Posttraumatic Stress Disorder is a Stronger Predictor of Long‐Term Neurobehavioral Outcomes Than Traumatic Brain Injury Severity

Abstract

Concurrent posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) is common in military populations. The purpose of this study was to examine long‐term neurobehavioral outcomes in service members and veterans (SMVs) with versus without PTSD symptoms following TBI of all severities. Participants were 536 SMVs prospectively enrolled from three military medical treatment facilities who were recruited into three experimental groups: TBI, injured controls (IC), and noninjured controls (NIC). Participants completed the PTSD Checklist, Neurobehavioral Symptom Inventory, and the TBI–Quality of Life (TBI‐QOL) and were divided into six subgroups based on the three experimental categories, two PTSD categories (i.e., present vs. absent), and two broad TBI severity categories (unMTBI, which included uncomplicated mild TBI; and smcTBI, which included severe TBI, moderate TBI, and complicated mild TBI): (a) NIC/PTSD‐absent, (b) IC/PTSD‐absent, (c) unMTBI/PTSD‐absent, (d) unMTBI/PTSD‐present, (e) smcTBI/PTSD‐absent, and (f) smcTBI/PTSD‐present. There were significant main effects across the six groups for all TBI‐QOL measures, ps < .001. Select pairwise comparisons revealed significantly lower scores, p < .001, on all TBI‐QOL measures in the PTSD‐present groups when compared to the PTSD‐absent groups within the same TBI severity classification, ds = 0.90–2.11. In contrast, when controlling for PTSD, there were no significant differences among the TBI severity groups for any TBI‐QOL measures. These results provide support for the strong influence of PTSD but not TBI severity on neurobehavioral outcomes following TBI. Concurrent PTSD and TBI of all severities should be considered a risk factor for poor long‐term neurobehavioral outcomes that require ongoing monitoring.

Objective and Subjective Auditory Effects of Traumatic Brain Injury and Blast Exposure in Service Members and Veterans

“…Comorbidities may also cloud our understanding of symptoms of TBI reported years following a TBI. Over 40% of soldiers with mTBI have a comorbid post-traumatic stress disorder (PTSD), and a number of health problems reported by service members with mTBI are strongly influenced by PTSD or depression ( 23 , 24 ).…”

Assessing vigilance in caregivers after traumatic brain injury: TBI-CareQOL Caregiver Vigilance.

“…TBIs sustained in theater often occur under combat situations and exposure to intense psychological stress, such as firing weapons or being fired on; seeing human remains; knowing someone who was killed or injured; being responsible for the death of a person; threat of abuse or execution if captured; and exposure to biological, chemical, or radiological weapons (Dausch & Saliman, 2009; French, Iverson, Lange, & Bryant, 2012; Hoge et al, 2004; Kennedy, Leal, Lewis, Cullen, & Amador, 2010; Sammons & Batten, 2008; Seal et al, 2008). Comorbid posttraumatic stress disorder (PTSD) is common (Hines, Sundin, Rona, Wessely, & Fear, 2014; Schneiderman, Braver, & Kang, 2008; Yurgil et al, 2014), affecting up to 44% of SMVs who have sustained a mild TBI and 42% of SMVs with a moderate, severe, or penetrating TBI (Hoge et al, 2008; Lange, French, Lippa, Ballie, & Brickell, 2019; Schneiderman et al, 2008). Comorbid TBI and PTSD is associated with physical and psychological expressions of anger and hostility, reexperiencing and hyper-arousal symptoms, emotional numbness, and withdrawal and detachment (Ben Arzi, Solomon, & Dekel, 2000; Beks, 2016; Mansfield, Schaper, Yanagida, & Rosen, 2014; Monson, Taft, & Fredman, 2009).…”

Unhealthy family functioning is associated with health-related quality of life among military spouse caregivers.

“…Comorbid mental health problems, such as PTSD, are common, and regardless of TBI severity can impede neurobehavioral recovery. In a recent study, up to 41% of SMVs following a TBI of any severity met symptom criteria for PTSD (Lange et al, 2020). It can be challenging for family members to understand the profound impact that mental health problems can have, particularly in the absence of visible physical impairment.…”