Assessment and Treatment of Individuals with History of TBI and PTSD

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Investigators: Kathleen Carlson, PhD; Co-Investigators: Shannon Kehle, PhD and Laura Meis, PhD. Research Associates: Nancy Greer, PhD, Rod MacDonald, MS, and Indulis Rutks, BA. Director: Timothy J Wilt, MD, MPH. Washington (DC): Department of Veterans Affairs; August 2009.

Download PDF: Complete Report, Executive Summary, Report, Appendices

Summary / Overview

VA and Department of Defense (DoD) healthcare facilities are increasingly serving a large population of OEF/OIF veterans who have sustained traumatic brain injury (TBI), suffer from post-traumatic stress disorder (PTSD), or have both a history of TBI and current PTSD. Mild TBI (mTBI) is considered the most common form of TBI. Uncertainty exists regarding the long-term health outcomes of mTBI as well as the validity of criteria used to assess for a history of this injury. Current evidence-based practices to screen, diagnose, prospectively evaluate, and treat mTBI symptoms or PTSD may be less accurate or effective when these conditions co-occur. Thus, there is a need to develop an evidence base to identify best practices to define, diagnose, evaluate, and manage patients with mTBI/PTSD, particularly in U.S. veterans of OEF/OIF.

The systematic literature review addressed the following key questions:

1. What is the prevalence of comorbid TBI and PTSD? Does the reported prevalence vary by study population, trauma etiology, TBI severity (mild versus moderate and severe), or methods of case ascertainment?
2. 1. What is the prevalence of comorbid TBI and PTSD? Does the reported prevalence vary by study population, trauma etiology, TBI severity (mild versus moderate and severe), or methods of case ascertainment?
   2. What is the relative accuracy of diagnostic tests used for assessing PTSD when PTSD is comorbid with mTBI?
3. 1. Are there psychosocial or pharmacological therapies used for treatment of mTBI and PTSD simultaneously?
   2. Are therapies for treatment of mTBI effective when mTBI is comorbid with PTSD? Is there evidence of harms?
   3. Are therapies for treatment of PTSD effective when PTSD is comorbid with mTBI? Is there evidence of harms?

See also

• Cyber Seminar on Assessment and Treatment of Individuals with History of TBI and PTSD
• Traumatic Brain Injury and PTSD: A Synthesis of the Evidence (VA HSR&D Management e-Brief)
• Carlson K, Kehle SM, Meis LA, et al. Prevalence, Assessment, and Treatment of Mild Traumatic Brain Injury and Posttraumatic Stress Disorder: A Systematic Review of the Evidence. Journal of Head Trauma Rehabilitation. 2011;26(2):103-115.