title: Traumatic brain injury and psychiatric diagnoses in veterans seeking outpatient substance abuse treatment.
abstract: OBJECTIVE
  Explore the incidence of traumatic brain injury (TBI) in veterans seeking outpatient substance abuse treatment and the association between TBI and psychiatric diagnoses.
  
  
  METHODS
  The Ohio State University TBI identification method (OSU TBI-ID) was administered to veterans with positive TBI-4 screens; substance-related and psychiatric diagnoses were extracted from the medical record.
  
  
  METHODS
  : Over an 18-month period, 247 veterans completed the TBI-4. Of the 136 who screened positive, 70 were administered the OSU TBI-ID.
  
  
  RESULTS
  On the basis of the TBI-4, 55% (95% CI: 49%-61%) of veterans screened positive for a history of TBI. The OSU TBI-ID was used to confirm screening results. Those who completed the OSU TBI-ID sustained an average of 3.4 lifetime TBIs. For each additional TBI sustained, after initial injury, there was an estimated 9% increase in the number of psychiatric diagnoses documented (99% CI: 1%-17%). For each additional documented psychiatric diagnosis, there was an estimated increase of 11% in the number of injuries sustained (99% CI: 1%-22%). Also, 54% (38/70) had a positive history of TBI prior to adulthood.
  
  
  CONCLUSIONS
  These results emphasize the need for TBI screening in this vulnerable population, as well as the importance of increasing brain injury awareness among those abusing substances and their care providers. These findings also highlight the need for specialized services for those with TBI and co-occurring substance misuse aimed at decreased future TBIs or negative psychiatric outcomes or both. Further study is needed to clarify best practices.
authors.affiliation: VA VISN 19 Mental Illness Research, Education, and Clinical Center, Denver, CO 80220, USA. jennifer.olson-madden@va.gov
authors.forename: Jennifer H
authors.initials: JH
authors.lastname: Olson-Madden
authors.forename: Lisa
authors.initials: L
authors.lastname: Brenner
authors.forename: Jeri E F
authors.initials: JE
authors.lastname: Harwood
authors.forename: Chad D
authors.initials: CD
authors.lastname: Emrick
authors.forename: John D
authors.initials: JD
authors.lastname: Corrigan
authors.forename: Caitlin
authors.initials: C
authors.lastname: Thompson
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D001930:Brain Injuries / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008403:Mass Screening; D008487:Medical History Taking; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology*; D008875:Middle Aged; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000534:rehabilitation; D011795:Surveys and Questionnaires; D014481:United States; D014728:Veterans