title: Exploring the Relationship Between Mild Traumatic Brain Injury Exposure and the Presence and Severity of Postconcussive Symptoms Among Veterans Deployed to Iraq and Afghanistan.
abstract: OBJECTIVE
  The aim of this study was to describe the association between mild traumatic brain injury (mTBI) and persisting postconcussive symptoms according to symptom category, number, and severity.
  
  
  METHODS
  The study design was observational.
  
  
  METHODS
  The study sample comprised veterans (≥18 years of age) deployed in Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) conflicts who had not received any treatment for mTBI in the 30 days preceding study enrollment.
  
  
  METHODS
  Veterans were interviewed and completed testing in a single day. The Standard TBI Diagnostic Interview and the Clinician-Administered PTSD Scale were used. Testing included the Neurobehavioral Symptom Inventory and a full neuropsychological battery. Gold standard classification methods were utilized to determine presence/absence of mTBI. For each of the 5 symptom outcomes, an adjusted multiple linear regression model (negative binomial count models) accounting for effects of socio-demographic variables and behavioral health conditions was used.
  
  
  METHODS
  Self-report of neurobehavioral symptoms categorized as affective, cognitive, somatic, and vestibular symptoms, in addition to the instruments specified above.
  
  
  RESULTS
  OEF/OIF veterans with mTBI, relative to veterans with no mTBI, were observed to have 30% more symptoms overall (P < .001), 34% more somatic symptoms (P < .001), 22% more cognitive symptoms (P = .008), 15% more affective symptoms (P = .017), and 59% more vestibular symptoms (P < .001). For adjusted models, variables significantly related to number of symptoms across all 4 symptom categories were anxiety (all P < .001) and insomnia (all P < .001). For the adjusted models, variables significantly related to symptom severity across all 4 symptom categories were insomnia (all P < .001), depression (P < .001-.05) and anxiety (all, P < .001).
  
  
  CONCLUSIONS
  OEF/OIF veterans with mTBI, relative to veterans with no mTBI, have significantly more and significantly more severe persisting symptoms, with vestibular symptoms reported with the greatest frequency. After accounting for behavioral health conditions and socio-demographic factors, OEF/OIF veterans with mTBI compared to veterans without mTBI had significantly more cognitive, affective, vestibular, and somatic symptoms persisting 4.8 years after the mTBI event(s).
authors.affiliation: Department of Veterans Affairs (VA), Center for Management of Complex Chronic Care Center of Excellence, Edward Hines Jr. VA Hospital, Hines, IL; Edward Hines Jr. VA Hospital Research Service, Hines, IL; Department of Psychiatry, Neuropsychology Service, Dartmouth Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756.
authors.forename: Megan
authors.initials: M
authors.lastname: Baldassarre
authors.affiliation: Department of Veterans Affairs (VA), Center for Management of Complex Chronic Care Center of Excellence, Edward Hines Jr. VA Hospital, Hines, IL; Northwestern University Feinberg School of Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Veterans Affairs (VA), Spinal Cord Injury QUERI, Edward Hines Jr. VA Hospital, Hines, IL.
authors.forename: Bridget
authors.initials: B
authors.lastname: Smith
authors.affiliation: University of Kentucky College of Medicine, Department of Psychology, Lexington, KY.
authors.forename: Jordan
authors.initials: J
authors.lastname: Harp
authors.affiliation: Department of Veterans Affairs (VA), Center for Management of Complex Chronic Care Center of Excellence, Edward Hines Jr. VA Hospital, Hines, IL; Edward Hines Jr. VA Hospital Research Service, Hines, IL; Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Amy
authors.initials: A
authors.lastname: Herrold
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Chicago, IL; Northwestern University Feinberg School of Medicine, Chicago, IL; Departments of Physical Medicine and Rehabilitation, Neurosurgery, and Psychology, University of Kentucky College of Medicine, Lexington, KY.
authors.forename: Walter M
authors.initials: WM
authors.lastname: High
authors.affiliation: Southern Arizona VA Health Care System (3-124), Tucson, AZ.
authors.forename: Judith
authors.initials: J
authors.lastname: Babcock-Parziale
authors.affiliation: Department of Veterans Affairs (VA), Center for Management of Complex Chronic Care Center of Excellence, Edward Hines Jr. VA Hospital, Hines, IL; Edward Hines Jr. VA Hospital Research Service, Hines, IL; Department of Physical Medicine and Rehabilitation, Office of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Theresa
authors.initials: T
authors.lastname: Louise-Bender Pape
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D001930:Brain Injuries / Q000150:complications* / Q000175:diagnosis; D003071:Cognition / Q000502:physiology*; D005260:Female; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D009483:Neuropsychological Tests; D038223:Post-Concussion Syndrome / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D015995:Prevalence; D057566:Self Report; D012720:Severity of Illness Index; D014481:United States / Q000453:epidemiology; D014728:Veterans