Article

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). 01/2010; 23(1):17-24. DOI: 10.1002/jts.20483
Source: PubMed

ABSTRACT 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.

Download full-text

Full-text

Available from: Nina A Sayer, Jun 30, 2015
0 Followers
 · 
67 Views
  • Source
    [Show abstract] [Hide abstract]
    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; DOI:10.1007/s11682-015-9402-8 · 3.39 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    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.
    Rehabilitation nursing: the official journal of the Association of Rehabilitation Nurses 11/2014; DOI:10.1002/rnj.182 · 0.85 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Depression is very common throughout the course of veterans' lives, and dementia is common in late life. Previous studies suggest an association between depression and dementia in military veterans. The most likely biologic mechanisms that may link depression and dementia among military veterans include vascular disease, changes in glucocorticoid steroids and hippocampal atrophy, deposition of β-amyloid plaques, inflammatory changes, and alterations of nerve growth factors. In addition, military veterans often have depression comorbid with posttraumatic stress disorder or traumatic brain injury. Therefore, in military veterans, these hypothesized biologic pathways going from depression to dementia are more than likely influenced by trauma-related processes. Treatment strategies for depression, posttraumatic stress disorder, or traumatic brain injury could alter these pathways and as a result decrease the risk for dementia. Given the projected increase of dementia, as well as the projected increase in the older segment of the veteran population, in the future, it is critically important that we understand whether treatment for depression alone or combined with other regimens improves cognition. In this review, we summarize the principal mechanisms of this relationship and discuss treatment implications in military veterans.
    Alzheimer's and Dementia 06/2014; 10(3):S166–S173. DOI:10.1016/j.jalz.2014.04.007 · 17.47 Impact Factor