title: Psychiatric comorbidity effects on compensatory cognitive training outcomes for veterans with traumatic brain injuries.
abstract: OBJECTIVE
  To investigate the influence of posttraumatic stress disorder (PTSD) diagnosis, and PTSD and depression severity, on the postconcussive symptom trajectory over the course of a 1-year study period.
  
  
  METHODS
  Secondary analysis of a randomized controlled trial comparing veterans who received supported employment combined with compensatory cognitive training to those who received supported employment only. Assessments were conducted at baseline, 3- (postintervention), 6-, and 12-months. Participants were 50 Operation Enduring and Iraqi Freedom (OEF/OIF) veterans with a history of mild to moderate traumatic brain injury (TBI) who were unemployed, seeking work, and who had neuropsychological impairment. Of all participants, 74% met diagnostic criteria for PTSD. All participants received supported employment and half of the sample also received Cognitive Symptom Management and Rehabilitation Therapy (CogSMART), a 12-session, manualized compensatory cognitive training intervention.
  
  
  RESULTS
  Veterans with PTSD and greater depression severity endorsed significantly more severe postconcussive symptomatology at all assessment time points. However, the rate of CogSMART-associated improvement in postconcussive symptoms did not differ as a result of psychiatric symptomatology.
  
  
  CONCLUSIONS
  Study results suggest that for veterans with a history of mild to moderate TBI, presence of comorbid PTSD or depressive symptoms should not preclude participation in cognitive rehabilitation interventions.
authors.affiliation: Veterans Medical Research Foundation, VA San Diego Healthcare System.
authors.forename: Kristen H
authors.initials: KH
authors.lastname: Walter
authors.affiliation: Center of Excellence for Stress and Mental Health and Psychology Service, VA San Diego Healthcare System.
authors.forename: Amy J
authors.initials: AJ
authors.lastname: Jak
authors.affiliation: Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System.
authors.forename: Elizabeth W
authors.initials: EW
authors.lastname: Twamley
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D001930:Brain Injuries / Q000453:epidemiology*; D003072:Cognition Disorders / Q000453:epidemiology / Q000534:rehabilitation*; D015897:Comorbidity; D003866:Depressive Disorder / Q000453:epidemiology*; D016832:Employment, Supported / Q000523:psychology* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D038223:Post-Concussion Syndrome / Q000453:epidemiology / Q000534:rehabilitation; D012720:Severity of Illness Index; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014728:Veterans / Q000523:psychology* / Q000706:statistics & numerical data