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.

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    • "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).
    Full-text · Article · Aug 2015 · Rehabilitation Psychology
    • "Removal of PCS items that overlap with PTSD symptoms had little effect on the reported relationships, indicating that the contribution of PTSD is not simply due to the overlapping symptoms of the two clinical syndromes. The observation that Blast mTBI and PTSD each contribute to the report of chronic PCS is consistent with prior MDD major depressive disorder, mTBI mild traumatic brain injury, PCS post-concussive symptoms, PTSD post-traumatic stress disorder *8 post-concussive symptoms were included: sensitivity to noise, sensitivity to light, balance problems, headaches, tinnitus, sleep problems, memory problems, and irritability †5 post-concussive symptoms were included: sensitivity to noise, sensitivity to light, balance problems, headaches, and tinnitus research (Brenner et al. 2010), though some investigations have suggested that mTBI is no longer associated with higher PCS after accounting for the effect of PTSD (Hoge et al. 2008; Polusny et al. 2011; Schneiderman et al. 2008 ). Most investigations of this relationship have characterized PTSD and mTBI through self-report questionnaires either with minimal in-person interview-based verification (Polusny et al. 2011) or with interview verification of only one of the conditions (Clarke et al. 2012; Larson et al. 2013; Wood et al. 2014). "
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    ABSTRACT: Mild traumatic brain injury (mTBI) is common among recent veterans and often is associated with chronic post-concussive symptoms (PCS). Elevated PCS may also be a consequence of post-traumatic stress disorder (PTSD) which shares symptoms with PCS. Identification of personality, biological, and psychopathology factors that contribute to the relationship between mTBI and PCS could help isolate the sources of chronic post concussive syndrome in veterans. Clinician rated diagnoses (PTSD, Major Depression, Alcohol Dependence), personality characteristics (Multidimensional Personality Questionnaire [MPQ] subscales), white matter brain imaging measures (Mean Diffusivity, Generalized Fractional Anisotropy), and diagnoses of mTBI were collected from 125 American military veterans of Iraq or Afghanistan. Linear and logistic regression models were tested to determine contributions to PCS and whether there were similar contributors to PTSD and mTBI. PCS score was associated with personality characteristics of high Stress Reaction and Traditionalism and low Control as well as mTBI. A diagnosis of PTSD was associated with low Social Closeness, PCS, Alcohol Dependence, and abnormal white matter mean diffusivity. Diagnosis of mTBI was associated with fewer white matter mean diffusivity abnormalities, PCS, and number of deployments. As commonly observed clinically, both PTSD and mTBI were associated with higher rates of PCS, though the contribution of PTSD appears to be secondary to personality traits, particularly Stress Reaction. Furthermore, the observation of factors that are uniquely associated with Blast mTBI (number of deployments) or with PTSD (Lifetime Alcohol Dependence and low Social Closeness), as well as a factor (region of abnormal MD) that had opposite effects on the likelihood of each diagnosis, indicates that the complex relationships between personality, psychopathology, and nature of mTBI need to be considered when interpreting chronic post-concussive symptoms.
    No preview · Article · Mar 2015 · Brain Imaging and Behavior
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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.
    Full-text · Article · Jan 2014 · Social Issues and Policy Review
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