Evaluation of objective and subjective clinical outcomes in combat veterans with and without mild TBI and PTSD: A four-group design

Self‐efficacy and coping style in Iraq and Afghanistan‐era veterans with and without mild traumatic brain injury and posttraumatic stress disorder

“…First, the comorbid group had significantly lower self‐efficacy than the control group for all three self‐efficacy subscales. This finding was consistent with our hypothesis as well as previous findings (Merritt et al, 2019) showing that Veterans with comorbid mTBI history and PTSD experience poorer functional outcomes and greater disability than those without these conditions—variables that could be related to, or influenced by, self‐efficacy and coping style. Furthermore, with regard to self‐efficacy related to cognition specifically, the mTBI‐only group had lower self‐efficacy compared to the combat‐exposed control group.…”

“…Furthermore, with regard to self‐efficacy related to cognition specifically, the mTBI‐only group had lower self‐efficacy compared to the combat‐exposed control group. This is a particularly interesting finding in light of previous research that has failed to find differences on objective cognitive testing in the chronic phase following mTBI (Brenner et al, 2010; Vasterling et al, 2012) or differences on neuropsychological measures across the four groups examined in this sample (Merritt et al, 2019). Although speculative, it is possible that this finding may have occurred due to the “expectation as etiology” phenomenon (Mittenberg et al, 1992; Silverberg & Iverson, 2011) or even the lack of adequate psychoeducation regarding recovery in the early stages following injury.…”

“…Finally, it is relevant to note that our findings are generally consistent with previous Veteran studies that have evaluated a wide range of clinical outcomes in comorbid mTBI and PTSD samples. Notably, several prior studies have found that PTSD status, rather than mTBI status, has a greater impact on neurobehavioral symptom reporting, psychiatric distress, and psychosocial outcome (Lange et al, 2020;Merritt et al, 2019;Polusny et al, 2011;Vanderploeg et al, 2009). Additionally, a prior study by Merritt et al (2019) using a similar CENC sample reported that Veterans with comorbid mTBI history and PTSD, and those with PTSD alone, endorsed less confidence in their abilities to work or engage in education when compared to Veterans with just mTBI history or combat controls with neither mTBI history nor PTSD.…”

“…Notably, several prior studies have found that PTSD status, rather than mTBI status, has a greater impact on neurobehavioral symptom reporting, psychiatric distress, and psychosocial outcome (Lange et al, 2020;Merritt et al, 2019;Polusny et al, 2011;Vanderploeg et al, 2009). Additionally, a prior study by Merritt et al (2019) using a similar CENC sample reported that Veterans with comorbid mTBI history and PTSD, and those with PTSD alone, endorsed less confidence in their abilities to work or engage in education when compared to Veterans with just mTBI history or combat controls with neither mTBI history nor PTSD. Our findings are largely consistent with these conclusions and bring to light the importance of harnessing these intrinsic, potentially malleable factors in treatment to improve the psychiatric and health-related outcomes of these populations.…”

Factors associated with employment and work perception in combat-exposed veterans.

“…Participants included combat-exposed Iraq/Afghanistan veterans primarily recruited from within a Veterans Affairs Medical Center as part of a larger Chronic Effects of Neurotrauma Consortium (CENC) project (Jurick et al, 2018; Merritt et al, 2019). Study procedures included structured interviews assessing combat-related experiences including TBI history and blast exposures as well as current psychiatric diagnoses, administration of self-report questionnaires, and a comprehensive neuropsychological assessment.…”