Deployment-related TBI, persistent postconcussive symptoms, PTSD, and depression in OEF/OIF veterans

Department of Veterans Affairs VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, Texas, USA.
Rehabilitation Psychology (Impact Factor: 1.91). 11/2011; 56(4):340-50. DOI: 10.1037/a0025462
Source: PubMed


A substantial proportion of the more than 2 million service members who have served in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) have experienced a traumatic brain injury (TBI). Understanding the long-term impact of TBI is complicated by the nonspecific nature of postconcussive symptoms (PCSs) and the high rates of co-occurrence among TBI, posttraumatic stress disorder (PTSD), and depression. The goal of the present research was to examine the relations among TBI, persistent PCSs, and symptoms of PTSD and depression among returning OEF/OIF veterans.
213 OEF/OIF veterans (87% male) completed a semistructured screening interview assessing deployment-related TBI and current, persistent PCSs. Participants also completed self-report measures of combat exposure and current symptoms of PTSD and depression.
Nearly half (46%) of sampled veterans screened positive for TBI, the majority of whom (85%) reported at least one persistent PCS after removing PCSs that overlapped with PTSD and depression. Veterans with deployment-related TBI reported higher levels of combat exposure and symptoms of PTSD and depression. Structural equation modeling was used to assess the fit of 3 models of the relationships among TBI, combat exposure, persistent PCSs, PTSD, and depression. Consistent with hypotheses, the best-fitting model was one in which the effects of TBI on both PTSD and depression were fully mediated by nonoverlapping persistent PCSs.
These findings highlight the importance of addressing persistent PCSs in order to facilitate the functional recovery of returning war veterans.

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Available from: Sara L Dolan, Apr 11, 2014
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    • "Restricted maximum likelihood estimation was used to account for missing data on the outcome variables. Analyses were conducted two ways: (a) using the NSI, CAPS, and HAM-D in their entirety; and (b) using the CAPS and HAM-D in their entirety, but removing the irritability, depression, and sleep items from the NSI to reduce symptom overlap with the CAPS and HAM-D (Morissette et al., 2011; .91 in the current analysis). Table 1 "
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    ABSTRACT: To investigate the influence of posttraumatic stress disorder (PTSD) diagnosis, and PTSD and depression severity, on the postconcussive symptom trajectory over the course of a 1-year study period. Secondary analysis of a randomized controlled trial comparing veterans who received supported employment combined with compensatory cognitive training to those who received supported employment only. Assessments were conducted at baseline, 3- (postintervention), 6-, and 12-months. Participants were 50 Operation Enduring and Iraqi Freedom (OEF/OIF) veterans with a history of mild to moderate traumatic brain injury (TBI) who were unemployed, seeking work, and who had neuropsychological impairment. Of all participants, 74% met diagnostic criteria for PTSD. All participants received supported employment and half of the sample also received Cognitive Symptom Management and Rehabilitation Therapy (CogSMART), a 12-session, manualized compensatory cognitive training intervention. Veterans with PTSD and greater depression severity endorsed significantly more severe postconcussive symptomatology at all assessment time points. However, the rate of CogSMART-associated improvement in postconcussive symptoms did not differ as a result of psychiatric symptomatology. Study results suggest that for veterans with a history of mild to moderate TBI, presence of comorbid PTSD or depressive symptoms should not preclude participation in cognitive rehabilitation interventions. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
    Rehabilitation Psychology 07/2015; 60(3). DOI:10.1037/rep0000049 · 1.91 Impact Factor
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    • "Despite these assessment limitations, it is clear that veterans returning from recent wars are presenting with high rates of this comorbidity. Although research has clearly demonstrated higher rates of PTSD diagnoses in veterans with deployment-related TBI compared to veterans without TBI (Carlson et al., 2010, 2011; Hoge et al., 2008; Morissette et al., 2011; Walker, Clark, & Sanders, 2010), researchers are just beginning to understand the differential clinical presentation of PTSD with and without TBI, as few studies to date have directly compared these discrete populations. What is known, however , is that both groups report comparable levels of suicide risk as measured by suicidal ideation, hopelessness, pain, emotional support , marital and employment status, and other axis I disorders (Barnes, Walter, & Chard, 2012), as well as comparable psychosocial outcomes (e.g., self-report of social adjustment, somatic symptoms, and quality of life; Polusny et al., 2011). "
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    ABSTRACT: Veterans of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) are presenting with high rates of co-occurring posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI). The purpose of this study was to compare the clinical presentations of combat-veterans with PTSD and TBI (N=40) to those with PTSD only (N=56). Results suggest that the groups present two distinct clinical profiles, with the PTSD+TBI group endorsing significantly higher PTSD scores, higher overall anxiety, and more functional limitations. The higher PTSD scores found for the PTSD+TBI group appeared to be due to higher symptom intensity, but not higher frequency, across PTSD clusters and symptoms. Groups did not differ on additional psychopathology or self-report of PTSD symptoms or executive functioning. Further analysis indicated PTSD severity, and not TBI, was responsible for group differences, suggesting that treatments implicated for PTSD would likely be effective for this population.
    Journal of anxiety disorders 04/2013; 27(4). DOI:10.1016/j.janxdis.2013.04.003 · 2.68 Impact Factor
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    • "Perhaps no single psychiatric co-morbidity has received more attention than PTSD in military and veteran populations . A vast research base over more than a decade has explored the co-occurrence of blast injury (including TBI), persistent PCS reports, and PTSD (e.g., Brenner et al., 2010; Carlson et al., 2011; Morisette et al., 2011; Tanielian & Jaycox, 2008), and there is ample reason to believe that the experience of wartime trauma and brain injury to a degree separates military and veteran samples from trends observed in civilian-based studies. Many authors (e.g., Summerall & McAllister, 2010) cite difficulties in estimating rates of TBI, PCS, and PTSD co-occurrence due to notable overlap in diagnostic criteria symptom reports as well as the fact that onset of PTSD symptoms may predate, coincide, or develop after TBI, or develop from entirely separate traumatic experiences. "
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    ABSTRACT: Traumatic brain injury (TBI) is a frequent occurrence in the United States, and has been given particular attention in the veteran population. Recent accounts have estimated TBI incidence rates as high as 20 % among US veterans who served in Afghanistan or Iraq, and many of these veterans experience a host of co-morbid concerns, including psychiatric complaints (such as depression and post-traumatic stress disorder), sleep disturbance, and substance abuse which may warrant referral to behavioral health specialists working in primary care settings. This paper reviews many common behavioral health concerns co-morbid with TBI, and suggests areas in which behavioral health specialists may assess, intervene, and help to facilitate holistic patient care beyond the acute phase of injury. The primary focus is on sequelae common to mild and moderate TBI which may more readily present in primary care clinics.
    Journal of Clinical Psychology in Medical Settings 11/2012; 19(4). DOI:10.1007/s10880-012-9345-9 · 1.49 Impact Factor
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