Publication year
2013
Citation Title
Risk factors for post concussion symptom reporting after traumatic brain injury in U.S. Military service members.
Journal Name
Journal of Neurotrauma
Journal Volume
30
Issue Number
4
Page Numbers
237-246
DOI
10.1089/neu.2012.2685
Summary
One hundred twenty-five U.S. Military Service members who sustained a traumatic brain injury (TBI) underwent neurocognitive testing and completed brief psychological measures to identify factors associated with post concussion symptom reporting. Post concussional disorder symptom reporting was strongly associated with possible symptom exaggeration, poor effort, depression and traumatic stress.
Key Findings
Participants with less severe body injuries and/or less severe brain injury had a greater risk for meeting post concussional disorder criteria (e.g., headache, dizziness, sensitivity to light and sound).
Depression and traumatic stress symptoms were strongly associated with post concussive symptom reporting.
Post concussional disorder symptom reporting was strongly associated with possible symptom exaggeration and poor effort; more than half of those who screened positive for post concussional disorder experienced failure in effort testing.
Post concussive symptom reporting rarely occurred in the absence of depression, traumatic stress, symptom exaggeration, or poor effort; only 6% of the participants met post concussional disorder in the absence of one of these four factors.
Implications for Program Leaders
Educate families that the symptoms they see in their Service member (e.g., headache, dizziness) could be due to a range of factors, and a formal assessment by appropriately trained providers is important
Provide families and Service members with additional mental health resources and referrals when post concussional symptoms are reported
Offer workshops during reintegration to help families and Service members adjust to the Service member’s return, especially when the deployment has included combat exposure
Implications for Policy Makers
Recommend partnerships among military-based and community-based programs to help military families feel more comfortable participating in mental and physical health services that are not on installations
Continue to support programs for identification and prevention of traumatic brain injuries among Service members
Recommend training for community providers to educate them about unique factors that contribute to marital strain for military couples who have experience traumatic brain injuries
Methods
U.S. Military Service members who sustained a traumatic brain injury (TBI) and were evaluated at Walter Reed Army Medical Center one month to four years post-injury between 2002 and 2008 were asked for permission to use their clinical data for research purposes.
TBI severity was classified based on duration of loss of consciousness and post-traumatic amnesia.
The sample was divided into two groups: 65 patients who met DSM-IV diagnostic criteria for post concussional disorder and 60 who did not meet these criteria.
Participants completed several neuropsychological measures, a checklist of PTSD symptoms, a checklist of psychological symptoms, and the abbreviated injury scale that classified bodily injury.
Participants
One hundred twenty-five U.S. Military Service members participanted in this study. Participants' average age was 29.6 years (SD = 8.9, range = 18-56).
Seventy-four percent of injuries were sustained during OIF, 19% as a result of non-combat activities, and 6% during OEF.
Forty-six percent had uncomplicated mild traumatic brain injury (MTBI), 25% severe TBI, 18% moderate TBI, and 11% complicated MTBI.
Limitations
Several known factors associated with post concussional disorder were not included, limiting the ability to draw conclusions from these findings.
Information regarding external incentives or compensation status was not available, and these may have influenced symptom reporting.
PTSD and depression were assessed using self-report instead of more sophisticated means of assessing these diagnoses (e.g., medical provider).
Avenues for Future Research
Replicate the study and incorporate information on the methods (e.g., external incentives for post concussional disorder symptoms) to better understand the design of the study
Examine changes in post concussional disorder over time
Gather data on family members' reports of Service members' functioning and symptoms after a traumatic brain injury
Focus
Multiple Branches
Target Population
Population Focus
Military Branch
Military Component
Abstract
The purpose of this study was to identify factors that are predictive of, or associated with, postconcussion symptom reporting after traumatic brain injury (TBI) in the U.S. military. Participants were 125?U.S. military service members (age: M=29.6 years, standard deviation [SD]=8.9, range=18–56 years) who sustained a TBI, divided into two groups based on symptom criteria for postconcussional disorder (PCD): PCD-Present (n=65) and PCD-Absent (n=60). Participants completed a neuropsychological evaluation at Walter Reed Army Medical Center (M=9.4 months after injury, SD=9.9; range: 1.1 to 44.8). Factors examined included demographic characteristics, injury-related variables, psychological testing, and effort testing. There were no significant group differences for age, sex, education, race, estimated premorbid intelligence, number of deployments, combat versus non-combat related injury, or mechanism of injury (p>0.098 for all). There were significant main effects for severity of body injury, duration of loss of consciousness, duration of post-traumatic amnesia, intracranial abnormality, time tested post-injury, possible symptom exaggeration, poor effort, depression, and traumatic stress (p<0.044 for all). PCD symptom reporting was most strongly associated with possible symptom exaggeration, poor effort, depression, and traumatic stress. PCD rarely occurred in the absence of depression, traumatic stress, possible symptom exaggeration, or poor effort (n=7, 5.6%). Many factors unrelated to brain injury were influential in self-reported postconcussion symptoms in this sample. Clinicians cannot assume uncritically that endorsement of items on a postconcussion symptom checklist is indicative of residual effects from a brain injury.
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