Chronic Postconcussion Symptoms and Functional Outcomes in OEF/OIF Veterans with Self-Report of Blast Exposure

Abstract

Postconcussion symptoms (PCS) and functional outcomes were evaluated in 91 OEF/OIF outpatient veterans with reported histories of blast-exposure, with the goal of evaluating (1) the association between these outcomes and a clinical diagnosis of mild traumatic brain injury (mTBI) with or without loss of consciousness (LOC); and (2) the influence of post-traumatic stress disorder (PTSD) and depression on PCS reporting and perceived functional limitations. Individuals who reported mTBI with LOC had greater PCS complaints than individuals who reported mTBI without LOC or individuals without mTBI. However, after adjusting for severity of PTSD and depression symptoms, this group difference disappeared. Functional limitations were particularly prominent in the psychosocial domain. Again, PTSD was significantly associated with functional outcomes, but the mTBI with LOC group had greater psychosocial limitations than the other two groups, even when PTSD and depression symptoms were taken into account. These findings highlight the role of mental health in both outcomes, but additionally point to the impact of mTBI with LOC on long-term psychosocial adjustment.

Prospectively Assessed Clinical Outcomes in Concussive Blast vs Nonblast Traumatic Brain Injury Among Evacuated US Military Personnel

“…The exacerbation of depression and PTSD symptoms after concussive brain injury is consistent with investigations examining patients with blast TBI after loss of consciousness, 17 self-report surveys in Operation Enduring Freedom and Operation Iraqi Freedom veterans, 23 and subjective complaint measures comparing predeployment and postdeployment. 43 A recent retrospective study 44 reported similar findings specifically in Marines at 3 months after deployment; however, questions remained about the generalizability to other branches of the military and the longer-term effect on outcomes.…”

“…17,18 Findings from previous investigations comparing patients with blast vs nonblast TBI vary. Specifically, similarities have been observed in neurocognitive performance, 14,19,20 symptom complaints, 6,20 and mental health, 5,20 while other investigations have found individuals with blast TBI to be worse compared with individuals with nonblast TBI in all 3 of these domains 13 or solely in mental health.…”

Alterations in autobiographical memory for a blast event in Operation Enduring Freedom and Operation Iraqi Freedom veterans with mild traumatic brain injury.

“…Individuals were stratified based on whether they suffered a mTBI (n=50) or not (n=25) due to a blast exposure (see Methods). Participants were part of a larger research study involving neuropsychological testing, diagnostic interviews, and self-report questionnaires (see Verfaellie, Lafleche, Spiro, Tun, & Bousquet, 2013). Exclusion criteria for the larger study (see Verfaellie et al, 2013) included history of psychosis or neurological diagnosis except mTBI.…”

“…Participants were part of a larger research study involving neuropsychological testing, diagnostic interviews, and self-report questionnaires (see Verfaellie, Lafleche, Spiro, Tun, & Bousquet, 2013). Exclusion criteria for the larger study (see Verfaellie et al, 2013) included history of psychosis or neurological diagnosis except mTBI. Participants were also excluded if they demonstrated questionable effort (i.e., below 45 on the retention trial of the Test of Memory Malingering; Tombaugh, 1996).…”

“…TBI Interview-Evaluation of TBI was based on an extensive semi-structured interview performed by a clinical neuropsychologist, which queried the nature of participants' blast exposure(s) (see Verfaellie et al, 2013). During this interview, participants were first probed about the three most significant deployment-related blast events they had experienced.…”