Association between combat stress and post-concussive symptom reporting in OEF/OIF service members with mild traumatic brain injuries.

OBJECTIVE: The relationship between combat stress and post-concussive symptoms in service members with mild traumatic brain injuries (mTBI) is poorly understood. It was hypothesized that the co-occurrence of combat stress would have a significant effect on the severity of post-concussive complaints, specifically on emotional and cognitive symptoms. METHODS: Four hundred and seventy-two combat-deployed service members with mTBI completed self-report inventories of post-traumatic stress and post-concussive symptoms. Two groups were formed based on post-traumatic stress symptoms (High Combat Stress and Low Combat Stress). RESULTS: A 3-8-fold increase in post-concussive symptoms was observed when comparing the High and Low Combat Stress Groups. Elevations in post-concussive symptom reporting were not limited to emotional and/or cognitive symptoms, but rather were inclusive of all measured post-concussive symptoms. CONCLUSIONS: The findings of the present study suggest that non-brain injury-related factors, such as high-levels of combat stress, may impact post-concussive symptom reporting in this population, further confounding the accuracy of the post-concussion syndrome (PCS) diagnosis. Considerable caution should be exercised in making the diagnosis of PCS in concussed service members with co-occurring combat-stress disorders.

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.

Routine TBI screening following combat deployments.

A precise estimate of the rates of traumatic brain injury (TBI) in returning combat troops is difficult to establish given the challenges of screening large numbers of military personnel returning from combat deployments. The Brief Traumatic Brain Injury Screen (BTBIS) was implemented in the First Marine Expeditionary Force between 2004 and 2006. Nine percent of the 7909 marines who completed the BTBIS were considered having a positive screen; that is, they endorsed at least one injury mechanism and indicated a change in mental status at the time of injury. The majority of combat-related TBI's were due to multiple injury agents with the next largest group related to blast exposure only. Most importantly, of those who screened positive for TBI 70.5% (n=500) were first identified by the screen. Service members who endorsed items on the BTBIS were contacted for follow-up assessment of persistent symptoms related to TBI and clinical referrals were made as needed. Given the rate of positive TBI screens in this non-referred sample of military personnel returning from a combat deployment, routine TBI screening appears valuable in screening individuals who might not be identified otherwise. Furthermore, this study appears to refute the contention that routine TBI screening will result in an over-identification of TBI in this population.