Publication year
2008
Citation Title
Mild traumatic brain injury in U.S. soldiers returning from Iraq.
Journal Name
New England Journal of Medicine
Journal Volume
358
Issue Number
20
Page Numbers
453-463
DOI
10.1056/NEJMoa072972
Summary
Soldiers who had been deployed to Iraq answered questions about injuries they sustained during deployment, their psychological health, and their physical health. Results indicate that 15% of Soldiers sustained injuries consistent with mild traumatic brain injury, and that these injuries are associated with higher odds of depression, posttraumatic stress disorder (PTSD), and poor physical health.
Key Findings
Fifteen percent of Soldiers reported injuries during deployment consistent with mild traumatic brain injury (e.g., loss of consciousness or altered mental state).
Mild traumatic brain injury was strongly associated with PTSD symptoms. Forty-four percent of Soldiers who experienced loss of consciousness, and 27% of soldiers who experienced altered mental states reported symptoms consistent with PTSD.
Experiencing loss of consciousness was associated with higher odds of major depression, and of poorer overall physical health; experiencing an altered mental state was associated with higher odds of PTSD.
PTSD, depression, or both were associated with a variety of physical health problems after returning from deployment, including: stomach pain, chest pain, heart pounding, and sleep disturbance.
Implications for Program Leaders
Offer classes about PTSD and other mental health concerns, including information about common warning signs, symptoms, coping tools, and sources of help
Provide courses containing concrete information on the possible psychological and physical health implications of mild traumatic brain injury
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 expanding efforts to educate practitioners who work with returning Service members about the role that psychological issues can have on overall physical health and well-being
Support the development of a range of treatments for Service members and Veterans who have experienced a range of traumatic brain injuries
Promote reintegration programs that include attention to assisting Service members’ family in adjusting to the Service member’s return
Methods
This study used self-report questionnaires that participants completed at two U.S. Army combat brigades, one Active and one Reserve (59% completion rate).
Participants completed questionnaires about their experience with injuries during deployment (including nature of injury and intensity of combat experience, assessed with Combat Experience Scale), their physical health (assessed with the Patient Health Questionnaire), and their mental health (including major depressive disorder and PTSD, assessed with the Patient Health Questionnaire).
Statistical analyses were used to determine associations between combat injuries (particularly traumatic brain injury), and mental health status.
Participants
Two thousand seven hundred fourteen Army soldiers who had recently returned from deployment to Iraq completed surveys. Among them, 2,525 were included in analyses (149 were excluded for missing data, 40 excluded for unclear information about physical injuries sustained).
Participants were predominantly male (96%), under age 30 (56%), and were a junior enlisted rank (48%). These demographics are similar to the Army’s general pattern of demographics for those deployed to Iraq.
No other demographic data were provided.
Limitations
The cross-sectional design limits causal inferences.
The self-report nature of the data introduces the possibility of recall bias.
The exclusion of those with serious bodily injury could have produced underestimates of the impact of the relationships among these variables.
Avenues for Future Research
Conduct additional longitudinal designs to test for changes across time in the associations between physical health, psychological health, and combat experiences
Evaluate the associations between PTSD and physical health symptoms to determine how best to predict specific health problems based on an individual’s diagnosis of PTSD
Examine the extent to which length of time in military service impacts the relationship between PTSD and physical health outcomes
Focus
Army
Target Population
Population Focus
Military Branch
Military Component
Abstract
Background: An important medical concern of the Iraq war is the potential long-term effect of mild traumatic brain injury, or concussion, particularly from blast explosions. However, the epidemiology of combat-related mild traumatic brain injury is poorly understood. Methods: We surveyed 2525 U.S. Army infantry soldiers 3 to 4 months after their return from a year-long deployment to Iraq. Validated clinical instruments were used to compare soldiers reporting mild traumatic brain injury, defined as an injury with loss of consciousness or altered mental status (e.g., dazed or confused), with soldiers who reported other injuries. Results: Of 2525 soldiers, 124 (4.9%) reported injuries with loss of consciousness, 260 (10.3%) reported injuries with altered mental status, and 435 (17.2%) reported other injuries during deployment. Of those reporting loss of consciousness, 43.9% met criteria for post-traumatic stress disorder (PTSD), as compared with 27.3% of those reporting altered mental status, 16.2% with other injuries, and 9.1% with no injury. Soldiers with mild traumatic brain injury, primarily those who had loss of consciousness, were significantly more likely to report poor general health, missed workdays, medical visits, and a high number of somatic and postconcussive symptoms than were soldiers with other injuries. However, after adjustment for PTSD and depression, mild traumatic brain injury was no longer significantly associated with these physical health outcomes or symptoms, except for headache. Conclusions: Mild traumatic brain injury (i.e., concussion) occurring among soldiers deployed in Iraq is strongly associated with PTSD and physical health problems 3 to 4 months after the soldiers return home. PTSD and depression are important mediators of the relationship between mild traumatic brain injury and physical health problems.
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