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Mild traumatic brain injury (concussion), posttraumatic stress disorder, and depression in U.S. soldiers involved in combat deployments: association with postdeployment symptoms.
Psychosom Med. 2012 Apr; 74(3):249-57.PM

Abstract

OBJECTIVES

Several studies have examined the relationship between concussion/mild traumatic brain injury (mTBI), posttraumatic stress disorder (PTSD), depression, and postdeployment symptoms. These studies indicate that the multiple factors involved in postdeployment symptoms are not accounted for in the screening processes of the Department of Defense/Veteran's Affairs months after concussion injuries. This study examined the associations of single and multiple deployment-related mTBIs on postdeployment health.

METHODS

A total of 1502 U.S. Army soldiers were administered anonymous surveys 4 to 6 months after returning from deployment to Iraq or Afghanistan assessing history of deployment-related concussions, current PTSD, depression, and presence of postdeployment physical and neurocognitive symptoms.

RESULTS

Of these soldiers, 17% reported an mTBI during their previous deployment. Of these, 59% reported having more than one. After adjustment for PTSD, depression, and other factors, loss of consciousness was significantly associated with three postconcussive symptoms, including headaches (odds ratio [OR] = 1.5, 95% confidence interval [CI] = 1.1-2.3). However, these symptoms were more strongly associated with PTSD and depression than with a history of mTBI. Multiple mTBIs with loss of consciousness increased the risk of headache (OR = 4.0, 95% CI = 2.4-6.8) compared with a single occurrence, although depression (OR = 4.2, 95% CI = 2.6-6.8) remained as strong a predictor.

CONCLUSIONS

These data indicate that current screening tools for mTBI being used by the Department of Defense/Veteran's Affairs do not optimally distinguish persistent postdeployment symptoms attributed to mTBI from other causes such as PTSD and depression. Accumulating evidence strongly supports the need for multidisciplinary collaborative care models of treatment in primary care to collectively address the full spectrum of postwar physical and neurocognitive health concerns.

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Authors+Show Affiliations

Wilk JE
Division of Psychiatry and Neuroscience, Walter Reed Army Institute of Research, U.S. Army Medical Research and Materiel Command, Silver Spring, Maryland 20910, USA. joshua.wilk@amedd.army.mil
Herrell RK
No affiliation info available
Wynn GH
No affiliation info available
Riviere LA
No affiliation info available
Hoge CW
No affiliation info available

MeSH

AdultAfghan Campaign 2001-Brain ConcussionBrain InjuriesCombat DisordersData CollectionDepressive Disorder, MajorFemaleHeadacheHumansIraq War, 2003-2011Logistic ModelsMaleMass ScreeningMilitary PersonnelPainPost-Concussion SyndromeRisk FactorsStress Disorders, Post-TraumaticUnited States

Pub Type(s)

Journal Article

Language

eng

PubMed ID

22366583

Citation

Wilk, Joshua E., et al. "Mild Traumatic Brain Injury (concussion), Posttraumatic Stress Disorder, and Depression in U.S. Soldiers Involved in Combat Deployments: Association With Postdeployment Symptoms." Psychosomatic Medicine, vol. 74, no. 3, 2012, pp. 249-57.
Wilk JE, Herrell RK, Wynn GH, et al. Mild traumatic brain injury (concussion), posttraumatic stress disorder, and depression in U.S. soldiers involved in combat deployments: association with postdeployment symptoms. Psychosom Med. 2012;74(3):249-57.
Wilk, J. E., Herrell, R. K., Wynn, G. H., Riviere, L. A., & Hoge, C. W. (2012). Mild traumatic brain injury (concussion), posttraumatic stress disorder, and depression in U.S. soldiers involved in combat deployments: association with postdeployment symptoms. Psychosomatic Medicine, 74(3), 249-57. https://doi.org/10.1097/PSY.0b013e318244c604
Wilk JE, et al. Mild Traumatic Brain Injury (concussion), Posttraumatic Stress Disorder, and Depression in U.S. Soldiers Involved in Combat Deployments: Association With Postdeployment Symptoms. Psychosom Med. 2012;74(3):249-57. PubMed PMID: 22366583.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Mild traumatic brain injury (concussion), posttraumatic stress disorder, and depression in U.S. soldiers involved in combat deployments: association with postdeployment symptoms. AU - Wilk,Joshua E, AU - Herrell,Richard K, AU - Wynn,Gary H, AU - Riviere,Lyndon A, AU - Hoge,Charles W, Y1 - 2012/02/24/ PY - 2012/2/28/entrez PY - 2012/3/1/pubmed PY - 2012/7/18/medline SP - 249 EP - 57 JF - Psychosomatic medicine JO - Psychosom Med VL - 74 IS - 3 N2 - OBJECTIVES: Several studies have examined the relationship between concussion/mild traumatic brain injury (mTBI), posttraumatic stress disorder (PTSD), depression, and postdeployment symptoms. These studies indicate that the multiple factors involved in postdeployment symptoms are not accounted for in the screening processes of the Department of Defense/Veteran's Affairs months after concussion injuries. This study examined the associations of single and multiple deployment-related mTBIs on postdeployment health. METHODS: A total of 1502 U.S. Army soldiers were administered anonymous surveys 4 to 6 months after returning from deployment to Iraq or Afghanistan assessing history of deployment-related concussions, current PTSD, depression, and presence of postdeployment physical and neurocognitive symptoms. RESULTS: Of these soldiers, 17% reported an mTBI during their previous deployment. Of these, 59% reported having more than one. After adjustment for PTSD, depression, and other factors, loss of consciousness was significantly associated with three postconcussive symptoms, including headaches (odds ratio [OR] = 1.5, 95% confidence interval [CI] = 1.1-2.3). However, these symptoms were more strongly associated with PTSD and depression than with a history of mTBI. Multiple mTBIs with loss of consciousness increased the risk of headache (OR = 4.0, 95% CI = 2.4-6.8) compared with a single occurrence, although depression (OR = 4.2, 95% CI = 2.6-6.8) remained as strong a predictor. CONCLUSIONS: These data indicate that current screening tools for mTBI being used by the Department of Defense/Veteran's Affairs do not optimally distinguish persistent postdeployment symptoms attributed to mTBI from other causes such as PTSD and depression. Accumulating evidence strongly supports the need for multidisciplinary collaborative care models of treatment in primary care to collectively address the full spectrum of postwar physical and neurocognitive health concerns. SN - 1534-7796 UR - https://www.unboundmedicine.com/medline/citation/22366583/Mild_traumatic_brain_injury__concussion__posttraumatic_stress_disorder_and_depression_in_U_S__soldiers_involved_in_combat_deployments:_association_with_postdeployment_symptoms_ L2 - https://doi.org/10.1097/PSY.0b013e318244c604 DB - PRIME DP - Unbound Medicine ER -