Sustaining a mild traumatic brain injury during combat is not associated with long-term negative psychosocial symptoms, unless combined with posttraumatic stress disorder, according to a study published Jan. 3 in the Archives of General Psychiatry.
Researchers at the Minneapolis Veterans Affairs Health Care System and the University of Minnesota Medical School analyzed survey results from 953 U.S. National Guard soldiers serving in Iraq both 1 month before returning home and 1 year later (Arch. Gen. Psychiatry 2011; 68:79-89). After the investigators controlled for PTSD symptoms at the time of the second survey, no differences were found between soldiers who reported a mild traumatic brain injury and those who had not sustained a brain injury in terms of depression, problematic drinking, social functioning, and quality of life.
The researchers also found that there were no differences on postdeployment psychosocial outcomes between soldiers with comorbid mild traumatic brain injury and PTSD, and those with only PTSD. Soldiers with PTSD-only also reported higher levels of depression, lower social functioning, and lower quality of life than did soldiers with mild traumatic brain injury alone, according to the study. The study does not address the impact of repeated concussions or of moderate to severe traumatic brain injury.
The findings are consistent with previous research in the civilian population, which showed that a history of concussion does not result in negative health effects beyond a few weeks, Melissa A. Polusny, Ph.D., the lead study investigator and a staff psychologist at the Minneapolis VA Medical Center, said in an interview. "We haven’t known in the veteran literature whether combat-related concussion may somehow be different and what the long-term impact of those experiences might be," she said. "Once you account for the effects of PTSD, we’re not seeing a lot of long-term impact from mild TBI."
For clinicians, one of the take home messages of the study is that if a veteran reports postconcussive symptoms months or a year after the event, it is important to thoroughly assess for PTSD, since PTSD could be driving those symptoms. "One of the things we know is that there are very effective treatments for PTSD and so making sure that veterans are appropriately assessed for PTSD symptoms and given access to evidence-based treatment for PTSD is really crucial," Dr. Polusny said.
The study also revealed a significant increase in reports of concussion/mild traumatic brain injury in the second survey given to the soldiers. The rate of self-reported concussion/mild traumatic brain injury sustained in Iraq was 9.2% at 1 month before returning home, but jumped to 22% a year later. The difference could be attributable to recall bias, poor reliability of the survey instrument, or other factors such as a reluctance to report health problems while serving in combat. More research is needed to figure out why the reports of injury increased.
The researchers reported no financial conflicts. The study was based on work supported in part by the Department of Veterans Affairs.