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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.

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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

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

Declaration of interest

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

Footnotes

References

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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.
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Supplementary Table S1-S3

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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)...

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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)...
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