title: Deployment-related TBI, persistent postconcussive symptoms, PTSD, and depression in OEF/OIF veterans.
abstract: OBJECTIVE
  A substantial proportion of the more than 2 million service members who have served in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) have experienced a traumatic brain injury (TBI). Understanding the long-term impact of TBI is complicated by the nonspecific nature of postconcussive symptoms (PCSs) and the high rates of co-occurrence among TBI, posttraumatic stress disorder (PTSD), and depression. The goal of the present research was to examine the relations among TBI, persistent PCSs, and symptoms of PTSD and depression among returning OEF/OIF veterans.
  
  
  METHODS
  213 OEF/OIF veterans (87% male) completed a semistructured screening interview assessing deployment-related TBI and current, persistent PCSs. Participants also completed self-report measures of combat exposure and current symptoms of PTSD and depression.
  
  
  RESULTS
  Nearly half (46%) of sampled veterans screened positive for TBI, the majority of whom (85%) reported at least one persistent PCS after removing PCSs that overlapped with PTSD and depression. Veterans with deployment-related TBI reported higher levels of combat exposure and symptoms of PTSD and depression. Structural equation modeling was used to assess the fit of 3 models of the relationships among TBI, combat exposure, persistent PCSs, PTSD, and depression. Consistent with hypotheses, the best-fitting model was one in which the effects of TBI on both PTSD and depression were fully mediated by nonoverlapping persistent PCSs.
  
  
  CONCLUSIONS
  These findings highlight the importance of addressing persistent PCSs in order to facilitate the functional recovery of returning war veterans.
authors: Department of Veterans Affairs VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, Texas, USA. sandra.morissette@va.gov
authors: Sandra B
authors: SB
authors: Morissette
authors: Matthew
authors: M
authors: Woodward
authors: Nathan A
authors: NA
authors: Kimbrel
authors: Eric C
authors: EC
authors: Meyer
authors: Marc I
authors: MI
authors: Kruse
authors: Sara
authors: S
authors: Dolan
authors: Suzy Bird
authors: SB
authors: Gulliver
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D001924:Brain Concussion / Q000453:epidemiology / Q000523:psychology; D001930:Brain Injuries / Q000453:epidemiology / Q000523:psychology*; D003866:Depressive Disorder / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D006801:Humans; D007406:Interview, Psychological; D054542:Iraq War, 2003-2011; D008297:Male; D008889:Military Personnel / Q000523:psychology* / Q000706:statistics & numerical data; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000523:psychology*; D014728:Veterans / Q000523:psychology* / Q000706:statistics & numerical data