Factors Influencing Postconcussion and Posttraumatic Stress Symptom Reporting Following Military-Related Concurrent Polytrauma and Traumatic Brain Injury

Abstract

The purpose of this study was to identify factors that are predictive of, or associated with, high endorsement of postconcussion and posttraumatic stress symptoms following military-related traumatic brain injury (TBI). Participants were 1,600 U.S. service members (age: M = 27.1, SD = 7.1; 95.4% male) who had sustained a mild-to-moderate TBI and who had been evaluated by the Defense and Veterans Brain Injury Center at one of six military medical centers. Twenty-two factors were examined that included demographic, injury circumstances/severity, treatment/evaluation, and psychological/physical variables. Four factors were statistically and meaningfully associated with clinically elevated postconcussion symptoms: (i) low bodily injury severity, (ii) posttraumatic stress, (iii) depression, and (iv) military operation where wounded (p < .001, 43.2% variance). The combination of depression and posttraumatic stress symptoms accounted for the vast majority of unique variance (41.5%) and were strongly associated with, and predictive of, clinically elevated postconcussion symptoms [range: odds ratios (OR) = 4.24-7.75; relative risk (RR) = 2.28-2.51]. Five factors were statistically and meaningfully associated with clinically elevated posttraumatic stress symptoms: (i) low bodily injury severity, (ii) depression, (iii) a longer time from injury to evaluation, (iv) military operation where wounded, and (v) current auditory deficits (p < .001; 65.6% variance accounted for). Depression alone accounted for the vast majority of unique variance (60.0%) and was strongly associated with, and predictive of, clinically elevated posttraumatic stress symptoms (OR = 38.78; RR = 4.63). There was a very clear, strong, and clinically meaningful association between depression, posttraumatic stress, and postconcussion symptoms in this sample. Brain injury severity, however, was not associated with symptom reporting following TBI.

Examination of the Mild Brain Injury Atypical Symptom Scale and the Validity-10 Scale to detect symptom exaggeration in US military service members

“…That is, is it possible to genuinely report psychological distress on the NSI without triggering the Validity-10 scale? In order to address this issue, we ran some exploratory analyses on data that we have previously used as part of other studies (e.g., Lange et al, 2014). In a sample of 782 service members who were evaluated at WRNMMC/Walter Reed Army Medical Center for a suspected or confirmed TBI, n = 583 had Validity-10 scores that fell below the cutoff score (i.e., presumed genuine responders).…”

Update on the Epidemiology of Concussion/Mild Traumatic Brain Injury

“…Among combat veterans, post-concussive symptom reporting is paradoxically not associated with brain injury severity per se but does appear to be related to the presence of posttraumatic stress, depression, and the military operation in which the subject was wounded and inversely related to the severity of bodily injury [37]. An overlap between posttraumatic stress symptoms and post-concussive symptoms can add to the challenges in diagnosis since posttraumatic neuropsychiatric symptoms may have been caused by a previously undocumented concussive injury, combat stress, or a combination of both [2].…”

Response to Goal Management Training in Veterans with blast-related mild traumatic brain injury

“…Third, blastrelated mTBI is determined by self-report. Fourth, there is controversy regarding whether cognitive impairments can be attributed to mTBI years after the injury [1,48] or whether cognitive impairments are strictly due to comorbidities such as PTSD and depression. In our work, four subjects had PTSD; considering this controversy, our results for GMT may have produced their effect on symptomatology from the combination of mTBI and comorbidities, or comorbidities alone.…”