Postconcussive, posttraumatic stress and depressive symptoms in recently deployed U.S. Army soldiers with traumatic brain injury.

Agtarap, Stephanie; Campbell‐Sills, Laura; Michael, Thomas; Kessler, Ronald C.; Ursano, Robert J.; Stein, Murray B.

doi:10.1037/pas0000756

Cited by 9 publications

(18 citation statements)

References 58 publications

(85 reference statements)

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“…The two anxiety studies utilized two different measures; the anxiety item bank from the Quality of Life in Neurological Disorder Computerized Adaptive Tests ( 60 , 92 ), and the Hospital and Anxiety Depression Scale ( 12 , 93 ). The eight adult studies that centered on symptoms of depression utilized the adapted version of the Composite International Diagnostic Interview Screening Scales ( 61 , 88 ), qualitative interviews ( 62 , 81 ), the British Columbia Major Depression Inventory, 2nd Edition ( 63 , 82 ), the Center for Epidemiological Studies Depression Scale ( 64 , 83 ), the Beck Depression Inventory ( 65 , 66 , 68 , 94 ), or the General Health Questionnaire ( 67 , 84 ). Between the nine adult studies on combined symptoms of anxiety and depression, four used the Hospital Anxiety and Depression Scale ( 70 , 72 , 75 , 76 , 93 ), while others used the Impact of Event Scale ( 69 , 95 ), the Rivermead Post-Concussion Symptoms Questionnaire ( 69 , 96 ), Depression and Anxiety Stress Scales-42 ( 71 , 85 ), the Beck Anxiety Inventory ( 73 , 86 ) and Beck Depression Inventory ( 73 , 94 ), interviews with symptoms according to DSM-IV criteria ( 74 , 87 ), and the Glasgow Outcome Scale -Extended ( 77 , 97 ).…”

Section: Resultsmentioning

confidence: 99%

“…Of the 19 studies that centered around adults with PPCS, eight studies measured symptoms of depression ( 61 – 68 ). Like in the pediatric population, most studies found that participants reporting higher PPCS symptoms also reported higher severity of depression symptoms ( 64 , 65 , 67 , 68 , 82 ).…”

Section: Resultsmentioning

confidence: 99%

“…Also noted in two studies, symptoms of depression was present in participants with PPCS, even without including overlapping symptoms between PPCS, PTSD, and depression, such as depressed mood, insomnia, fatigue, irritability, restlessness ( 65 , 67 ). In a study with a participant group of veterans, it was reported that deployment stress was related to an increase in both PPCS scores and depression scores ( 61 ). Furthermore, in a qualitative study conducted with university students, all five participants reported symptoms of depression following PPCS, and one participant described a previous suicide attempt following concussion ( 62 ).…”

Section: Resultsmentioning

confidence: 99%

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Mental Health Outcomes Across the Lifespan in Individuals With Persistent Post-Concussion Symptoms: A Scoping Review

et al. 2022

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Objective:Concussion is a common yet heterogenous injury. Approximately 15–30% of cases present with persistent post-concussion symptoms (PPCS), continuing 4 weeks or more post-injury in children, youth, and adolescents, and 3 months or more in adults. There are known bidirectional links between PPCS and mental health outcomes. The focus of this scoping review is to explore the literature on mental health outcomes in individuals experiencing PPCS. Research objectives were to explore: (1) the mental health outcomes of individuals with PPCS and types of assessments used to identify mental health outcomes this group, and (2) how mental health outcomes compare in terms of similarities and differences among pediatric and adult populations with PPCS.MethodOvid MEDLINE; EMBASE; CINAHL, and PsycInfo databases were searched. After title and abstract screening of 11,920 studies, 481 articles were reviewed. Twenty-five papers met inclusion criteria. Results were organized by mental health outcomes of pediatric and adult populations, separately.ResultsThere was a significantly higher number of studies devoted to adult populations. Of the 25 studies, 19 (76%) focused on adults, while six (24%) focused on adolescents. In adult populations, studies focused on symptoms of: anxiety (n = 2), depression (n = 8), and anxiety and depression (n = 9). Two studies assessed other emotional outcomes (10.5%). Within pediatric populations, an equal number of studies explored symptoms of: anxiety (n = 2), depression (n = 2), and anxiety and depression (n = 2). No studies focused on other emotional outcomes. Studies ranged greatly in methods, design, and control group. Most studies reported higher psychiatric symptoms of anxiety and/or depression in those with PPCS compared to individuals with recovered concussion or healthy controls.DiscussionThis review contributes to the understanding of mental health outcomes in those experiencing PPCS. Mental health and PPCS requires greater attention in pediatric populations, and consider strategies for those experiencing PPCS and mental health impacts. Future studies should consider including a wider range of emotional outcomes in their design, not limited to anxiety and depression. Study results may lead to improvements and research in the identification, assessment, and management of PPCS and mental health.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Mental Health Outcomes Across the Lifespan in Individuals With Persistent Post-Concussion Symptoms: A Scoping Review

et al. 2022

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“…12 As such, postconcussive (PCS) and posttraumatic stress (PTS) symptoms are often studied together among military service members. 2,[13][14][15]…”

Section: Symptoms Of Mtbi and Related Conditions Among Military Servi...mentioning

confidence: 99%

Identifying Unique Symptom Groups Following Mild Traumatic Brain Injury Using the Neurobehavioral Symptom Inventory and PTSD Checklist-5 in Military Personnel: A Bifactor Analysis

Agtarap

Hungerford

Ettenhofer

2023

Journal of Head Trauma Rehabilitation

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Objective: To identify both shared and unique groups of posttraumatic stress and postconcussive symptoms using bifactor analysis. Setting: Two large military outpatient traumatic brain injury (TBI) rehabilitation clinics in the Southwestern United States. Participants: A sample of 1476 Active Duty Service Members seeking treatment for a mild TBI sustained more than 30 days previously, without history of moderate or severe TBI, who completed measures of postconcussive and posttraumatic stress symptoms assessed at clinic intake. Design: Observational, correlational study with data taken from an institutional review board-approved clinical registry study. Main Measures: Neurobehavioral Symptom Inventory (NSI) and Posttraumatic Stress Disorder (PTSD) Checklist for Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-V) (PCL-5). Concurrent measures were Patient Health Questionnaire (PHQ-8), Pittsburgh Sleep Quality Index (PSQI), and Headache Impact Test (HIT-6). Results: Results identified a bifactor model demonstrating unique posttraumatic stress, depressive, cognitive, and neurological/somatic symptom groups that were still evident after accounting for a universal factor representing general distress. These symptom groups were differentially related to concurrently measured clinical outcomes. Conclusion: Use of a bifactor structure may help derive clinically useful signals from self-reported symptoms among Active Duty Service Members seeking outpatient treatment for mild TBI.

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“…Estimates of TBI among service members who have returned from military operations in Iraq and Afghanistan vary moderately, which highlights the critical importance of TBI definitions and methods to ascertain TBI exposure. Estimates suggest that between 9% and 28% of service members experienced a TBI . Complicating matters further, many veterans experienced 1 or more TBIs before their military service, thereby suggesting that military-related injuries may be neither the first nor the worst lifetime injury sustained.…”

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confidence: 99%

Traumatic Brain Injury and Veteran Mortality After the War in Afghanistan

2022

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On August 30, 2021, the last US military service members left Afghanistan, marking the end of America's longest war. It is important to continue to examine the impact of the war on service members, veterans, family members, clinicians, and health care systems. Traumatic brain injuries (TBIs) are often described as one of the signature injuries of the war. Estimates of TBI among service members who have returned from military operations in Iraq and Afghanistan vary moderately, which highlights the critical importance of TBI definitions and methods to ascertain TBI exposure. Estimates suggest that between 9% and 28% of service members experienced a TBI. 1 Complicating matters further, many veterans experienced 1 or more TBIs before their military service, thereby suggesting that military-related injuries may be neither the first nor the worst lifetime injury sustained.Regardless of the true prevalence of TBI, it is clear that TBI represents a major health care issue for veterans. Additional research is needed to understand the long-term health outcomes for veterans with TBIs. The results should guide clinical, research, and policy-based decisions.Within this context, the analyses by Howard and colleagues 2 represent a timely contribution examining the association of TBI severity with mortality among more than 2.5 million veterans serving after September 11, 2001 (9/11). These secondary analyses were conducted as part of a larger study designed to examine health trajectories over time. Therefore, Howard et al 2 were right to highlight their limitations; this was not a population-based cohort study of all post-9/11 TBI cases. Cases were required to have 3 or more years of Department of Defense (DoD) health care, and 2 or more years of Veterans Health Administration (VHA) care for those who entered the VHA; therefore, these results should be confirmed in future studies. The authors found that all-cause mortality was higher among post-9/11 military veterans compared with the general population, and the differences increased along with TBI severity, especially among older veterans. 2 Different patterns emerged when external causes of death (ie, accidents, suicide, and homicides), cancer, and cardiovascular disease were examined separately; rates of external causes of death were especially high among those with a moderate-to-severe TBI. The authors calculated excess death estimates. Although only 3% of the post-9/11 cohort had a moderateto-severe TBI, they accounted for 33.6% of total excess deaths. 2The study by Howard et al 2 highlights challenges identified early in the war as TBI evolved as a critical issue. How should TBI be defined? What methods should be used to ascertain TBI cases? Despite substantial progress on these issues, many researchers are forced to make trade-off decisions that balance feasibility with reference standard methods. These methodological issues create challenges for identifying the true rate of TBI, injury severity, and short-and long-term outcomes associated with such injuries (eg, mortalit...

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Postconcussive, posttraumatic stress and depressive symptoms in recently deployed U.S. Army soldiers with traumatic brain injury.

Cited by 9 publications

References 58 publications

Mental Health Outcomes Across the Lifespan in Individuals With Persistent Post-Concussion Symptoms: A Scoping Review

Mental Health Outcomes Across the Lifespan in Individuals With Persistent Post-Concussion Symptoms: A Scoping Review

Identifying Unique Symptom Groups Following Mild Traumatic Brain Injury Using the Neurobehavioral Symptom Inventory and PTSD Checklist-5 in Military Personnel: A Bifactor Analysis

Traumatic Brain Injury and Veteran Mortality After the War in Afghanistan

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