Veterans with history of mild traumatic brain injury and posttraumatic stress disorder: Challenges from provider perspective

Abstract

Abstract-The Department of Veterans Affairs (VA) has separate clinical structures and care processes for traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD). However, because veterans are returning from the wars in Iraq and Afghanistan with TBI (most frequently mild TBI [mTBI]) and PTSD, the VA needs to evaluate current service delivery systems. We conducted key informant interviews with 40 providers from across the United States who represented separate clinical teams providing specialized TBI or PTSD services. We identified challenges providers perceive in scheduling and engaging patients with co-occurring mTBI and PTSD (mTBI/ PTSD) in treatment, determining the etiology of patients' presenting problems, coordinating services, and knowing whether or how to alter standard treatments. We found consensus that patients with mTBI/PTSD often have other morbidities requiring specialized treatment, including pain and sleep disturbance. Another important theme we found was the need for patient and family educational material on mTBI/PTSD or pain and mTBI/PTSD and provider education tailored to provider specialty. Together, findings point to the need for guidance for providers on best practices to assess and treat mTBI/PTSD given available information, a systematic approach toward patient and provider education, and research to build the evidence base for practice.

Relationship of screen-based symptoms for mild traumatic brain injury and mental health problems in Iraq and Afghanistan veterans: Distinct or overlapping symptoms?

“…For example, treatments that focus on shared symptoms of insomnia, emotional regulation, and cognitive dysfunction may be the best firstline treatments. This shift is consistent with other findings that have stressed the need for integrated care and have highlighted the clinical challenges of addressing PTSD and TBI as separate conditions [17].…”

“…Because the symptoms of TBI, PTSD, and depression can overlap clinically, problems with triage and appropriate referral for specialty care can ensue, creating delays in diagnosis and treatment [15][16][17]. Specifically, using factor analytic techniques, we sought to identify symptoms from TBI, PTSD, and depression screens that were overlapping and, in contrast, symptoms that were uniquely associated with a positive TBI screen (and not better accounted for by PTSD or depression).…”

Multisensory impairment reported by veterans with and without mild traumatic brain injury history

“…Because of the degree of symptom overlap between TBI and psychiatric disorders [46,61,[63][64]66,[76][77][78][79][80], clinicians evaluating TBI also should determine whether mental health conditions are present to decide on the best course of treatment [6,62]. Patients with MSI may benefit from a team-based approach to care [63][64][77][78].…”

“…Patients with MSI may benefit from a team-based approach to care [63][64][77][78]. As discussed elsewhere [7], the VA CTBIE process and NSI-22 allow clinicians, at a glance, to survey symptoms that patients endorse as being disruptive to their daily functioning, obtain a better history of the nature of the problem(s), and decide what type of follow-up care is warranted.…”

Exploratory pilot study of driving perceptions among OIF/OEF Veterans with mTBI and PTSD

“…Veterans with mTBI and/or PTSD face challenges with organization, planning, and memory-related tasks [30][31][32][33][34]. Deficits in these areas affect driver performance, especially as demands of the driving task increase [35][36].…”