Risk factors for the presence and persistence of posttraumatic stress symptoms following traumatic brain injury in U.S. service members and veterans

Abstract

This study aimed to identify risk factors predictive of the presence and persistence of posttraumatic stress disorder (PTSD) symptom reporting following traumatic brain injury (TBI). Participants were 1,301 U.S. service members and veterans (SMVs) divided into four groups: uncomplicated mild TBI (mTBI; n = 543); complicated mild, moderate, severe, and penetrating TBI (n = 230); injured controls (n = 340); and noninjured controls (n = 188). We examined 25 factors related to demographic, injury-related, military-specific, treatment/health care need, and mental health/social support variables. Seven factors were statistically associated with the presence of DSM-IV-TR symptom criteria for PTSD: premorbid IQ, combat exposure, depression, social participation, history of mTBI, need for managing mood and stress, and need for improving memory and attention, p < .001 (51.3% variance). When comparing the prevalence of these risk factors in a longitudinal cohort (n = 742) across four PTSD trajectory groups (i.e., asymptomatic, improved, developed, persistent), a higher proportion of participants in the persistent PTSD group reported worse depression, a lack of social participation, and history of mTBI. Additionally, a higher proportion of participants in the persistent and developed PTSD groups reported the need for managing mood/stress and improving memory/attention. When considered simultaneously, the presence of ≥ 1 or ≥ 2 risk factors was associated with a higher proportion of participants in the developed and persistent PTSD groups, ps < .001. These risk factors may be useful in identifying SMVs at risk for the development and/or persistence of PTSD symptoms who may need intervention.

White Matter Alterations in Military Service Members With Remote Mild Traumatic Brain Injury

“…Prior studies have highlighted the increased risk of comorbid PTSD and mTBI among military service members compared with civilians. [87][88][89][90] This emphasizes the importance of assessing PTSD symptoms and associated neuropsychiatric symptoms in the management of military-related mTBI. Indeed, while neuroimaging metrics did not show superior discriminatory ability, they did facilitate the JAMA Network Open | Neurology identification of potential lesions associated with neuropsychiatric outcomes, which can be used to predict clinical progression and determine the most suitable treatment approach.…”

Traumatic brain injury and relationship distress during military deployment and reunion

“…Although our findings were comparable for the single‐item measures of marital stress and family stress versus the multi‐item measure of marital distress, a key agenda item is to capitalize on the superior psychometric qualities of multi‐item measures (e.g., Diamantopoulos et al, 2012). Fourth, we followed the precedent in the literature to operationalize postconcussive symptoms and PTSD symptoms globally (e.g., Agtarap et al, 2019; Lange et al, 2022; McDonald et al, 2021; Stein et al, 2016), but additional research is needed to tie those symptoms to TBI specifically. Finally, the duration of the study was fairly short and concluded 9 months after soldiers returned home from deployment.…”

“…Finally, the duration of the study was fairly short and concluded 9 months after soldiers returned home from deployment. Both postconcussive symptoms (McDonald et al, 2021) and PTSD symptoms (Lange et al, 2022; Lange, Lippa, et al, 2020) can linger for decades after brain injury, so a priority for future work is to track the effects of TBI on marriage over the long term.…”

“…Such findings underscore the importance of gaining a dyadic view of TBI within marriage. As an added bonus, data from couples could help illuminate family dynamics that may erode marital well‐being in the context of TBI, including lack of support (e.g., Anke et al, 2020; Lange et al, 2022) and caregiver burden (e.g., Brickell et al, 2018). Consequently, we advocate for research synthesizing the voices of both patients and spouses as a next step in supporting marital well‐being after brain injury.…”

“…Calls are growing to distinguish between postconcussive symptoms, which mark the physical aftermath of trauma, and PTSD symptoms, which mark the psychological aftermath of trauma (e.g., Agtarap et al, 2019; McDonald et al, 2021; O'Neil et al, 2021; Stein et al, 2016). Both postconcussive symptoms (McDonald et al, 2021; Stein et al, 2016) and PTSD symptoms (Lange et al, 2022; Lange, Lippa, et al, 2020; O'Neil et al, 2021) can linger or become chronic after people suffer a brain injury. Estimates suggest that service members who sustain TBI during deployment are approximately 4 times more likely to report persistent postconcussive symptoms (McDonald et al, 2021) and more than 40% will experience persistent PTSD symptoms (O'Neil et al, 2021), often for years after the injury occurred.…”