Impact of PTSD on post-concussive symptoms, neuropsychological functioning, and pain in post-9/11 veterans with mild traumatic brain injury

Aase, Darrin M.; Babione, Joseph M.; Proescher, Eric; Greenstein, Justin E.; DiGangi, Julia A.; Schroth, Christopher; Kennedy, Amy E.; Feeley, Stacey; Tan, Michelle; Coghill, David; Phan, K. Luan

doi:10.1016/j.psychres.2018.08.019

Cited by 25 publications

(8 citation statements)

References 37 publications

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“…Intriguingly, the rank order paralleled the PTSD severity level in each respective group, evoking Belanger et al’s (2009) conclusion of emotional distress most strongly relating to greater symptom reporting. As a matter of fact, the literature frequently cites that veterans with both mTBI and PTSD report greater subjective difficulties in physical, cognitive, and emotional functioning (Aase et al, 2018; Brenner et al, 2010; Donnelly et al, 2018; Hoge et al, 2008; Merritt et al, 2019). It could also be said that blast-induced mTBI is an extremely traumatic event that brings forth higher severity of PTSD symptoms and self-perceived cognitive and emotional difficulties.…”

Section: Discussionmentioning

confidence: 99%

Examining posttraumatic stress disorder as a key postinjury risk factor in OIF/OEF veterans with blast-induced mild traumatic brain injury.

Kim¹,

Lee

Martin

et al. 2020

Neuropsychology

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Objective: To explore the neuropsychological sequelae of blast-induced mild traumatic brain injury (mTBI) and posttraumatic stress disorder (PTSD), several neuropsychological tests and self-reported measures of cognitive and emotional functioning were administered to 138 Operation Iraqi Freedom (OIF)/Operation Enduring Freedom (OEF) veterans. We hypothesized that veterans affected by mTBI and PTSD would manifest differences in neuropsychological testing and self-report measures compared to a group of healthy veteran controls and to veterans with only PTSD. Method: Participants included 3 groups of veterans: (a) healthy controls (n ϭ 43); (b) PTSD only (n ϭ 48); and (c) comorbid blast-induced mTBI and PTSD (n ϭ 47). An exploratory factor analysis (EFA) was used to extract a smaller number of latent dimensions for group comparison. Results: The EFA supported an 8-factor model. A multivariate analysis of variance on the 8 factor scores demonstrated 3 significant factor mean differences: (a) perceived cognitive complications (PCC), (b) perceived emotional distress (PED), and (c) processing speed (PS). Post hoc analyses showed significant group mean difference in PS between the comorbid and the control groups. In addition, the comorbid group presented with the highest levels of PCC and PED. Conclusions: Results suggest that among OIF/OEF veterans with blast-induced mTBI, PTSD with its accompanying emotional distress may be a significant determinant of subjective sense of well-being both cognitively and emotionally. The objective discrepancy in PS between the comorbid group and the healthy controls also appears largely due to PTSD more so than the remote blast-induced mTBI, as the group mean difference in PS became negligible after controlling for PTSD levels.

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Section: Discussionmentioning

confidence: 99%

Examining posttraumatic stress disorder as a key postinjury risk factor in OIF/OEF veterans with blast-induced mild traumatic brain injury.

Kim¹,

Lee

Martin

et al. 2020

Neuropsychology

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“…Eight manuscripts (16.67%) assessed combat or military types of trauma. Among these manuscripts, six included pain catastrophizing orientation (Aase et al, 2018; Alschuler & Otis, 2012; Ciccone & Kline, 2012; Outcalt et al, 2014; Tsur, Defrin, & Ginzburg, 2017; Tsur, Defrin, et al, 2018), three included AS-physical orientation (Raines, Capron, et al, 2017; Raines, Walton, et al, 2017; Tsur, Defrin, et al, 2018), one included fear of pain orientation (Tsur, Defrin, & Ginzburg, 2017), and no manuscripts included body vigilance orientation.…”

Section: Methodsmentioning

confidence: 99%

“…Three manuscripts (6.25% of manuscripts) assessed injury or brain injury type of trauma type. Two manuscripts included pain catastrophizing (Aase et al, 2018; Giummarra et al, 2017), and another manuscript included AS-physical (Zahradnik et al, 2009). None of these manuscripts included either fear of pain or body vigilance.…”

Section: Methodsmentioning

confidence: 99%

Post-Traumatic Orientation to Bodily Signals: A Systematic Literature Review

Tsur

Talmon

2021

Trauma, Violence, & Abuse

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Theoretical literature suggests that trauma and (PTSD) may instigate changes in the interpretation of bodily signals. Some findings support these inquiries, revealing that exposure to traumatic events and PTSD are associated with pain catastrophizing, body vigilance, fear of pain, and other manifestations of bodily perceptions and interpretations. However, these findings are not integrated into an inclusive empirically based conceptualization, thus leading to a limited comprehension of this phenomenon. This systematic literature review was conducted to synthesize the existing literature referring to orientation to bodily signals. Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the review included a final of 48 manuscripts that addressed orientation to bodily signals among participants (aged 18 and above) and its potential associations with PTSD. The review revealed that most studies assessed one orientation manifestation, which was tested for its link to PTSD. The majority of the manuscripts were cross-sectional and included participants who faced combat, vehicle accidents, or various types of traumas. Only five manuscripts focused on interpersonal trauma and abuse. Most manuscripts reported significant correlations, revealing that trauma and PTSD are associated with a negative, catastrophic and frightful interpretation of bodily signals. These findings emphasize the need to encapsulate the various manifestations of orientation to bodily signals under a unified construct, as proposed by the term post-traumatic orientation to bodily signals. Further research is needed to illuminate the circumstances and processes by which trauma is implicated in post-traumatic orientation to bodily signals.

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“…PTSD can also influence treatment and time to recovery, as well as symptom severity after mTBI, often leading to more disabling postconcussive symptoms. [ 33 34 35 36 ] Therefore, special attention must be paid to the possibility of comorbid PTSD and mTBI in SMs and veterans. Many SMs diagnosed with PTSD report feeling a stigma about this “psychological” condition, and because of this are less likely to seek treatment, resulting in poorer mental health outcomes.…”

Section: Comorbiditiesmentioning

confidence: 99%

Military TBI—What civilian primary care providers should know

Lindberg¹,

Sloley

Ivins

et al. 2021

Journal of Family Medicine and Primary Care

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In June 2019, the Department of Veterans Affairs (VA) launched the VA Mission Act, which expanded veterans’ health-care access to the private sector. Since civilian primary care providers may see more veterans in their practice, it will be important to understand the unique experiences, comorbidities, and culture of this population in order to provide optimal care. Military service members (SMs) are at an increased risk for traumatic brain injury (TBI), and comorbidities, such as post traumatic stress disorder (PTSD), increasing the likelihood of prolonged symptoms. Military training and repetitive low-level blast exposure may cause symptoms similar to TBI or increase long-term negative effects in SMs. Military culture often has a strong influence in this population. Those who serve in the military identify with military values and have a strong team mentality, which places emphasis on the mission above all else, not accepting defeat, and not ever leaving a fellow SM behind. These values can impact the way a SM/veteran seeks care and/or communicates with his or her health-care provider. Taking a detailed history to understand how these factors apply, as well as screening for mental health comorbidities, are recommended. Understanding the military cultural influences can assist in promoting a stronger therapeutic alliance and encourage more open communication. Ultimately, it is the trusting and respectful relationship between the SM/veteran and the provider that will determine the most effective treatment and result in the most effective resolution of TBI and comorbid symptoms.

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Impact of PTSD on post-concussive symptoms, neuropsychological functioning, and pain in post-9/11 veterans with mild traumatic brain injury

Cited by 25 publications

References 37 publications

Examining posttraumatic stress disorder as a key postinjury risk factor in OIF/OEF veterans with blast-induced mild traumatic brain injury.

Examining posttraumatic stress disorder as a key postinjury risk factor in OIF/OEF veterans with blast-induced mild traumatic brain injury.

Post-Traumatic Orientation to Bodily Signals: A Systematic Literature Review

Military TBI—What civilian primary care providers should know

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