Relationship of screen-based symptoms for mild traumatic brain injury and mental health problems in Iraq and Afghanistan veterans: Distinct or overlapping symptoms?

Abstract

Abstract-This study used factor analytic techniques to differentiate distinct from overlapping screen-based symptoms of traumatic brain injury (TBI), posttraumatic stress disorder (PTSD), and depression in Iraq and Afghanistan veterans. These symptoms were derived from screen results of 1,549 veterans undergoing Department of Veterans Affairs postdeployment screening between April 2007 and January 2010. Veterans with positive TBI screens were approximately twice as likely to also screen positive for depression and PTSD (adjusted relative risks = 1.9 and 2.1, respectively). Irritability was a shared symptom between TBI and PTSD, and emotional numbing was a shared symptom between PTSD and depression. Symptoms unique to TBI included dizziness, headaches, memory problems, and light sensitivity. Four separate constructs emerged: TBI, PTSD, depression, and a fourth construct consisting of hypervigilance and sleep problems. These findings illuminate areas of overlap between TBI and common postdeployment mental health problems. Discriminating symptoms of TBI from mental health problems may facilitate diagnosis, triage to specialty care, and targeted symptom management. The emergence of a fourth factor consisting of sleep problems and hypervigilance highlights the need to attend to specific symptoms in the postdeployment screening process.

Association between mild traumatic brain injury and mental health problems and self-reported cognitive dysfunction in Iraq and Afghanistan Veterans

“…In particular, postconcussive cognitive symptoms attributed to mTBI, such as trouble with memory and attention, have long been understood to overlap with symptoms of PTSD and depression [14][15][16]. Hoge et al found that, of Operation Iraqi Freedom (OIF) servicemembers who reported mTBI with loss of consciousness for <30 min, 44 percent met criteria for PTSD and 23 percent met criteria for depression [2].…”

“…While mTBI has been shown to have unique effects on health and functioning [20][21][22][23], we focus on the overlap of mTBI with PTSD and depression because these most commonly present together, and cognitive complaints are important overlapping features of all three conditions [11][12][13][14][15][16]. We hypothesize that self-reported cognitive symptoms that adversely affect daily functioning at the level of moderate to very severe are more strongly associated with individual mental health disorders and with mental health disorders in conjunction with mTBI than with mTBI alone.…”

Sleep disturbances, TBI and PTSD: Implications for treatment and recovery

“…The results suggest that sleep problems may be an early indicator of risk for PTSD or depression in TBI. Further, there is evidence that sleep problems can be considered a separate post-deployment health problem, distinct from PTSD, TBI, and depression (Maguen, Lau, Madden, & Seal, 2012). These and other research findings highlighted in this review, despite their methodological limitations, provide future research directions and suggest that early identification and treatment of sleep disturbance may potentially prevent the development and improve the outcome of mental health disorders, such as PTSD and depression.…”

“…The emergence of sleep as a distinct post-deployment factor (Maguen et al, 2012) highlights the need to address sleep disturbances in the clinical screening process and to develop sleep-specific treatment protocols. Moreover, sleep treatment has the potential to provide a non-stigmatizing entry into mental health services by focusing on a topic that Veterans may not consider to be ‘mental health treatment’, thereby maximizing engagement in treatment (Epstein, Babcock-Parziale, Herb, Goren, & Bushnell, 2013).…”

A Review of the Effectiveness of Neuroimaging Modalities for the Detection of Traumatic Brain Injury

“…13 Mental health issues, such as post-traumatic stress disorder (PTSD) and depression, also are strongly associated with TBI, especially in combat. 6,[14][15][16] Physical disturbances also are observed with TBI. Headache.…”