Traumatic Brain Injury and PTSD:
A Synthesis of the Evidence

VA's Health Services Research and Development Services' (HSR&D) Evidence-Based Synthesis Program (ESP) recently produced an important synthesis report on traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD).

Investigators at the Minneapolis VAMC and HSR&D's Center for Chronic Disease Outcomes Research conducted a literature review to answer key questions regarding TBI and PTSD. The topic is important and timely because both VA and the DoD are serving a significant number of Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) Veterans with TBI, PTSD, or both.

Investigators examined data from 31 observational studies published between 1980 and June 2009, in addition to a large survey of OEF/OIF Veterans conducted by the RAND Corporation, to answer these questions:

1. What is the prevalence of comorbid TBI and PTSD?
2. What is the relative accuracy of diagnostic tests used to assess mild TBI, considered the most common form of this disorder, and comorbid PTSD?
3. What treatments are available for comorbid PTSD and mild TBI? And is there any evidence regarding the effectiveness or harms of different therapies?

Findings regarding question 1 showed that the reported prevalence of comorbid TBI and PTSD (TBI/PSTD) varies widely; for example, from 0% among medical patients recruited from a single neurology department to 70% in a clinical sample of patients with obsessive-compulsive disorder. In the RAND cohort, the prevalence rate of TBI/PTSD was 6.6%.

With regard to question 2, there were no published studies addressing the relative accuracy of diagnostic tests used for assessing history or symptoms of mild TBI or PTSD when one condition co-occurs with the other.

As for question 3, there also were no published studies that evaluated the effectiveness and harms of therapies in adults with these comorbid conditions.

Conclusions

Reviewed studies varied considerably by design, population, trauma etiology and severity, or mental health disorders; therefore, results could not be pooled across studies, few patterns could be discerned, and reliable outcome estimates could not be obtained for key patient groups. Thus, the authors suggest that long-term prospective observational studies are needed to validate measures of both history and symptoms of TBI and PTSD, in order to determine prevalence, severity, and long-term outcomes.

Carlson K, Kehle S, Meis L, Greer N, MacDonald R, Rutks I, Wilt TJ. The Assessment and Treatment of Individuals with History of Traumatic Brain Injury and Post-Traumatic Stress Disorder: A Systematic Review of the Evidence. Final Report, August, 2009. Department of Veterans Affairs, Health Services Research & Development Service, Evidence-Based Synthesis Program.

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This Management e-Brief is provided to inform you about recent HSR&D findings that may be of interest. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs. If you have any questions or comments about this Brief, please email CIDER. The Center for Information Dissemination and Education Resources (CIDER) is a VA HSR&D Resource Center charged with disseminating important HSR&D findings and information to policy makers, managers, clinicians, and researchers working to improve the health and care of Veterans.

This report is a product of the HSR&D Evidence-Based Synthesis Program (ESP), which was established to provide timely and accurate synthesis of targeted healthcare topics of particular importance to VA managers and policymakers - and to disseminate these reports throughout VA.

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