Factors Associated with Mild Traumatic Brain Injury in Veterans and Military Personnel: A Systematic Review

Abstract

A history of mild traumatic brain injury (mTBI) is common among military members who served in Operations Enduring Freedom, Iraqi Freedom, and New Dawn (OEF/OIF/OND). We completed a systematic review to describe the cognitive, mental health, physical health, functional, social, and cost consequences of mTBI in Veteran and military personnel. Of 2668 reviewed abstracts, the 31 included studies provided very low strength evidence for the questions of interest. Cognitive, physical, and mental health symptoms were commonly reported by Veterans/military members with a history of mTBI. On average, these symptoms were not significantly more common in those with a history of mTBI than in those without, although a lack of significant mean differences does not preclude the possibility that some individuals could experience substantial effects related to mTBI history. Evidence of potential risk or protective factors moderating mTBI outcomes was unclear. Although the overall strength of evidence is very low due to methodological limitations of included studies, our findings are consistent with civilian studies. Appropriate re-integration services are needed to address common comorbid conditions, such as treatment for post-traumatic stress disorder, substance use disorders, headaches, and other difficulties that Veterans and members of the military may experience after deployment regardless of mTBI history. (JINS, 2014, 20, 1-13).

Characteristics of Veterans diagnosed with seizures within Veterans Health Administration

“…Moreover, among OIF/OEF/ OND Veterans with epilepsy, these numbers increased further to 52.6 and 70.4 percent for TBI and PTSD, respectively. As noted previously in another study, an estimated 12 to 23 percent of servicemembers returning from OIF/OEF/OND experienced a TBI in deployment [11] and among OEF/OIF/OND Veterans who used the VHA from October 01, 2001, to September 30, 2012, approximately 28.9 percent had a diagnosis of PTSD [13]. It is not known what proportion of seizure diagnoses affected by TBI and PTSD in the Veteran population is epileptic versus nonepileptic; prior studies suggest more of the latter.…”

“…In the wake of the more recent Iraq and Afghanistan conflicts (Operation Iraqi Freedom [OIF]/Operation Enduring Freedom [OEF]/ Operation New Dawn [OND]) and multiple deployments of military personnel, monitoring of returning Veterans becomes imperative. A systemic review on complications of mild TBI estimated that 12 to 23 percent of servicemembers returning from OIF/OEF/OND experienced a TBI in deployment [11]. A congressional study found that among OIF/OEF patients treated by the VHA from 2004 through 2009, 21 percent were diagnosed with PTSD [12].…”

The role of biomarkers and MEG-based imaging markers in the diagnosis of post-traumatic stress disorder and blast-induced mild traumatic brain injury

“…According to a recent U.S. Department Veterans Affairs (DVA) and Defense (DoD) report, 12-23% of returning service members reported a TBI during deployment (O'Neil et al, 2013). Of these, the majority are in the ''mild'' range of severity (mTBI) (Centers for Disease Control and Prevention and National Center for Injury Prevention and Control 2003;Hoge et al, 2009;O'Neil et al, 2013).…”

“…Brain changes that may accompany mTBI have been hard to visualize using standard imaging methods (Huang et al, 2012). While neurocognitive tests are used clinically and can be helpful, authors of the recent U.S. DVA Report observed that only a few studies among those reviewed found an association between mTBI and cognitive deficits (O'Neil et al, 2013). However, longitudinal follow-up of military personnel initially evacuated to Longstuhl with mTBI (self-report of war-related brain injury event) showed that rates of disability 6-12 months after evacuation were high and outcomes worse, overall in those service members with mTBI, comparable to those of civilian cohorts or polytrauma patients with mTBI (MacDonald et al, 2014).…”

“…According to a recent U.S. Department Veterans Affairs (DVA) and Defense (DoD) report, 12-23% of returning service members reported a TBI during deployment (O'Neil et al, 2013). Of these, the majority are in the ''mild'' range of severity (mTBI) (Centers for Disease Control and Prevention and National Center for Injury Prevention and Control 2003;Hoge et al, 2009;O'Neil et al, 2013). A review of the literature from 20th century wars (WWI, WWII, Vietnam) shows that current lines of scientific inquiry regarding the etiology of those symptoms parallel earlier attempts to disentangle the pathophysiology of post-concussive symptoms (PCS) from mental health symptoms, and to distinguish mTBI from war-related mental health syndromes, such as PTSD (Jones et al, 2007).…”