Differences in Post-Traumatic Stress Disorder Symptoms among Post-9/11 Veterans with Blast- and Non-Blast Mild Traumatic Brain Injury

Ryan-Gonzalez, Clark; Kimbrel, Nathan A.; Meyer, Eric C.; Gordon, Evan M.; DeBeer, Bryann B.; Gulliver, Suzy B.; Elliott, Timothy R.; Morissette, Sandra B.

doi:10.1089/neu.2017.5590

Cited by 21 publications

(12 citation statements)

References 44 publications

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“…Substantial research has attempted to elucidate these outcomes which has provided important insights and paved the way for future efforts. However, it has primarily be reliant upon self-report [6][7][8][9][10] or retrospective records 8,11 , with single time point of assessment 6,[10][11][12][13] , and lumping together all chronic injury 8,12,14 .…”

Section: Introductionmentioning

confidence: 99%

Comparison of Clinical Outcomes 1 and 5 Years Post-Injury Following Combat Concussion

et al. 2021

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ObjectiveTo compare 1-year and 5-year clinical outcomes in 2 groups of combat-deployed-non-brain-injured service members to 2 groups of combat-related concussion to better understand long-term clinical outcome trajectories.MethodsThis prospective, observational, longitudinal multi-cohort study examined 4 combat-deployed groups: non-head-injured controls with or without blast exposure, and patients with combat concussion arising from blast or blunt trauma. 1-year and 5-year clinical evaluations included identical batteries for neurobehavioral, psychiatric, and cognitive outcomes. Three hundred forty-seven participants completed both time points of evaluation. Cross-sectional and longitudinal comparisons were assessed. Overall group-effect was modelled as a four-category variable with rank regression adjusting for demographic factors using a two-sided significance threshold of 0.05, with post-hoc Tukey p-values calculated for the pairwise comparisons.ResultsSignificant group differences in both combat concussion groups were identified cross-sectionally at 5-year follow-up compared to controls in domains of neurobehavioral-NRS (Cohen's-d, −1.10 to −1.40, CIs [−0.82: −1.32] to [−0.97: −1.83] by group), and psychiatric-CAPS (Cohen's-d, −0.91 to −1.19, CIs [−0.63: −1.19] to [−0.76: −1.62] by group) symptoms with minimal differences in cognitive performance. Both combat concussion groups also showed clinically significant decline from 1-to-5-year evaluation (66%–76% neurobehavior-NRS; 41%–54% psychiatric-CAPS by group). Both control groups fared better but a subset also had clinically significant decline (37%–50% neurobehavior-NRS; 9%–25% psychiatric-CAPS by group).ConclusionsThere was an evolution not resolution of symptoms from 1-to-5-year evaluation challenging the assumption that chronic stages of concussive injury are relatively stable. Even some of the combat-deployed controls worsened. The evidence supports new considerations for chronic trajectories of concussion outcome in combat-deployed service members.

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Section: Introductionmentioning

confidence: 99%

Comparison of Clinical Outcomes 1 and 5 Years Post-Injury Following Combat Concussion

et al. 2021

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“…Multiple studies have demonstrated significant central nervous system (CNS) damage after blast exposure in both humans and laboratory models 2–14. Residual effects of blast exposure in patients include decreased auditory function,13,15–17 increased incidence of posttraumatic headache,18 development of PTSD,19 difficulty with cognitive tasks,20 and an increased incidence of affective disorders 21. Damage to and dysfunction of the visual system are common after bTBI, which results in anatomic damage, convergence difficulties, decreased visual acuity, light sensitivity, ocular motility, and increased visual field loss 10,22…”

mentioning

confidence: 99%

Blast Preconditioning Protects Retinal Ganglion Cells and Reveals Targets for Prevention of Neurodegeneration Following Blast-Mediated Traumatic Brian Injury

Harper

Woll

Evans

et al. 2019

Invest. Ophthalmol. Vis. Sci.

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“…[ 30 ] Exposure to blast, in particular, is associated with increased diagnosis and symptom severity of PTSD when compared to nonblast related mTBI. [ 31 ] The cooccurrence of mTBI and PTSD can uniquely influence diagnoses, since they are each associated with symptoms including insomnia, fatigue, irritability, depression, anxiety, emotional numbing, avoidance, trouble concentrating, memory deficits, and hyperarousal. [ 32 ]…”

Section: Comorbiditiesmentioning

confidence: 99%

Military TBI—What civilian primary care providers should know

Lindberg¹,

Sloley

Ivins

et al. 2021

Journal of Family Medicine and Primary Care

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In June 2019, the Department of Veterans Affairs (VA) launched the VA Mission Act, which expanded veterans’ health-care access to the private sector. Since civilian primary care providers may see more veterans in their practice, it will be important to understand the unique experiences, comorbidities, and culture of this population in order to provide optimal care. Military service members (SMs) are at an increased risk for traumatic brain injury (TBI), and comorbidities, such as post traumatic stress disorder (PTSD), increasing the likelihood of prolonged symptoms. Military training and repetitive low-level blast exposure may cause symptoms similar to TBI or increase long-term negative effects in SMs. Military culture often has a strong influence in this population. Those who serve in the military identify with military values and have a strong team mentality, which places emphasis on the mission above all else, not accepting defeat, and not ever leaving a fellow SM behind. These values can impact the way a SM/veteran seeks care and/or communicates with his or her health-care provider. Taking a detailed history to understand how these factors apply, as well as screening for mental health comorbidities, are recommended. Understanding the military cultural influences can assist in promoting a stronger therapeutic alliance and encourage more open communication. Ultimately, it is the trusting and respectful relationship between the SM/veteran and the provider that will determine the most effective treatment and result in the most effective resolution of TBI and comorbid symptoms.

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Differences in Post-Traumatic Stress Disorder Symptoms among Post-9/11 Veterans with Blast- and Non-Blast Mild Traumatic Brain Injury

Cited by 21 publications

References 44 publications

Comparison of Clinical Outcomes 1 and 5 Years Post-Injury Following Combat Concussion

Comparison of Clinical Outcomes 1 and 5 Years Post-Injury Following Combat Concussion

Blast Preconditioning Protects Retinal Ganglion Cells and Reveals Targets for Prevention of Neurodegeneration Following Blast-Mediated Traumatic Brian Injury

Military TBI—What civilian primary care providers should know

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