Multisite Investigation of Traumatic Brain Injuries, Posttraumatic Stress Disorder, and Self-reported Health and Cognitive Impairments

Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, 98104, USA.
Archives of general psychiatry (Impact Factor: 14.48). 12/2010; 67(12):1291-300. DOI: 10.1001/archgenpsychiatry.2010.158
Source: PubMed


Few large-scale, multisite investigations have assessed the development of posttraumatic stress disorder (PTSD) symptoms and health outcomes across the spectrum of patients with mild, moderate, and severe traumatic brain injury (TBI).
To understand the risk of developing PTSD symptoms and to assess the impact of PTSD on the development of health and cognitive impairments across the full spectrum of TBI severity.
Multisite US prospective cohort study.
Eighteen level I trauma centers and 51 non-trauma center hospitals.
A total of 3047 (weighted n = 10 372) survivors of multiple traumatic injuries between the ages of 18 and 84 years.
Severity of TBI was categorized from chart-abstracted International Classification of Diseases, Ninth Revision, Clinical Modification codes. Symptoms consistent with a DSM-IV diagnosis of PTSD were assessed with the PTSD Checklist 12 months after injury. Self-reported outcome assessment included the 8 Medical Outcomes Study 36-Item Short Form Health Survey health status domains and a 4-item assessment of cognitive function at telephone interviews 3 and 12 months after injury.
At the time of injury hospitalization, 20.5% of patients had severe TBI, 11.7% moderate TBI, 12.9% mild TBI, and 54.9% no TBI. Patients with severe (relative risk, 0.72; 95% confidence interval, 0.58-0.90) and moderate (0.63; 0.44-0.89) TBI, but not mild TBI (0.83; 0.61-1.13), demonstrated a significantly diminished risk of PTSD symptoms relative to patients without TBI. Across TBI categories, in adjusted analyses patients with PTSD demonstrated an increased risk of health status and cognitive impairments when compared with patients without PTSD.
More severe TBI was associated with a diminished risk of PTSD. Regardless of TBI severity, injured patients with PTSD demonstrated the greatest impairments in self-reported health and cognitive function. Treatment programs for patients with the full spectrum of TBI severity should integrate intervention approaches targeting PTSD.

Download full-text


Available from: Sarah Peregrine Lord, Dec 29, 2014
  • Source
    • "Low and high levels of exposure to violence correspond to 1 SD below and above the mean, respectively levels of both exposure to violence and trauma symptoms. For instance, 14 % endorsed the equivalent of experiencing each of the 25 types of violence at least once (or 8 or more types lots of times), and 10 % met the DSM-IV diagnostic criteria for PTSD (using algorithms described by Zatzick et al. 2010). These rates of exposure to violence and trauma symptoms are very similar to other studies with college students conducted across the US (e.g., Brady 2006; Ruggiero et al. 2003), and suggest that a number of college students have been exposed to high levels of real-life violence and are experiencing significant trauma symptoms that would qualify them for a clinical diagnosis. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Youth are exposed to large amounts of violence in real life and media, which may lead to desensitization. Given evidence of curvilinear associations between exposure to violence and emotional distress, we examined linear and curvilinear associations of exposure to real-life and movie violence with PTSD symptoms, empathy, and physiological arousal, as well emotional and physiological reactivity to movie violence. College students (N = 209; mean age = 18.74) reported on their exposure to real-life and televised violence, PTSD symptoms, and empathy. Then, students were randomly assigned to view a series of violent or nonviolent high-action movie scenes, providing ratings of emotional distress after each clip. Blood pressure was measured at rest and during video viewing. Results showed that with increasing exposure to real-life violence, youth reported more PTSD symptoms and greater identification with fictional characters. Cognitive and emotional empathy increased from low to medium levels of exposure to violence, but declined at higher levels. For males, exposure to higher levels of real-life violence was associated with diminishing (vs. increasing) emotional distress when viewing violent videos. Exposure to televised violence was generally unrelated to emotional functioning. However, those with medium levels of exposure to TV/movie violence experienced lower elevations of blood pressure when viewing violent videos compared to those with low exposure, and those with higher levels of exposure evidenced rapid increase in blood pressure that quickly declined over time. The results point to diminished empathy and reduced emotional reactivity to violence as key aspects of desensitization to real-life violence, and more limited evidence of physiological desensitization to movie violence among those exposed to high levels of televised violence.
    Journal of Youth and Adolescence 10/2014; 44(5). DOI:10.1007/s10964-014-0202-z · 2.72 Impact Factor
  • Source
    • "Post-traumatic stress disorder, a psychiatric condition that arises after exposure to a life threatening experience such as conditions experienced in combat war zone with or without blast exposure as a form of mTBI (75). This, by itself, poses a challenge in the clinical diagnosis in veterans who are exposed to mTBI since the symptoms may overlap between these conditions exacerbated by other comorbid conditions such as drug abuse or other neuropsychiatric complications (75, 76). A Rand Corporation study indicated that ~20% of returning service personnel (~300,000) have had a TBI and that there was substantial overlap of TBI with the occurrence of PTSD (77). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Among the U.S. military personnel, blast injury is among the leading causes of brain injury. During the past decade, it has become apparent that even blast injury as a form of mild traumatic brain injury (mTBI) may lead to multiple different adverse outcomes, such as neuropsychiatric symptoms and long-term cognitive disability. Blast injury is characterized by blast overpressure, blast duration, and blast impulse. While the blast injuries of a victim close to the explosion will be severe, majority of victims are usually at a distance leading to milder form described as mild blast TBI (mbTBI). A major feature of mbTBI is its complex manifestation occurring in concert at different organ levels involving systemic, cerebral, neuronal, and neuropsychiatric responses; some of which are shared with other forms of brain trauma such as acute brain injury and other neuropsychiatric disorders such as post-traumatic stress disorder. The pathophysiology of blast injury exposure involves complex cascades of chronic psychological stress, autonomic dysfunction, and neuro/systemic inflammation. These factors render blast injury as an arduous challenge in terms of diagnosis and treatment as well as identification of sensitive and specific biomarkers distinguishing mTBI from other non-TBI pathologies and from neuropsychiatric disorders with similar symptoms. This is due to the "distinct" but shared and partially identified biochemical pathways and neuro-histopathological changes that might be linked to behavioral deficits observed. Taken together, this article aims to provide an overview of the current status of the cellular and pathological mechanisms involved in blast overpressure injury and argues for the urgent need to identify potential biomarkers that can hint at the different mechanisms involved.
    Frontiers in Neurology 11/2013; 4:186. DOI:10.3389/fneur.2013.00186
  • Source
    • "Amador, 2010; Hoge et al., 2008; Schneiderman, Braver, & Kang, 2008). In addition, when compared with psychological symptoms associated with more severe brain injuries, mTBI might particularly increase the risk for PTSD among trauma survivors because of partial recall for distressing events (Zatzick et al., 2010). As such, clarifying the role of mTBI has been a key priority for researchers and clinicians working with returning veterans. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective: Research has demonstrated that a substantial number of veterans returning from Iraq and Afghanistan with mild traumatic brain injury (mTBI) also contend with symptoms of posttraumatic stress disorder (PTSD). One possible contributing factor for the development and/or exacerbation of PTSD symptoms among individuals with mTBI could involve challenges processing trauma and integrating their memories into existing global meaning systems. The goal of this study was to provide a preliminary examination of whether meaning made of trauma could account for the association between mTBI and PTSD (i.e., reexperiencing, avoidance, and hyperarousal symptoms). Method: The sample was comprised of 162 Iraq and/or Afghanistan veterans who presented for health care services at a Department of Veterans Affairs hospital. These veterans completed a two-level evaluation for mTBI as well as a self-report questionnaire assessing demographic and military background factors, meaning made of trauma, and PTSD symptomatology. Results: Drawing on structural equation modeling, results indicated that probable mTBI was indirectly associated with the three domains of PTSD symptomatology via veterans' meaning made of trauma. Conclusions: Although the cross-sectional nature of this study limits the conclusions that can be drawn, these results offer support for difficulties with meaning-making as a contributing factor for risk of PTSD among veterans with mTBI. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
    Rehabilitation Psychology 07/2013; 58(3). DOI:10.1037/a0033399 · 1.91 Impact Factor
Show more