title: The impact of head injury mechanism on mental health symptoms in veterans: do number and type of exposures matter?
abstract: This study examined the association between screening results for mental health problems and the number and type of head injuries in 1,082 Iraq and Afghanistan War veterans who received population-based screening for traumatic brain injury at a Veterans Administration health care facility. Nearly one third of all veterans reported multiple types of head injuries (median = 1 among those with any head injury, range = 1-6 types of head injury). Veterans reporting multiple head injury mechanisms had 6 times the odds of screening positive for posttraumatic stress disorder (PTSD), adjusted odds ratio (OR) = 6.15, 95% confidence interval (CI) [4.4, 8.7], p < .001, over 4 times the odds of screening positive for depression, adjusted OR = 4.09, 95% CI [2.8, 5.9], p < .001, and about twice the odds of screening positive for alcohol misuse, adjusted OR = 1.64, 95% CI [1.19, 2.3], p = .003, compared to those without head injuries. Veterans reporting a blast plus another head injury mechanism had higher odds of screening positive for all mental health outcomes than any other group (e.g., compared to no head injury group): PTSD, adjusted OR = 6.52, 95% CI [4.6, 9.3], p < .001; depression, adjusted OR = 4.42, 95% CI [3.0, 6.4], p < .001; alcohol misuse, adjusted OR =1.59, 95% CI [1.14, 2.2], p = .006. Given their association with a variety of mental health outcomes, number and type of head injury mechanism should be considered as part of any postdeployment evaluation.
authors.affiliation: San Francisco VA Medical Center, San Francisco, California 94121, USA. Shira.Maguen@va.gov
authors.forename: Shira
authors.initials: S
authors.lastname: Maguen
authors.forename: Erin
authors.initials: E
authors.lastname: Madden
authors.forename: Karen M
authors.initials: KM
authors.lastname: Lau
authors.forename: Karen
authors.initials: K
authors.lastname: Seal
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D000437:Alcoholism / Q000453:epidemiology / Q000209:etiology; D006259:Craniocerebral Trauma / Q000145:classification* / Q000150:complications / Q000523:psychology*; D003866:Depressive Disorder / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D008403:Mass Screening; D001523:Mental Disorders / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology*; D016017:Odds Ratio; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000209:etiology; D014481:United States / Q000453:epidemiology; D014728:Veterans / Q000523:psychology*; D055815:Young Adult