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Symptoms of post-concussional syndrome are non-specifically related to mild traumatic brain injury in UK Armed Forces personnel on return from deployment in Iraq: an analysis of self-reported data

  • N. T. Fear (a1), E. Jones (a2), M. Groom (a3), N. Greenberg (a1), L. Hull (a2), T. J. Hodgetts (a4) and S. Wessely (a2)
  • DOI:
  • Published online: 23 October 2008

Mild traumatic brain injury (mTBI) is being claimed as the ‘signature’ injury of the Iraq war, and is believed to be the cause of long-term symptomatic ill health (post-concussional syndrome; PCS) in an unknown proportion of military personnel.


We analysed cross-sectional data from a large, randomly selected cohort of UK military personnel deployed to Iraq (n=5869). Two markers of PCS were generated: ‘PCS symptoms’ (indicating the presence of mTBI-related symptoms: none, 1–2, 3+) and ‘PCS symptom severity’ (indicating the presence of mTBI-related symptoms at either a moderate or severe level of severity: none, 1–2, 3+).


PCS symptoms and PCS symptom severity were associated with self-reported exposure to blast whilst in a combat zone. However, the same symptoms were also associated with other in-theatre exposures such as potential exposure to depleted uranium and aiding the wounded. Strong associations were apparent between having PCS symptoms and other health outcomes, in particular being a post-traumatic stress disorder or General Health Questionnaire case.


PCS symptoms are common and some are related to exposures such as blast injury. However, this association is not specific, and the same symptom complex is also related to numerous other risk factors and exposures. Post-deployment screening for PCS and/or mTBI in the absence of contemporaneous recording of exposure is likely to be fraught with hazards.

Corresponding author
*Address for correspondence: N. T. Fear, D.Phil. (Oxon), Academic Centre for Defence Mental Health, King's College London, Weston Education Centre, 10 Cutcombe Road, London SE5 9RJ, UK. (Email:
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EB Blanchard , J Jones-Alexander , TC Buckley , CA Forneris (1996). Psychometric properties of the PTSD Checklist (PCL). Behavioural Research and Therapy 34, 669673.

T Chalder , G Berelowitz , T Pawlikowska , L Watts (1993). Development of a fatigue scale. Journal of Psychosomatic Research 37, 147153.

DP Goldberg , R Gater , N Sartorius , TB Ustun , M Piccinelli , O Gureje , C Rutter (1997). The validity of two versions of the GHQ in the WHO study of mental illness in general health care. Psychological Medicine 27, 191197.

C Hoge , A Terhakopian , CA Castro , SC Messer , CC Engel (2007). Association of posttraumatic stress disorder with somatic symptoms, health care visits, and absenteeism among Iraq war veterans. American Journal of Psychiatry 164, 150153.

CW Hoge , D McGurk , JL Thomas , A Cox , CC Engel , CA Castro (2008). Mild traumatic brain injuries among U.S. soldiers returning from Iraq. New England Journal of Medicine 358, 453463.

L Holm , JD Cassidy , LJ Carroll , J Borg (2005). Summary of the WHO Collaborating Centre for Neurotrauma Task Force on mild traumatic brain injury. Journal of Rehabilitation Medicine 37, 137141.

M Hotopf , L Hull , NT Fear , T Browne , O Horn , A Iversen , M Jones , D Murphy , D Bland , M Earnshaw , N Greenberg , J Hacker Hughes , AR Tate , C Dandeker , R Rona , S Wessely (2006). The health of UK military personnel who deployed to the 2003 Iraq war: a cohort study. Lancet 367, 17311741.

A Iversen , K Liddell , N Fear , M Hotopf , S Wessely (2006). Consent, confidentiality, and the Data Protection Act. British Medical Journal 332, 165169.

E Jones , N Fear , S Wessely (2007). Shell shock and mild traumatic brain injury: a historical review. American Journal of Psychiatry 164, 16411645.

CA McHorney , JE Ware Jr., AE Raczek (1993). The MOS 36-Item Short-Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Medical Care 31, 247263.

S Okie (2005). Traumatic brain injury in the war zone. New England Journal of Medicine 352, 20432047.

AI Schneiderman , ER Braver , HK Kang (2008). Understanding sequelae of injury mechanisms and mild traumatic brain injury incurred during the conflicts in Iraq and Afghanistan: Persistent postconcussive symptoms and posttraumatic stress disorder. American Journal of Epidemiology 167, 14461452.

G Simon , M Von Korff , M Piccinelli , C Fullerton , J Ormel (1999). An international study of the relation between somatic symptoms and depression. New England Journal of Medicine 341, 13291355.

AR Tate , M Jones , L Hull , NT Fear , R Rona , S Wessely , M Hotopf (2007). How many mailouts? Could attempts to increase the response rate in the Iraq war cohort study be counterproductive? BMC Medical Research Methodology 7, 51.

JE Ware Jr., CD Sherbourne (1992). The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Medical Care 30, 473483.

S Wessely , C Unwin , M Hotopf , L Hull , K Ismail , V Nicolaou , A David (2003). Stability of recall of military hazards over time. Evidence from the Persian Gulf War of 1991. British Journal of Psychiatry 183, 314322.

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