title: Prognostic Indicators of Persistent Post-Concussive Symptoms after Deployment-Related Mild Traumatic Brain Injury: A Prospective Longitudinal Study in U.S. Army Soldiers.
abstract: Mild traumatic brain injury (mTBI), or concussion, is prevalent in the military. The course of recovery can be highly variable. This study investigates whether deployment-acquired mTBI is associated with subsequent presence and severity of post-concussive symptoms (PCS) and identifies predictors of persistent PCS among US Army personnel who sustained mTBI while deployed to Afghanistan. We used data from a prospective longitudinal survey of soldiers assessed 1-2 months before a 10-month deployment to Afghanistan (T0), on redeployment to the United States (T1), approximately 3 months later (T2), and approximately 9 months later (T3). Outcomes of interest were PCS at T2 and T3. Predictors considered were: sociodemographic factors, number of previous deployments, pre-deployment mental health and TBI history, and mTBI and other military-related stress during the index deployment. The study sample comprised 4518 soldiers, 822 (18.2%) of whom experienced mTBI during the index deployment. After adjusting for demographic, clinical, and deployment-related factors, deployment-acquired mTBI was associated with nearly triple the risk of reporting any PCS and with increased severity of PCS when symptoms were present. Among those who sustained mTBI, severity of PCS at follow-up was associated with history of pre-deployment TBI(s), pre-deployment psychological distress, more severe deployment stress, and loss of consciousness or lapse of memory (versus being "dazed" only) as a result of deployment-acquired mTBI. In summary, we found that sustaining mTBI increases risk for persistent PCS. Previous TBI(s), pre-deployment psychological distress, severe deployment stress, and loss of consciousness or lapse of memory resulting from mTBI(s) are prognostic indicators of persistent PCS after an index mTBI. These observations may have actionable implications for prevention of chronic sequelae of mTBI in the military and other settings.
authors.affiliation: 1 Departments of Psychiatry and Family Medicine and Public Health, University of California San Diego , La Jolla, California; VA San Diego Healthcare System, San Diego, California.
authors.forename: Murray B
authors.initials: MB
authors.lastname: Stein
authors.affiliation: 2 Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences , Bethesda, Maryland.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Ursano
authors.affiliation: 3 Department of Psychiatry, University of California San Diego , La Jolla, California.
authors.forename: Laura
authors.initials: L
authors.lastname: Campbell-Sills
authors.affiliation: 4 National Institute of Mental Health , Rockville, Maryland.
authors.forename: Lisa J
authors.initials: LJ
authors.lastname: Colpe
authors.affiliation: 2 Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences , Bethesda, Maryland.
authors.forename: Carol S
authors.initials: CS
authors.lastname: Fullerton
authors.affiliation: 5 University of Michigan, Institute for Social Research , Ann Arbor, Michigan.
authors.forename: Steven G
authors.initials: SG
authors.lastname: Heeringa
authors.affiliation: 6 Department of Psychology, Harvard University , Cambridge, Massachusetts.
authors.forename: Matthew K
authors.initials: MK
authors.lastname: Nock
authors.affiliation: 7 Department of Health Care Policy, Harvard Medical School , Boston, Massachusetts.
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Sampson
authors.affiliation: 4 National Institute of Mental Health , Rockville, Maryland.
authors.forename: Michael
authors.initials: M
authors.lastname: Schoenbaum
authors.affiliation: 8 Department of Family Medicine and Public Health, University of California San Diego , La Jolla, California.
authors.forename: Xiaoying
authors.initials: X
authors.lastname: Sun
authors.affiliation: 8 Department of Family Medicine and Public Health, University of California San Diego , La Jolla, California.
authors.forename: Sonia
authors.initials: S
authors.lastname: Jain
authors.affiliation: 7 Department of Health Care Policy, Harvard Medical School , Boston, Massachusetts.
authors.forename: Ronald C
authors.initials: RC
authors.lastname: Kessler
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D001753:Blast Injuries / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D001924:Brain Concussion / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008889:Military Personnel / Q000523:psychology*; D038223:Post-Concussion Syndrome / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology*; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: concussion; deployment; mental health; military; stress; traumatic brain injury