Postconcussion symptoms reported by Operation Enduring Freedom/Operation Iraqi Freedom veterans with and without blast exposure, mild traumatic brain injury, and posttraumatic stress disorder.
OBJECTIVE
This study examined symptom reporting related to the 10th Edition of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) criteria for postconcussional syndrome (PCS) in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) Veterans. Our aims were to: (a) examine relationships among PCS symptoms by identifying potential subscales of the British Columbia Postconcussion Symptom Inventory (BC-PSI); and (b) examine group differences in BC-PSI items and subscales in Veterans with and without blast exposure, mild traumatic brain injury (mTBI), and posttraumatic stress disorder (PTSD).


METHODS
Our sample included Veterans with blast-related mTBI history (n = 47), with blast exposure but no mTBI history (n = 20), and without blast exposure (n = 23). Overall, 37 Veterans had PTSD, and 53 did not. We conducted an exploratory factor analysis (EFA) of the BC-PSI followed by multivariate analysis of variance to examine differences in BC-PSI subscale scores by blast exposure, mTBI history, and PTSD.


RESULTS
BC-PSI factors were interpreted as cognitive, vestibular, affective, anger, and somatic. Items and factor scores were highest for Veterans with blast exposure plus mTBI, and lowest for controls. Vestibular, affective, and somatic factors were significantly higher for Veterans with blast exposure plus mTBI than for controls, but not significantly different for those with blast exposure but no mTBI. These results remained significant when PTSD symptom severity was included as a covariate. Cognitive, anger, and somatic subscales were significantly higher for Veterans with PTSD, though there was no interaction effect of PTSD and mTBI or blast history.


CONCLUSIONS
EFA-derived subscales of the BC-PSI differentiated Veterans based on blast exposure, mTBI history, and PTSD.
a Department of Psychiatry , Oregon Health & Science University , Portland , OR , USA.|b Department of Medical Informatics & Clinical Epidemiology , Oregon Health & Science University , Portland , OR , USA.|c VA Portland Health Care System , Portland , OR , USA.
Maya Elin
ME
O'Neil
c VA Portland Health Care System , Portland , OR , USA.
Megan
M
Callahan
c VA Portland Health Care System , Portland , OR , USA.|d School of Public Health , Oregon Health & Science University , Portland , OR , USA.
Kathleen F
KF
Carlson
c VA Portland Health Care System , Portland , OR , USA.
Mai
M
Roost
c VA Portland Health Care System , Portland , OR , USA.
Benjamin
B
Laman-Maharg
e Center of Excellence for Stress and Mental Health , VA San Diego Healthcare System , San Diego , CA , USA.|f Department of Psychiatry , University of California , San Diego , CA , USA.
Elizabeth W
EW
Twamley
g Department of Physical Medicine & Rehabilitation , Harvard Medical School , Charlestown , MA , USA.|h Home Base , Red Sox Foundation and Massachusetts General Hospital , Boston , MA , USA.|i MassGeneral Hospital for Children Sports Concussion Program , Boston , MA , USA.|j Defense and Veterans Brain Injury Center , Bethesda , MD , USA.
Grant L
GL
Iverson
a Department of Psychiatry , Oregon Health & Science University , Portland , OR , USA.|c VA Portland Health Care System , Portland , OR , USA.|k Department of Neurology , Oregon Health & Science University , Portland , OR , USA.
Daniel
D
Storzbach
D000328:Adult; D055826:Afghan Campaign 2001-; D001753:Blast Injuries / Q000150:complications* / Q000523:psychology; D001924:Brain Concussion / Q000150:complications* / Q000523:psychology; D000070642:Brain Injuries, Traumatic / Q000150:complications* / Q000523:psychology; D006801:Humans; D054542:Iraq War, 2003-2011; D009483:Neuropsychological Tests; D038223:Post-Concussion Syndrome / Q000175:diagnosis* / Q000209:etiology; D013313:Stress Disorders, Post-Traumatic / Q000150:complications* / Q000523:psychology; D014728:Veterans / Q000523:psychology*
Blast exposure; Concussion; Factor analysis; Head trauma; Posttraumatic stress disorder; Traumatic brain injury; Veterans Affairs