Skip to main content
×
×
Home

Neuropsychological outcomes of mild traumatic brain injury, post-traumatic stress disorder and depression in Iraq-deployed US Army soldiers

  • Jennifer J. Vasterling (a1), Kevin Brailey (a1), Susan P. Proctor (a2), Robert Kane (a3), Timothy Heeren (a4) and Molly Franz (a5)...
Abstract
Background

Traumatic brain injury (TBI) is a concern of contemporary military deployments. Whether milder TBI leads to enduring impairment remains controversial.

Aims

To determine the influence of deployment TBI, and posttraumatic stress disorder (PTSD) and depression symptoms on neuropsychological and functional outcomes.

Method

A sample of 760 US Army soldiers were assessed pre- and post-deployment. Outcomes included neuropsychological performances and subjective functional impairment.

Results

In total, 9% of the participants reported (predominantly mild) TBI with loss of consciousness between pre- and post-deployment. At post-deployment, 17.6% of individuals with TBI screened positive for PTSD and 31.3% screened positive for depression. Before and after adjustment for psychiatric symptoms, TBI was significantly associated only with functional impairment. Both PTSD and depression symptoms adjusted for TBI were significantly associated with several neuropsychological performance deficits and functional impairment.

Conclusions

Milder TBI reported by deployed service members typically has limited lasting neuropsychological consequences; PTSD and depression are associated with more enduring cognitive compromise.

    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Neuropsychological outcomes of mild traumatic brain injury, post-traumatic stress disorder and depression in Iraq-deployed US Army soldiers
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about sending content to Dropbox.

      Neuropsychological outcomes of mild traumatic brain injury, post-traumatic stress disorder and depression in Iraq-deployed US Army soldiers
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about sending content to Google Drive.

      Neuropsychological outcomes of mild traumatic brain injury, post-traumatic stress disorder and depression in Iraq-deployed US Army soldiers
      Available formats
      ×
Copyright
Corresponding author
Jennifer J. Vasterling, PhD, VA Boston Healthcare System, 150 S. Huntington Ave, Boston, MA 02130, USA. Email: jennifer.vasterling@va.gov
Footnotes
Hide All

See editorial, pp. 172–174, this issue.

Funding was provided by the US Department of Defense CDMRP (W81XWH-08-2-0035), US Army Medical Research and Materiel Command (DAMD 17-03-0020); and US Veterans Affairs Clinical Sciences Research and Development. The primary funding organisation had no role in the scientific aspects of the study or the preparation of the manuscript. The manuscript underwent scientific and administrative review within the US Army Research Institute for Environmental Medicine and US Army Medical Research and Materiel Command. The content of this article does not necessarily reflect the position or policy of the US government, and no official endorsement should be inferred.

Declaration of interest

J.J.V., K.B., S.P.P. and M.F. are US government employees.

Footnotes
References
Hide All
1 Dikmen SS, Corrigan JD, Levin HS, Machamer J, Stiers W, Weisskopf MG. Cognitive outcome following traumatic brain injury. J Head Trauma Rehabil 2009; 24: 430–8.
2 Rassovsky Y, Satz P, Alfano MS, Light RK, Zaucha K, McArthur DL, et al. Functional outcome in TBI II: verbal memory and information processing speed mediators. J Clin Exp Neuropsychol 2006; 28: 581–91.
3 Dikmen S, Machamer J, Fann JR, Temkin NR. Rates of symptom reporting following traumatic brain injury. J Int Neuropsychol Soc 2010; 16: 401–11.
4 Binder LM, Rohling ML, Larrabee GJ. A review of mild head trauma. Part I: meta–analytic review of neuropsychological studies. J Clin Exp Neuropsychol 1997; 19: 421–31.
5 Pertab JL, James KM, Bigler ED. Limitations of mild traumatic brain injury meta–analyses. Brain Inj 2009; 23: 498508.
6 Levin HS, Wilde E, Troyanskaya M, Petersen NJ, Scheibel R, Newsome M, et al. Diffusion tensor imaging of mild to moderate blast–related traumatic brain injury and its sequelae. J Neurotrauma 2010; 27: 683–94.
7 Brenner LA, Terrio H, Homaifar BY, Gutierrez PM, Staves PJ, Harwood JEF, et al. Neuropsychological test performance in soldiers with blast–related mild TBI. Neuropsychology 2010; 24: 160–7.
8 Ivins BJ, Kane R, Schwab KA. Performance on the Automated Neuropsychological Assessment Metrics in a nonclinical sample of soldiers screened for mild TBI after returning from Iraq and Afghanistan: a descriptive analysis. J Head Trauma Rehabil 2009; 24: 2431.
9 Rona RJ, Jones M, Fear NT, Hull L, Murphy D, Machell L, et al. Mild traumatic brain injury in UK military personnel returning from Afghanistan and Iraq: cohort and cross–sectional analyses. J Head Trauma Rehabil 2012; 27: 3344.
10 Hoge CW, McGurk D, Thomas JL, Cox AL, Engel CC, Castro CA. Mild traumatic brain injury in US Soldiers returning from Iraq. N Engl J Med 2008; 358: 453–63.
11 Tanielian T, Jaycox LH. Invisible Wounds of War: Psychological and Cognitive Injuries, their Consequences, and Services to Assist Recovery. RAND Corporation, 2008.
12 Bryant RA, O'Donnell ML, Creamer M, McFarlane AC, Clark CR, Silove D. The psychiatric sequelae of traumatic injury. Am J Psychiatry 2010; 167: 312–20.
13 Levin HS, McCauley SR, Pedroza Josic C, Boake C, Brown SA, Goodman HS, et al. Predicting depression following mild traumatic brain injury. Arch Gen Psychiatry 2005; 62: 523–8.
14 Hoge CW, Goldberg HM, Castro CA. Care of war veterans with mild traumatic brain injury – flawed perspectives. N Engl J Med 2009; 360: 1588–91.
15 David AS, Farrin L, Hull L, Unwin C, Wessely S, Wykes T. Cognitive functioning and disturbances of mood in UK veterans of the Persian Gulf War: a comparative study. Psychol Med 2002; 32: 1357–70.
16 Committee on Gulf War and Health: Brain Injuries in Veterans and Long–term Health Outcomes. Gulf War and Health, Volume 7: Long–Term Consequences of Traumatic Brain Injury. The National Academies Press, 2009.
17 Vasterling JJ, Proctor SP, Amoroso P, Kane R, Gackstetter G, Ryan MAK, et al. The Neurocognition Deployment Health Study: a prospective cohort study of Army Soldiers. Mil Med 2006; 171: 253–60.
18 Vasterling JJ, Proctor SP, Amoroso P, Kane R, Heeren T, White RF. Neuropsychological outcomes of army personnel following deployment to the Iraq war. JAMA 2006; 296: 519–29.
19 Tombaugh T. Test of Memory Malingering Manual. Multi–Health Systems, 1996.
20 King LA, King DW, Vogt DS, Knight J, Samper RE. Deployment Risk and Resilience Inventory: a collection of measures for studying deployment–related experiences of military personnel and veterans. Mil Psychol 2006; 18: 89120.
21 Luethcke CA, Bryan CJ, Morrow CE, Isler WC. Comparison of concussive symptoms, cognitive performance, and psychological symptoms between acute blast–versus nonblast–induced mild traumatic brain injury. J Int Neuropsychol Soc 2011; 17: 3645.
22 Ruggiero J, Del–Ben K, Scotti JR, Rabalais AE. Psychometric properties of the PTSD checklist–civilian version. J Trauma Stress 2003; 16: 495502.
23 Hotopf M, Hull L, Fear NT, Browne T, Horn O, Iversen A, et al. The health of UK military personnel who deployed to the 2003 Iraq war: a cohort study. Lancet 2006; 367: 1731–41.
24 Smith TC, Ryan MA, Wingard DL, Slymen DJ, Sallis JF, Kritz–Silverstein D. New onset and persistent symptoms of post–traumatic stress disorder self reported after deployment and combat exposures: prospective population based US military cohort study. BMJ 2008; 336: 366–71.
25 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (4th edn, revised) (DSM–IV–TR). APA, 2000.
26 Santor DA, Coyne JC. Shortening the CES–D to improve its ability to detect cases of depression. Psychol Assess 1997; 9: 233–43.
27 Selim AJ, Rogers W, Fleishman JA, Qian SX, Fincke BJ, Rothendler JA, et al. Updated U.S. population standard for the veterans RAND 12–item Health Survey (VR–12). Qual Life Res 2009; 18: 4352.
28 Stewart AL, Ware JE, Sherbourne CD, Wells KB. Psychological distress/well–being and cognitive functioning measures. In Measuring Functioning and Well–being: The Medical Outcomes Study Approach (eds Stewart AL, Ware JE): 102–42. Duke University, 1992.
29 Vanderploeg RD, Belanger HG, Curtiss G. Mild traumatic brain injury and posttraumatic stress disorder and their associations with health symptoms. Arch Phys Med Rehabil 2009; 90: 1084–93.
30 Fear NT, Jones E, Groom M, Greenberg N, Hull L, Hodgetts TJ, et al. 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. Psychol Med 2009; 39: 1379–87.
31 Schneiderman AI, Braver ER, Kang HK. 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. Am J Epidemiol 2008; 167: 1446–52.
32 Brewin CR, Kleiner JS, Vasterling JJ, Field AP. Memory for emotionally neutral information in posttraumatic stress disorder: a meta–analytic investigation. J Abnorm Psychol 2007; 116: 448–63.
33 Douglas KM, Porter RJ. Longitudinal assessment of neuropsychological function in major depression. Aust N Z J Psychiatry 2009; 43: 1105–17.
34 Southwick SM, Rasmusson A, Barron J, Arnsten A. Neurobiological and neurocognitive alterations in PTSD: a focus on norepinephrine, serotonin, and the hypothalamic–pituitary–adrenal axis. In Neuropsychology of PTSD: Biological, Cognitive, and Clinical Perspectives (eds Vasterling JJ, Brewin CR): 2758. Guilford Press, 2005.
35 Corrigan JD, Selassie AW, Orman JA. The epidemiology of traumatic brain injury. J Head Trauma Rehabil 2010; 25: 7280.
36 Wessely S, Unwin C, Hotopf M, Hull L, Ismail K, Nicolaou V, et al. Stability of recall of military hazards over time. Evidence from the Persian Gulf War of 1991. Br J Psychiatry 2003; 183: 314–22.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×
Type Description Title
PDF
Supplementary materials

Vasterling et al. supplementary material
Supplementary Table S1-S3

 PDF (50 KB)
50 KB

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 3 *
Loading metrics...

Abstract views

Total abstract views: 13 *
Loading metrics...

* Views captured on Cambridge Core between 3rd January 2018 - 22nd January 2018. This data will be updated every 24 hours.

Neuropsychological outcomes of mild traumatic brain injury, post-traumatic stress disorder and depression in Iraq-deployed US Army soldiers

  • Jennifer J. Vasterling (a1), Kevin Brailey (a1), Susan P. Proctor (a2), Robert Kane (a3), Timothy Heeren (a4) and Molly Franz (a5)...
Submit a response

eLetters

No eLetters have been published for this article.

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *