Prospective longitudinal evaluation of the effect of deployment-acquired traumatic brain injury on posttraumatic stress and related disorders: results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS).
OBJECTIVE
Traumatic brain injury (TBI) is increasingly recognized as a risk factor for deleterious mental health and functional outcomes. The purpose of this study was to examine the strength and specificity of the association between deployment-acquired TBI and subsequent posttraumatic stress and related disorders among U.S. Army personnel.


METHODS
A prospective, longitudinal survey of soldiers in three Brigade Combat Teams was conducted 1-2 months prior to an average 10-month deployment to Afghanistan (T0), upon redeployment to the United States (T1), approximately 3 months later (T2), and approximately 9 months later (T3). Outcomes of interest were 30-day prevalence postdeployment of posttraumatic stress disorder (PTSD), major depressive episode, generalized anxiety disorder, and suicidality, as well as presence and severity of postdeployment PTSD symptoms.


RESULTS
Complete information was available for 4,645 soldiers. Approximately one in five soldiers reported exposure to mild (18.0%) or more-than-mild (1.2%) TBI(s) during the index deployment. Even after adjusting for other risk factors (e.g., predeployment mental health status, severity of deployment stress, prior TBI history), deployment-acquired TBI was associated with elevated adjusted odds of PTSD and generalized anxiety disorder at T2 and T3 and of major depressive episode at T2. Suicidality risk at T2 appeared similarly elevated, but this association did not reach statistical significance.


CONCLUSIONS
The findings highlight the importance of surveillance efforts to identify soldiers who have sustained TBIs and are therefore at risk for an array of postdeployment adverse mental health outcomes, including but not limited to PTSD. The mechanism(s) accounting for these associations need to be elucidated to inform development of effective preventive and early intervention programs.
From the Department of Psychiatry, University of California San Diego, La Jolla, Calif.; the Department of Family Medicine and Public Health, University of California San Diego, La Jolla, Calif.; the VA San Diego Healthcare System, San Diego; the Department of Health Care Policy, Harvard Medical School, Boston; the University of Michigan, Institute for Social Research, Ann Arbor, Mich.; the National Institute of Mental Health, Bethesda, Md.; the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Md.; and the Department of Psychology, Harvard College, Cambridge, Mass.
Murray B
MB
Stein
From the Department of Psychiatry, University of California San Diego, La Jolla, Calif.; the Department of Family Medicine and Public Health, University of California San Diego, La Jolla, Calif.; the VA San Diego Healthcare System, San Diego; the Department of Health Care Policy, Harvard Medical School, Boston; the University of Michigan, Institute for Social Research, Ann Arbor, Mich.; the National Institute of Mental Health, Bethesda, Md.; the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Md.; and the Department of Psychology, Harvard College, Cambridge, Mass.
Ronald C
RC
Kessler
From the Department of Psychiatry, University of California San Diego, La Jolla, Calif.; the Department of Family Medicine and Public Health, University of California San Diego, La Jolla, Calif.; the VA San Diego Healthcare System, San Diego; the Department of Health Care Policy, Harvard Medical School, Boston; the University of Michigan, Institute for Social Research, Ann Arbor, Mich.; the National Institute of Mental Health, Bethesda, Md.; the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Md.; and the Department of Psychology, Harvard College, Cambridge, Mass.
Steven G
SG
Heeringa
From the Department of Psychiatry, University of California San Diego, La Jolla, Calif.; the Department of Family Medicine and Public Health, University of California San Diego, La Jolla, Calif.; the VA San Diego Healthcare System, San Diego; the Department of Health Care Policy, Harvard Medical School, Boston; the University of Michigan, Institute for Social Research, Ann Arbor, Mich.; the National Institute of Mental Health, Bethesda, Md.; the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Md.; and the Department of Psychology, Harvard College, Cambridge, Mass.
Sonia
S
Jain
From the Department of Psychiatry, University of California San Diego, La Jolla, Calif.; the Department of Family Medicine and Public Health, University of California San Diego, La Jolla, Calif.; the VA San Diego Healthcare System, San Diego; the Department of Health Care Policy, Harvard Medical School, Boston; the University of Michigan, Institute for Social Research, Ann Arbor, Mich.; the National Institute of Mental Health, Bethesda, Md.; the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Md.; and the Department of Psychology, Harvard College, Cambridge, Mass.
Laura
L
Campbell-Sills
From the Department of Psychiatry, University of California San Diego, La Jolla, Calif.; the Department of Family Medicine and Public Health, University of California San Diego, La Jolla, Calif.; the VA San Diego Healthcare System, San Diego; the Department of Health Care Policy, Harvard Medical School, Boston; the University of Michigan, Institute for Social Research, Ann Arbor, Mich.; the National Institute of Mental Health, Bethesda, Md.; the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Md.; and the Department of Psychology, Harvard College, Cambridge, Mass.
Lisa J
LJ
Colpe
From the Department of Psychiatry, University of California San Diego, La Jolla, Calif.; the Department of Family Medicine and Public Health, University of California San Diego, La Jolla, Calif.; the VA San Diego Healthcare System, San Diego; the Department of Health Care Policy, Harvard Medical School, Boston; the University of Michigan, Institute for Social Research, Ann Arbor, Mich.; the National Institute of Mental Health, Bethesda, Md.; the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Md.; and the Department of Psychology, Harvard College, Cambridge, Mass.
Carol S
CS
Fullerton
From the Department of Psychiatry, University of California San Diego, La Jolla, Calif.; the Department of Family Medicine and Public Health, University of California San Diego, La Jolla, Calif.; the VA San Diego Healthcare System, San Diego; the Department of Health Care Policy, Harvard Medical School, Boston; the University of Michigan, Institute for Social Research, Ann Arbor, Mich.; the National Institute of Mental Health, Bethesda, Md.; the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Md.; and the Department of Psychology, Harvard College, Cambridge, Mass.
Matthew K
MK
Nock
From the Department of Psychiatry, University of California San Diego, La Jolla, Calif.; the Department of Family Medicine and Public Health, University of California San Diego, La Jolla, Calif.; the VA San Diego Healthcare System, San Diego; the Department of Health Care Policy, Harvard Medical School, Boston; the University of Michigan, Institute for Social Research, Ann Arbor, Mich.; the National Institute of Mental Health, Bethesda, Md.; the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Md.; and the Department of Psychology, Harvard College, Cambridge, Mass.
Nancy A
NA
Sampson
From the Department of Psychiatry, University of California San Diego, La Jolla, Calif.; the Department of Family Medicine and Public Health, University of California San Diego, La Jolla, Calif.; the VA San Diego Healthcare System, San Diego; the Department of Health Care Policy, Harvard Medical School, Boston; the University of Michigan, Institute for Social Research, Ann Arbor, Mich.; the National Institute of Mental Health, Bethesda, Md.; the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Md.; and the Department of Psychology, Harvard College, Cambridge, Mass.
Michael
M
Schoenbaum
From the Department of Psychiatry, University of California San Diego, La Jolla, Calif.; the Department of Family Medicine and Public Health, University of California San Diego, La Jolla, Calif.; the VA San Diego Healthcare System, San Diego; the Department of Health Care Policy, Harvard Medical School, Boston; the University of Michigan, Institute for Social Research, Ann Arbor, Mich.; the National Institute of Mental Health, Bethesda, Md.; the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Md.; and the Department of Psychology, Harvard College, Cambridge, Mass.
Xiaoying
X
Sun
From the Department of Psychiatry, University of California San Diego, La Jolla, Calif.; the Department of Family Medicine and Public Health, University of California San Diego, La Jolla, Calif.; the VA San Diego Healthcare System, San Diego; the Department of Health Care Policy, Harvard Medical School, Boston; the University of Michigan, Institute for Social Research, Ann Arbor, Mich.; the National Institute of Mental Health, Bethesda, Md.; the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Md.; and the Department of Psychology, Harvard College, Cambridge, Mass.
Michael L
ML
Thomas
From the Department of Psychiatry, University of California San Diego, La Jolla, Calif.; the Department of Family Medicine and Public Health, University of California San Diego, La Jolla, Calif.; the VA San Diego Healthcare System, San Diego; the Department of Health Care Policy, Harvard Medical School, Boston; the University of Michigan, Institute for Social Research, Ann Arbor, Mich.; the National Institute of Mental Health, Bethesda, Md.; the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Md.; and the Department of Psychology, Harvard College, Cambridge, Mass.
Robert J
RJ
Ursano
D000328:Adult; D055826:Afghan Campaign 2001-; D001008:Anxiety Disorders / Q000453:epidemiology* / Q000523:psychology; D001924:Brain Concussion / Q000453:epidemiology* / Q000523:psychology; D001930:Brain Injuries / Q000453:epidemiology / Q000523:psychology; D015331:Cohort Studies; D003865:Major Depressive Disorder / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008889:Military Personnel / Q000523:psychology / Q000706:statistics & numerical data*; D060051:Occupational Injuries / Q000453:epidemiology* / Q000523:psychology; D015995:Prevalence; D011446:Prospective Studies; D012737:Sex Factors; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology* / Q000523:psychology; D059020:Suicidal Ideation; D013406:Suicide, Attempted / Q000523:psychology / Q000706:statistics & numerical data*; D015599:Trauma Severity Indices; D014481:United States / Q000453:epidemiology; D055815:Young Adult