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2011 HSR&D National Meeting Abstract

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2011 National Meeting

1001 — The Differential Pattern of Post-Concussive Symptoms among Female Compared to Male OEF/OIF Veterans with Deployment-Related TBI

Baker EH (VA Boston Healthcare System, Center for Organization, Leadership & Management Research (COLMR)), Iverson KM (VA Boston Healthcare System, National Center for PTSD - Women's Health Division), Meterko M (VA Boston Healthcare System, COLMR), Stolzmann KL (VA Boston Healthcare System, COLMR), Hendricks A (VA Boston Healthcare System)

Objectives:
A significant proportion of women using VA services after deployment in Afghanistan and Iraq (OEF/OIF) screen positive for traumatic brain injury (TBI; 10.5%) or report having a prior diagnosis of TBI (2.0%). Research from the sports concussion literature suggests that women report worse post-concussive symptoms relative to men. A key component of the TBI evaluation process within VA is the administration of the 22-item Neurobehavioral Symptom Inventory (NSI-22), a self-report assessment of current post-concussive symptom severity. The present study examines whether women who have suffered concussion(s) while deployed demonstrate a different pattern of post-concussive symptoms than male Veterans.

Methods:
This study utilized NSI-22 data from 5,941 OEF/OIF Veterans, including 306 women, who underwent a comprehensive TBI evaluation in FY08-09 and were judged to have a history of concussion. These participants were stratified by etiology of concussion into three groups: Blast-only; non-Blast; and Blast plus non-Blast. Each group was further stratified by gender and post-traumatic stress disorder (PTSD) co-morbidity. Multi-item scale scores were computed representing Affective, Cognitive, Somatosensory and Vestibular symptom clusters, based on a prior factor analysis. A three-way multivariate analyses of variance was conducted, followed by a series of univariate analyses of variance.

Results:
Women demonstrated statistically and clinically significant higher severity score on all four factors compared to men. For the Affect (p = .004) and Cognition (p = .043) scales there were significant gender x etiology x PTSD interactions; for the Vestibular scale (p = .048) there was a significant gender x etiology interaction; for the Somatosensory scale gender did not interact with either variable.

Implications:
Women deployed to OEF/OIF experience concussions of all etiologies in meaningful numbers and have returned with more severe post-concussive symptoms than their male counterparts. The effects of Blast are more pronounced in women than men.

Impacts:
In caring for Veterans, female gender may predict more long-term post-concussive symptoms after deployment-related TBI, especially if the etiology was a blast. These differential effects indicate a critical need to proactively identify women Veterans with TBI and to provide appropriate treatment for their elevated post-conconcussive symptoms.


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