Factors influencing postconcussion and posttraumatic stress symptom reporting following military-related concurrent polytrauma and traumatic brain injury.
The purpose of this study was to identify factors that are predictive of, or associated with, high endorsement of postconcussion and posttraumatic stress symptoms following military-related traumatic brain injury (TBI). Participants were 1,600 U.S. service members (age: M = 27.1, SD = 7.1; 95.4% male) who had sustained a mild-to-moderate TBI and who had been evaluated by the Defense and Veterans Brain Injury Center at one of six military medical centers. Twenty-two factors were examined that included demographic, injury circumstances/severity, treatment/evaluation, and psychological/physical variables. Four factors were statistically and meaningfully associated with clinically elevated postconcussion symptoms: (i) low bodily injury severity, (ii) posttraumatic stress, (iii) depression, and (iv) military operation where wounded (p < .001, 43.2% variance). The combination of depression and posttraumatic stress symptoms accounted for the vast majority of unique variance (41.5%) and were strongly associated with, and predictive of, clinically elevated postconcussion symptoms [range: odds ratios (OR) = 4.24-7.75; relative risk (RR) = 2.28-2.51]. Five factors were statistically and meaningfully associated with clinically elevated posttraumatic stress symptoms: (i) low bodily injury severity, (ii) depression, (iii) a longer time from injury to evaluation, (iv) military operation where wounded, and (v) current auditory deficits (p < .001; 65.6% variance accounted for). Depression alone accounted for the vast majority of unique variance (60.0%) and was strongly associated with, and predictive of, clinically elevated posttraumatic stress symptoms (OR = 38.78; RR = 4.63). There was a very clear, strong, and clinically meaningful association between depression, posttraumatic stress, and postconcussion symptoms in this sample. Brain injury severity, however, was not associated with symptom reporting following TBI.
Defense and Veterans Brain Injury Center, Bethesda, MD, USA Walter Reed National Military Medical Center, Bethesda, MD, USA University of British Columbia, Vancouver, BC, Canada Center for Neuroscience and Regenerative Medicine, Bethesda, MD, USA rael.t.lange@us.army.mil rael.lange@gmail.com.
Rael T
RT
Lange
Defense and Veterans Brain Injury Center, Bethesda, MD, USA Walter Reed National Military Medical Center, Bethesda, MD, USA Uniformed Services University of the Health Sciences, Bethesda, MD, USA Center for Neuroscience and Regenerative Medicine, Bethesda, MD, USA.
Tracey A
TA
Brickell
Defense and Veterans Brain Injury Center, Bethesda, MD, USA San Antonio Military Medical Center, Fort Sam Houston, TX, USA.
Jan E
JE
Kennedy
Defense and Veterans Brain Injury Center, Bethesda, MD, USA Naval Medical Center San Diego, San Diego, CA, USA.
Jason M
JM
Bailie
Defense and Veterans Brain Injury Center, Bethesda, MD, USA San Antonio Military Medical Center, Fort Sam Houston, TX, USA.
Cheryl
C
Sills
Defense and Veterans Brain Injury Center, Bethesda, MD, USA 33 Area Branch Clinic Camp Pendleton, Camp Pendleton, CA, USA.
Sarah
S
Asmussen
Defense and Veterans Brain Injury Center, Bethesda, MD, USA San Antonio Military Medical Center, Fort Sam Houston, TX, USA.
Ricardo
R
Amador
Defense and Veterans Brain Injury Center, Bethesda, MD, USA Naval Medical Center San Diego, San Diego, CA, USA.
Angelica
A
Dilay
Defense and Veterans Brain Injury Center, Bethesda, MD, USA.
Brian
B
Ivins
Defense and Veterans Brain Injury Center, Bethesda, MD, USA Walter Reed National Military Medical Center, Bethesda, MD, USA Uniformed Services University of the Health Sciences, Bethesda, MD, USA Center for Neuroscience and Regenerative Medicine, Bethesda, MD, USA.
Louis M
LM
French
D000328:Adult; D001930:Brain Injuries / Q000150:complications*; D005260:Female; D015600:Glasgow Coma Scale; D006772:Hospitals, Military; D006801:Humans; D016015:Logistic Models; D008297:Male; D008889:Military Personnel; D009104:Multiple Trauma / Q000150:complications*; D009483:Neuropsychological Tests; D038223:Post-Concussion Syndrome / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000209:etiology*; D015599:Trauma Severity Indices; D014481:United States; D055815:Young Adult
Depression; Military; Postconcussion; Posttraumatic stress; Traumatic brain injury