Correlates of Depression in U.S. Military Service Members With a History of Mild Traumatic Brain Injury.

OBJECTIVES: Post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI) are identified as signature injuries of the Wars in Iraq and Afghanistan. Statistics have confirmed a high incidence of PTSD among military personnel with mild TBI (mTBI) who served in these conflicts. Although receiving less attention, individuals with a history of mTBI are also at increased risk for depressive disorders. This study examines the incidence and correlates of depression in service members with a history of mTBI received an average of 4-1/2 years prior to evaluation. METHODS: Retrospective analysis of 184 service members with a history of mTBI extracted from a data repository maintained at a military medical center. RESULTS: One-third of the sample (34.2%) was clinically diagnosed with a depressive disorder in the month preceding evaluation. Of those with depression, 81% (51 of 63) were also diagnosed with PTSD. Proportionately more women than men had depression. Depression was more common among those who were undergoing a Military Evaluation Board and those who served in more than three combat deployments. CONCLUSIONS: Results confirm chronically elevated the rates of depressive disorders and PTSD comorbidity among service members with a history of mTBI. Depression screening and treatment within the Military Health System should remain a priority for service members reporting a remote history of mTBI. Individuals with chronic PTSD, women, service members undergoing MEB and those who served in greater than three combat deployments are at particular risk.

Symptoms in military service members after blast mTBI with and without associated injuries.

Traumatic combat events can lead to neurobehavioral and stress-related symptoms among military troops. Physical injuries received during combat are associated with increased symptom report. The effect of a concurrent mild traumatic brain injury (mTBI) on this relationship is unknown and forms the basis for this report. Subjects included a cohort of 274 male service members who received a blast-related mTBI during deployment in Iraq. They completed symptom ratings on the Posttraumatic Stress Disorder Checklist-Civilian version (PCL-C) and Neurobehavioral Symptom Inventory (NSI). Service members with mTBI, but no other associated physical injuries had higher symptom ratings than those who received mTBI plus associated injuries. Results suggest that in the presence of an invisible injury, such as mTBI, associated bodily injuries may be at least partially protective against the development of stress and neurobehavioral symptoms. It is proposed that an invisible wound, such as mTBI, creates ambiguity regarding the etiology of symptoms and expected course of recovery and leads to increased emotional and somatic symptom report. However, the observable nature of an associated physical injury and the systematic rehabilitation involved in recovery from such an injury provide a focus for attention and measurable progress toward recovery that serve to reduce emotionally-based symptom reports.

Posttraumatic stress symptoms in OIF/OEF service members with blast-related and non-blast-related mild TBI.

PURPOSE: To examine the proportion and severity of stress-related symptoms in U.S. service members with mild traumatic brain injuries (mTBI) received during deployment to Operation Iraqi Freedom (OIF) or Operation Enduring Freedom (OEF). Stress-related symptoms reported by service members with mTBI from explosive munitions are compared to symptoms reported by those with mTBI received from other mechanisms (i.e. falls, motor vehicle accidents). METHODS: Posttraumatic stress, as measured by scores on the Posttraumatic Stress Disorder Checklist (PCL-C), for a sample of 586 OIF/OEF service members with blast-related mTBI was compared to a sample of 138 OIF/OEF service members with non-blast mTBI selected from retrospective review of research records. RESULTS: Re-experiencing symptoms such as flashbacks and nightmares were higher for the blast mTBI group than for the non-blast mTBI group. Symptoms on other PTSD clusters and total score did not significantly differ between groups. Equivalent proportions of the blast and non-blast groups endorsed severe PTSD symptoms, with total PCL-C scores greater than or equal to 50. CONCLUSIONS: Consistent with prior reports, high levels of posttraumatic stress symptoms occur in a substantial proportion of service members who experienced deployment-related blast and non-blast mTBI. Results suggest that the psychological rehabilitation of OIF/OEF service members with mTBI from explosive blast should include particular attention to addressing re-experiencing symptoms.

Posttraumatic stress disorder and posttraumatic stress disorder-like symptoms and mild traumatic brain injury.

In this article, we review the literature on posttraumatic stress disorder (PTSD) and PTSD-like symptoms that can occur along with mild traumatic brain injury (TBI) and concussion, with specific reference to concussive injuries in the military. We address four major areas: (1) clinical aspects of TBI and PTSD, including diagnostic criteria, incidence, predictive factors, and course; (2) biological overlap between PTSD and TBI; (3) comorbidity between PTSD and other mental disorders that can occur after mild TBI; and (4) current treatments for PTSD, with specific considerations related to treatment for patients with mild TBI or concussive injuries.