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Association between traumatic brain injury and risk of posttraumatic stress disorder in active-duty Marines.
JAMA Psychiatry. 2014 Feb; 71(2):149-57.JP

Abstract

IMPORTANCE

Whether traumatic brain injury (TBI) is a risk factor for posttraumatic stress disorder (PTSD) has been difficult to determine because of the prevalence of comorbid conditions, overlapping symptoms, and cross-sectional samples.

OBJECTIVE

To examine the extent to which self-reported predeployment and deployment-related TBI confers increased risk of PTSD when accounting for combat intensity and predeployment mental health symptoms.

DESIGN, SETTING, AND PARTICIPANTS

As part of the prospective, longitudinal Marine Resiliency Study (June 2008 to May 2012), structured clinical interviews and self-report assessments were administered approximately 1 month before a 7-month deployment to Iraq or Afghanistan and again 3 to 6 months after deployment. The study was conducted at training areas on a Marine Corps base in southern California or at Veterans Affairs San Diego Medical Center. Participants for the final analytic sample were 1648 active-duty Marine and Navy servicemen who completed predeployment and postdeployment assessments. Reasons for exclusions were nondeployment (n = 34), missing data (n = 181), and rank of noncommissioned and commissioned officers (n = 66).

MAIN OUTCOMES AND MEASURES

The primary outcome was the total score on the Clinician-Administered PTSD Scale (CAPS) 3 months after deployment.

RESULTS

At the predeployment assessment, 56.8% of the participants reported prior TBI; at postdeployment assessment, 19.8% reported sustaining TBI between predeployment and postdeployment assessments (ie, deployment-related TBI). Approximately 87.2% of deployment-related TBIs were mild; 250 of 287 participants (87.1%) who reported posttraumatic amnesia reported less than 24 hours of posttraumatic amnesia (37 reported ≥ 24 hours), and 111 of 117 of those who lost consciousness (94.9%) reported less than 30 minutes of unconsciousness. Predeployment CAPS score and combat intensity score raised predicted 3-month postdeployment CAPS scores by factors of 1.02 (P < .001; 95% CI, 1.02-1.02) and 1.02 (P < .001; 95% CI, 1.01-1.02) per unit increase, respectively. Deployment-related mild TBI raised predicted CAPS scores by a factor of 1.23 (P < .001; 95% CI, 1.11-1.36), and moderate/severe TBI raised predicted scores by a factor of 1.71 (P < .001; 95% CI, 1.37-2.12). Probability of PTSD was highest for participants with severe predeployment symptoms, high combat intensity, and deployment-related TBI. Traumatic brain injury doubled or nearly doubled the PTSD rates for participants with less severe predeployment PTSD symptoms.

CONCLUSIONS AND RELEVANCE

Even when accounting for predeployment symptoms, prior TBI, and combat intensity, TBI during the most recent deployment is the strongest predictor of postdeployment PTSD symptoms.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Yurgil KA
Department of Psychiatry, Veterans Affairs San Diego Healthcare System, San Diego, California2Veterans Affairs Center of Excellence for Stress and Mental Health, San Diego, California.
Barkauskas DA
Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles.
Vasterling JJ
Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts 5Division of Behavioral Sciences, Veterans Affairs National Center for Posttraumatic Stress Syndrome, Boston, Massachusetts 6Department of Psychology, Veterans Affairs B.
Nievergelt CM
Department of Psychiatry, Veterans Affairs San Diego Healthcare System, San Diego, California2Veterans Affairs Center of Excellence for Stress and Mental Health, San Diego, California7Department of Psychiatry, School of Medicine, University of California.
Larson GE
Department of Behavioral Science and Epidemiology, Naval Health Research Center, San Diego, California.
Schork NJ
Department of Molecular and Experimental Medicine, Scripps Translational Research Institute, San Diego, California.
Litz BT
Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts 5Division of Behavioral Sciences, Veterans Affairs National Center for Posttraumatic Stress Syndrome, Boston, Massachusetts 6Department of Psychology, Veterans Affairs B.
Nash WP
Boston Veterans Affairs Research Institute, Boston, Massachusetts.
Baker DG
Department of Psychiatry, Veterans Affairs San Diego Healthcare System, San Diego, California2Veterans Affairs Center of Excellence for Stress and Mental Health, San Diego, California7Department of Psychiatry, School of Medicine, University of California.
Marine Resiliency Study Team
No affiliation info available

MeSH

AdultAfghan Campaign 2001-Brain InjuriesCombat DisordersComorbidityHumansIraq War, 2003-2011MaleMilitary PersonnelProspective StudiesPsychiatric Status Rating ScalesResilience, PsychologicalRisk FactorsSeverity of Illness IndexStress Disorders, Post-TraumaticTime FactorsUnited StatesYoung Adult

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

24337530

Citation

Yurgil, Kate A., et al. "Association Between Traumatic Brain Injury and Risk of Posttraumatic Stress Disorder in Active-duty Marines." JAMA Psychiatry, vol. 71, no. 2, 2014, pp. 149-57.
Yurgil KA, Barkauskas DA, Vasterling JJ, et al. Association between traumatic brain injury and risk of posttraumatic stress disorder in active-duty Marines. JAMA Psychiatry. 2014;71(2):149-57.
Yurgil, K. A., Barkauskas, D. A., Vasterling, J. J., Nievergelt, C. M., Larson, G. E., Schork, N. J., Litz, B. T., Nash, W. P., & Baker, D. G. (2014). Association between traumatic brain injury and risk of posttraumatic stress disorder in active-duty Marines. JAMA Psychiatry, 71(2), 149-57. https://doi.org/10.1001/jamapsychiatry.2013.3080
Yurgil KA, et al. Association Between Traumatic Brain Injury and Risk of Posttraumatic Stress Disorder in Active-duty Marines. JAMA Psychiatry. 2014;71(2):149-57. PubMed PMID: 24337530.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association between traumatic brain injury and risk of posttraumatic stress disorder in active-duty Marines. AU - Yurgil,Kate A, AU - Barkauskas,Donald A, AU - Vasterling,Jennifer J, AU - Nievergelt,Caroline M, AU - Larson,Gerald E, AU - Schork,Nicholas J, AU - Litz,Brett T, AU - Nash,William P, AU - Baker,Dewleen G, AU - ,, PY - 2013/12/17/entrez PY - 2013/12/18/pubmed PY - 2014/4/2/medline SP - 149 EP - 57 JF - JAMA psychiatry JO - JAMA Psychiatry VL - 71 IS - 2 N2 - IMPORTANCE: Whether traumatic brain injury (TBI) is a risk factor for posttraumatic stress disorder (PTSD) has been difficult to determine because of the prevalence of comorbid conditions, overlapping symptoms, and cross-sectional samples. OBJECTIVE: To examine the extent to which self-reported predeployment and deployment-related TBI confers increased risk of PTSD when accounting for combat intensity and predeployment mental health symptoms. DESIGN, SETTING, AND PARTICIPANTS: As part of the prospective, longitudinal Marine Resiliency Study (June 2008 to May 2012), structured clinical interviews and self-report assessments were administered approximately 1 month before a 7-month deployment to Iraq or Afghanistan and again 3 to 6 months after deployment. The study was conducted at training areas on a Marine Corps base in southern California or at Veterans Affairs San Diego Medical Center. Participants for the final analytic sample were 1648 active-duty Marine and Navy servicemen who completed predeployment and postdeployment assessments. Reasons for exclusions were nondeployment (n = 34), missing data (n = 181), and rank of noncommissioned and commissioned officers (n = 66). MAIN OUTCOMES AND MEASURES: The primary outcome was the total score on the Clinician-Administered PTSD Scale (CAPS) 3 months after deployment. RESULTS: At the predeployment assessment, 56.8% of the participants reported prior TBI; at postdeployment assessment, 19.8% reported sustaining TBI between predeployment and postdeployment assessments (ie, deployment-related TBI). Approximately 87.2% of deployment-related TBIs were mild; 250 of 287 participants (87.1%) who reported posttraumatic amnesia reported less than 24 hours of posttraumatic amnesia (37 reported ≥ 24 hours), and 111 of 117 of those who lost consciousness (94.9%) reported less than 30 minutes of unconsciousness. Predeployment CAPS score and combat intensity score raised predicted 3-month postdeployment CAPS scores by factors of 1.02 (P < .001; 95% CI, 1.02-1.02) and 1.02 (P < .001; 95% CI, 1.01-1.02) per unit increase, respectively. Deployment-related mild TBI raised predicted CAPS scores by a factor of 1.23 (P < .001; 95% CI, 1.11-1.36), and moderate/severe TBI raised predicted scores by a factor of 1.71 (P < .001; 95% CI, 1.37-2.12). Probability of PTSD was highest for participants with severe predeployment symptoms, high combat intensity, and deployment-related TBI. Traumatic brain injury doubled or nearly doubled the PTSD rates for participants with less severe predeployment PTSD symptoms. CONCLUSIONS AND RELEVANCE: Even when accounting for predeployment symptoms, prior TBI, and combat intensity, TBI during the most recent deployment is the strongest predictor of postdeployment PTSD symptoms. SN - 2168-6238 UR - https://www.unboundmedicine.com/medline/citation/24337530/Association_between_traumatic_brain_injury_and_risk_of_posttraumatic_stress_disorder_in_active_duty_Marines_ DB - PRIME DP - Unbound Medicine ER -