title: The Effects of Mild Traumatic Brain Injury, Post-Traumatic Stress Disorder, and Combined Mild Traumatic Brain Injury/Post-Traumatic Stress Disorder on Returning Veterans.
abstract: United States veterans of the Iraqi (Operation Iraqi Freedom [OIF]) and Afghanistan (Operation Enduring Freedom [OEF]) conflicts have frequently returned from deployment after sustaining mild traumatic brain injury (mTBI) and enduring stressful events resulting in post-traumatic stress disorder (PTSD). A large number of returning service members have been diagnosed with both a history of mTBI and current PTSD. Substantial literature exists on the neuropsychological factors associated with mTBI and PTSD occurring separately; far less research has explored the combined effects of PTSD and mTBI. The current study employed neuropsychological and psychological measures in a sample of 251 OIF/OEF veterans to determine whether participants with a history of mTBI and current PTSD (mTBI+PTSD) have poorer cognitive and psychological outcomes than participants with mTBI only (mTBI-o), PTSD only (PTSD-o), or veteran controls (VC), when groups are comparable on intelligence quotient, education, and age. The mTBI+PTSD group performed more poorly than VC, mTBI-o, and PTSD-o groups on several neuropsychological measures. Effect size comparisons suggest small deleterious effects for mTBI-o on measures of processing speed and visual attention and small effects for PTSD-o on measures of verbal memory, with moderate effects for mTBI+PTSD on the same variables. Additionally, the mTBI+PTSD group was significantly more psychologically distressed than the PTSD-o group, and PTSD-o group was more distressed than VC and mTBI-o groups. These findings suggest that veterans with mTBI+PTSD perform significantly lower on neuropsychological and psychiatric measures than veterans with mTBI-o or PTSD-o. The results also raise the possibility of mild but persisting cognitive changes following mTBI sustained during deployment.
authors.affiliation: 1 Department of Psychology, University of Kentucky , Lexington, Kentucky.
authors.forename: Hannah L
authors.initials: HL
authors.lastname: Combs
authors.affiliation: 1 Department of Psychology, University of Kentucky , Lexington, Kentucky.
authors.forename: David T R
authors.initials: DT
authors.lastname: Berry
authors.affiliation: 2 Edward Hines Jr. Hospital , Hines, Illinois.|3 Northwestern University Feinberg School of Medicine , Chicago, Illinois.
authors.forename: Theresa
authors.initials: T
authors.lastname: Pape
authors.affiliation: 4 Southern Arizona Department of Veterans Affairs Health Care System, Tucson, Arizona .
authors.forename: Judith
authors.initials: J
authors.lastname: Babcock-Parziale
authors.affiliation: 2 Edward Hines Jr. Hospital , Hines, Illinois.|3 Northwestern University Feinberg School of Medicine , Chicago, Illinois.
authors.forename: Bridget
authors.initials: B
authors.lastname: Smith
authors.affiliation: 5 Department of Physical Medicine and Rehabilitation, University of Kentucky , Lexington, Kentucky.|6 Lexington Veterans Affairs Medical Center , Lexington, Kentucky.
authors.forename: Randal
authors.initials: R
authors.lastname: Schleenbaker
authors.affiliation: 1 Department of Psychology, University of Kentucky , Lexington, Kentucky.|7 Department of Psychiatry and Psychology, Mayo Clinic , Jacksonville, Florida.
authors.forename: Anne
authors.initials: A
authors.lastname: Shandera-Ochsner
authors.affiliation: 1 Department of Psychology, University of Kentucky , Lexington, Kentucky.
authors.forename: Jordan P
authors.initials: JP
authors.lastname: Harp
authors.affiliation: 5 Department of Physical Medicine and Rehabilitation, University of Kentucky , Lexington, Kentucky.|6 Lexington Veterans Affairs Medical Center , Lexington, Kentucky.
authors.forename: Walter M
authors.initials: WM
authors.lastname: High
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D001930:Brain Injuries / Q000453:epidemiology / Q000503:physiopathology* / Q000523:psychology; D003072:Cognition Disorders / Q000453:epidemiology / Q000503:physiopathology* / Q000523:psychology; D015897:Comorbidity; D005260:Female; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D009483:Neuropsychological Tests; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000503:physiopathology* / Q000523:psychology; D014481:United States; D014728:Veterans / Q000523:psychology / Q000706:statistics & numerical data; D055815:Young Adult
keywords: PTSD; assessment; mild TBI; veterans