Differences in Posttraumatic Stress Disorder, Depression, and Attribution of Symptoms in Service Members With Combat Versus Noncombat Mild Traumatic Brain Injury

Abstract

Objective: This study compares combat-related mild traumatic brain injury (mTBI) to non-combat-related mTBI in rates of posttraumatic stress disorder (PTSD) and depression after injury, severity of postconcussive symptoms (PCSs), and attribution of those symptoms to mTBI versus PTSD. Participants: A total of 371 active duty service members (SMs) with documented history of mTBI, divided into combat and non-combat-related cohorts. Design: Retrospective cohort study. Main Measures: Diagnoses of PTSD and depression based on medical record review and self-report. PCSs measured using Neurobehavioral Symptom Index. Attribution of symptoms based on a rating scale asking how much mTBI, PTSD, depression, deployment, or readjustment stress contributed to current symptoms. Results: Prevalence of PTSD was significantly higher after a combat-related mTBI, compared with a noncombat mTBI (P = .001). Prevalence of depression did not differ between the 2 groups. PCSs were high in both combat and noncombat mTBIs, with no statistical difference between groups. SMs with PTSD reported higher PCS, regardless of combat status. SMs without PTSD attributed symptoms mainly to mTBI, whereas SMs with PTSD, regardless of combat status, were much more likely to attribute symptoms to PTSD, depression, and deployment/readjustment stress. Conclusions: This research contributes to our understanding of the complex interplay between mTBI and PTSD in both combat and noncombat injuries within the military population and the importance of addressing both simultaneously.

Military TBI—What civilian primary care providers should know

“…Evidence shows that the characteristics of PTSD symptoms are also impacted by military-specific environments, as combat-related mTBI is linked to increased PTSD symptom severity when compared to noncombat related mTBI. [ 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.…”

Lifetime Traumatic Brain Injury and Risk of Post-Concussive Symptoms in the Millennium Cohort Study

“…Previous PCS studies in military populations are limited by methodological issues including small sample sizes, 6 , 34 , 38 , 46 the use of non-probability sampling, 6 , 38 , 47 or failure to include the number of TBIs the worker has experienced. 6 , 47 Although diagnosis of TBI has become more common with operations in Afghanistan and Iraq, few studies have considered the total count of TBI experienced by service members when examining the risk of PCS. Instead, they have defined TBI as either having it or not without consideration of the count.…”