond to an early onset of diffuse axonal injury (DAI). However, blast injury generated a higher FA compared to controls. This increase in FA has been linked previously to various phenomena including edema, neuroplasticity, and even recovery. Subsequent image analysis revealed that both blunt and blast injuries produced a significantly higher AF and significantly lower NND, which correlated to voids formed by the reduced fluid retention within injured axons. In conclusion, DTI can detect subtle pathophysiological changes in axonal fiber structure after mild blunt and blast trauma. Our injury model and DTI method provide a practical basis for studying mild traumatic brain injury (mTBI) in a controllable manner and for tracking injury progression. Knowledge gained from our approach could lead to enhanced mTBI diagnoses, biofidelic constitutive brain models, and specialized pharmaceutical treatments.
    Journal of Biomechanics 11/2014; 47(15):3704-3711. DOI:10.1016/j.jbiomech.2014.09.026 · 2.75 Impact Factor
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    • "Family caregivers were instrumental in advocating for the veteran and reporting troubling symptoms to clinicians to support accurate TBI diagnosis. Although previous literature (Carlson et al., 2010; Olson-Madden et al., 2010) confirms the challenges of diagnosing TBI in veterans, no studies were found that considered the role of family caregivers in providing information to assist with the diagnosis of TBI in this population. Given that some of our study participants identified that their loved ones attempted to hide their symptoms during clinic visits , it may be important for clinicians to provide family caregivers a greater voice in the evaluation and care of veterans with TBI. "
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    ABSTRACT: To describe the experience of family caregivers providing care to veterans with traumatic brain injury (TBI). Using a qualitative design, interviews were conducted with a purposeful sample of women caregivers. Data were analyzed using content analysis procedures. Findings resulted in the key concept phrased by participants as "He looks normal but." This phrase conceptualizes the participants' description of their experience caring for a brain injured veteran who could appear normal to others but the caregiver's description revealed substantial cognitive, social, and emotional deficits. Concepts include (a) Becoming aware of his disabilities, (b) Observing his troubling symptoms, (c) Dealing with his memory loss, (d) Being fearful of his anger, (e) Sensing his loneliness, (f) Acknowledging the effects on the children, and (g) Managing the best I can. A better understanding of the needs of caregivers of veterans with TBI may allow clinicians to better support caregivers. © 2014 Association of Rehabilitation Nurses.
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