Prospective Longitudinal Evaluation of the Effect of Deployment-Acquired Traumatic Brain Injury on Posttraumatic Stress and Related Disorders: Results From the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS)

Abstract

Objective Traumatic brain injury (TBI) is increasingly recognized as a risk factor for deleterious mental health and functional outcomes. The purpose of this study was to examine the strength and specificity of the association between deployment-acquired TBI and subsequent posttraumatic stress and related disorders among U.S. Army personnel. Method A prospective, longitudinal survey of soldiers in three Brigade Combat Teams was conducted 1–2 months prior to an average 10-month deployment to Afghanistan (T0), upon redeployment to the United States (T1), approximately 3 months later (T2), and approximately 9 months later (T3). Outcomes of interest were 30-day prevalence postdeployment of posttraumatic stress disorder (PTSD), major depressive episode, generalized anxiety disorder, and suicidality, as well as presence and severity of postdeployment PTSD symptoms. Results Complete information was available for 4,645 soldiers. Approximately one in five soldiers reported exposure to mild (18.0%) or more-than-mild (1.2%) TBI(s) during the index deployment. Even after adjusting for other risk factors (e.g., predeployment mental health status, severity of deployment stress, prior TBI history), deployment-acquired TBI was associated with elevated adjusted odds of PTSD and generalized anxiety disorder at T2 and T3 and of major depressive episode at T2. Suicidality risk at T2 appeared similarly elevated, but this association did not reach statistical significance. Conclusions The findings highlight the importance of surveillance efforts to identify soldiers who have sustained TBIs and are therefore at risk for an array of postdeployment adverse mental health outcomes, including but not limited to PTSD. The mechanism(s) accounting for these associations need to be elucidated to inform development of effective preventive and early intervention programs.

Genome-wide Association Studies of Posttraumatic Stress Disorder in 2 Cohorts of US Army Soldiers

“…For this purpose we chose a dimensional measure of lifetime (“at its worst”) PTSD severity, a 6-item version (range: 0-24) of the PTSD Checklist (PCL) 64 that we have used in other published Army STARRS research. 65 Among European Americans rs11085374 was significantly associated with lifetime PCL-6 severity in NSS1 (p-value=0.007) and NSS2 (p-value <0.001), but not PPDS (p-value=0.82). Among African Americans rs159572 was significantly associated with lifetime PCL-6 severity in NSS1 (p-value=0.002) and NSS2 (p-value=0.028) but not PPDS (p-value=0.419).…”

Childhood adversity, adult stress, and the risk of major depression or generalized anxiety disorder in US soldiers: a test of the stress sensitization hypothesis

“…2014; Rosellini et al . 2015; Stein et al . 2015) which have been associated with substantial morbidity and severe role impairment (Rosellini et al .…”

Reduced prefrontal MEG alpha-band power in mild traumatic brain injury with associated posttraumatic stress disorder symptoms

“…Multiple studies have reported an increased incidence of post-traumatic stress disorder (PTSD) in active-duty service members (Hoge et al, 2008;Schneiderman et al 2008;Yurgil et al, 2014;Stein et al, 2015) and civilians (Bryant et al, 2009;Bryant et al, 2010) with a history of mild traumatic brain injury (mTBI). Amongst veterans who have been deployed to Iraq or Afghanistan, a history of mild TBI is associated with a 2.37 fold increase in the prevalence of PTSD (Schneiderman et al 2008).…”

“…Amongst veterans who have been deployed to Iraq or Afghanistan, a history of mild TBI is associated with a 2.37 fold increase in the prevalence of PTSD (Schneiderman et al 2008). In civilian populations, the association between mTBI and PTSD is as high as 56% (Howlett and Stein, 2015). The frequent co-morbidity of these two conditions has fueled a growing interest in characterizing the pathophysiological mechanisms that would support an increased susceptibility to PTSD in individuals who sustained mTBI (Joseph and Masterson, 1999;Gil et al, 2005;Kennedy et al, 2007;Elder et al, 2012).…”