Multisite Investigation of Traumatic Brain Injuries, Posttraumatic Stress Disorder, and Self-reported Health and Cognitive Impairments PTSD After Traumatic Brain Injury

Zatzick DF, Rivara FP, Jurkovich GJ, et al. — Mon, 06 Dec 2010 00:00:00 GMT

Context

Few large-scale, multisite investigations have assessed the development of posttraumatic stress disorder (PTSD) symptoms and health outcomes across the spectrum of patients with mild, moderate, and severe traumatic brain injury (TBI).

Objectives

To understand the risk of developing PTSD symptoms and to assess the impact of PTSD on the development of health and cognitive impairments across the full spectrum of TBI severity.

Design

Multisite US prospective cohort study.

Setting

Eighteen level I trauma centers and 51 non–trauma center hospitals.

Patients

A total of 3047 (weighted n = 10 372) survivors of multiple traumatic injuries between the ages of 18 and 84 years.

Main Outcome Measures

Severity of TBI was categorized from chart-abstracted International Classification of Diseases, Ninth Revision, Clinical Modification codes. Symptoms consistent with a DSM-IV diagnosis of PTSD were assessed with the PTSD Checklist 12 months after injury. Self-reported outcome assessment included the 8 Medical Outcomes Study 36-Item Short Form Health Survey health status domains and a 4-item assessment of cognitive function at telephone interviews 3 and 12 months after injury.

Results

At the time of injury hospitalization, 20.5% of patients had severe TBI, 11.7% moderate TBI, 12.9% mild TBI, and 54.9% no TBI. Patients with severe (relative risk, 0.72; 95% confidence interval, 0.58-0.90) and moderate (0.63; 0.44-0.89) TBI, but not mild TBI (0.83; 0.61-1.13), demonstrated a significantly diminished risk of PTSD symptoms relative to patients without TBI. Across TBI categories, in adjusted analyses patients with PTSD demonstrated an increased risk of health status and cognitive impairments when compared with patients without PTSD.

Conclusions

More severe TBI was associated with a diminished risk of PTSD. Regardless of TBI severity, injured patients with PTSD demonstrated the greatest impairments in self-reported health and cognitive function. Treatment programs for patients with the full spectrum of TBI severity should integrate intervention approaches targeting PTSD.

Longitudinal Effects of Mild Traumatic Brain Injury and Posttraumatic Stress Disorder Comorbidity on Postdeployment Outcomes in National Guard Soldiers Deployed to Iraq Longitudinal Effects of Traumatic Brain Injury

Polusny MA, Kehle SM, Nelson NW, et al. — Mon, 03 Jan 2011 00:00:00 GMT

Context

Troops deployed to Iraq and Afghanistan are at high risk for exposure to combat events resulting in mild traumatic brain injury (MTBI) or concussion and posttraumatic stress disorder (PTSD). The longer-term impact of combat-related concussion/MTBI and comorbid PTSD on troops' health and well-being is unknown.

Objective

To assess longitudinal associations between concussion/MTBI and PTSD symptoms reported in theater and longer-term psychosocial outcomes in combat-deployed National Guard soldiers.

Design

Longitudinal cohort study. Participants were surveyed in Iraq 1 month before returning home (time 1) and 1 year later (time 2). Self-reports of concussion/MTBI and PTSD were assessed at times 1 and 2. Based on time 1 concussion/MTBI status (defined as an injury during deployment with loss of consciousness or altered mental status) and time 2 postdeployment probable PTSD status, soldiers were compared on a range of time 2 psychosocial outcomes.

Participants

Nine hundred fifty-three US National Guard soldiers.

Setting

The time 1 sample was assessed during redeployment transition briefings held at military installations in the Iraq combat theater. The time 2 sample was assessed using mailed surveys sent to the homes of US National Guard service members.

Main Outcome Measures

Postconcussive, depression, and physical symptoms; alcohol use; social functioning; and quality of life assessed at time 2 using valid clinical instruments.

Results

The rate of self-reported concussion/MTBI during deployment was 9.2% at time 1 and 22.0% at time 2. Soldiers with a history of concussion/MTBI were more likely than those without to report postdeployment postconcussive symptoms and poorer psychosocial outcomes. However, after adjusting for PTSD symptoms, concussion/MTBI was not associated with postdeployment symptoms or outcomes. Time 1 PTSD symptoms more strongly predicted postdeployment symptoms and outcomes than did concussion/MTBI history.

Conclusions

Although combat-related PTSD was strongly associated with postconcussive symptoms and psychosocial outcomes 1 year after soldiers returned from Iraq, there was little evidence of a long-term negative impact of concussion/MTBI history on these outcomes after accounting for PTSD. These findings and the 2-fold increase in reports of deployment-related concussion/MTBI history have important implications for screening and treatment.

JAMA Psychiatry: Brain Trauma Topic Collection

Multisite Investigation of Traumatic Brain Injuries, Posttraumatic Stress Disorder, and Self-reported Health and Cognitive Impairments PTSD After Traumatic Brain Injury

Longitudinal Effects of Mild Traumatic Brain Injury and Posttraumatic Stress Disorder Comorbidity on Postdeployment Outcomes in National Guard Soldiers Deployed to Iraq Longitudinal Effects of Traumatic Brain Injury