Publication year
2010
Citation Title
Symptoms in military service members after blast mTBI with and without associated injuries.
Journal Name
NeuroRehabilitation
Journal Volume
26
Page Numbers
191-197
DOI
10.3233/NRE-2010-0555
Summary
Data from U.S. Military Service members who received mild traumatic brain injury (mTBI) due to explosive/blast munitions while deployed in Iraq assessed their current symptoms through surveys. This study explored the effects of both a physical wound and mTBI on stress-related emotional and somatic symptoms. Findings indicate that participants with mTBI but no bodily injury reported more physical, cognitive, affective, and sensory post-concussive symptoms and experienced more posttraumatic stress disorder (PTSD) symptoms.
Key Findings
Symptoms of PTSD (re-experiencing, avoidance, and hyper-arousal) were significantly higher among participants with mTBI but without bodily injury compared to those with mTBI and at least one additional associated injury.
Post-concussive symptoms (affective, cognitive, somatic, and sensory) were significantly higher among participants with mTBI and no bodily injury compared to those with mTBI and at least one additional associated injury.
Participants with more severe bodily injuries experienced fewer post-concussive symptoms and less severe PTSD symptoms.
Implications for Program Leaders
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
Provide outreach or additional screening for Service members who have elevated levels of PTSD symptoms and mTBI in the absence of bodily injury
Enhance education, activities, and curriculum related to coping behaviors and dealing with anxiety symptoms
Implications for Policy Makers
Continue to support resources for screening and the provision of acute treatment for soldiers with mTBI regardless of whether or not other associated injuries exist
Consider implementing additional programs to inform Service members, families, clinicians, and medical staff about PTSD and its symptoms
Recommend partnerships among military-based and community-based programs to help military families feel more comfortable accessing services that are not on installations
Methods
Veterans were interviewed at Brooke Army Medical Center, Fort Sam Houston, Texas and Wilford Hall Medical Center and at Lackland Air Force Base from January 2007-April 2009.
The severity of injuries throughout the body were calculated with the Abbreviated Injury Scale (AIS), post-concussive symptoms were measured with the Neurobehavioral Symptom Inventory (NSI), and PTSD was measured with the PTSD Checklist–Civilian version (PCL-C).
Symptoms on these measures were compared for participants with only mTBIs (Group 1) and those with mTBIs and at least one associated injury (Group 2). Researchers included age as a control variable in the analysis because Group 1 was significantly older than Group 2.
Participants
Participants included 274 U.S. Military Service members who received mTBIs due to explosive/blast munitions while deployed to a combat theater in Iraq and returned to the U.S. because of their injuries and/or subsequent symptoms.
All participants were male and were 18 to 50 years old (average age = 26.9).
Most participants identified as Army (88%), Marines (3%), Air Force (1%), and 8% Reserves/Guard.
Limitations
The study sample was comprised of male Active Duty servicemen, mostly Army Soldiers. Results may not generalize to women, Service members in other branches of the military, or non-military populations.
Findings may be specific only to Service members who sustained explosive/blast related injuries and were unable to return to combat.
The version of the PTSD scale used in the study was developed for civilians and there are limited data on how well this measure assessed PTSD in a Veteran sample.
Avenues for Future Research
Replicate the study with other populations, including other branches of the military and those with injuries that do not preclude returning to combat
Conduct a longitudinal study designed to follow Service members throughout their treatment may provide a more clear explanation for the pattern of results seen in the present study
Examine mTBIs that were a result of more diverse mechanisms of injury, such as physical abuse
Focus
Multiple Branches
Target Population
Population Focus
Military Branch
Military Component
Abstract
Traumatic combat events can lead to neurobehavioral and stress-related symptoms among military troops. Physical injuries received during combat are associated with increased symptom report. The effect of a concurrent mild traumatic brain injury (mTBI) on this relationship is unknown and forms the basis for this report. Subjects included a cohort of 274 male service members who received a blast-related mTBI during deployment in Iraq. They completed symptom ratings on the Posttraumatic Stress Disorder Checklist-Civilian version (PCL-C) and Neurobehavioral Symptom Inventory (NSI). Service members with mTBI, but no other associated physical injuries had higher symptom ratings than those who received mTBI plus associated injuries. Results suggest that in the presence of an invisible injury, such as mTBI, associated bodily injuries may be at least partially protective against the development of stress and neurobehavioral symptoms. It is proposed that an invisible wound, such as mTBI, creates ambiguity regarding the etiology of symptoms and expected course of recovery and leads to increased emotional and somatic symptom report. However, the observable nature of an associated physical injury and the systematic rehabilitation involved in recovery from such an injury provide a focus for attention and measurable progress toward recovery that serve to reduce emotionally-based symptom reports.
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