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RRP 08-252 – QUERI Project

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RRP 08-252
Mild TBI/PTSD Comorbidity and Post-Deployment Outcomes in National Guard Soldiers
Melissa A. Polusny PhD
Minneapolis VA Health Care System, Minneapolis, MN
Minneapolis, MN
Funding Period: July 2008 - December 2008

BACKGROUND/RATIONALE:
Traumatic Brain Injury (TBI) due to explosive blasts is considered the "signature injury" of Operations Enduring Freedom (OEF) and Operations Iraqi Freedom (OIF), with the majority of TBI's sustained being mild in severity (mTBI). Data regarding rates of mTBI in military personnel is very limited with only one published study suggesting that as many as 15% of recently returned OIF soldiers reported mTBI while serving in Iraq. MTBI is strongly associated with co-morbid posttraumatic stress disorder (PTSD) and poorer physical outcomes. Despite increasing attention from DoD and VA calling for the urgent need to identify and provide appropriate follow up care for blast injuries, mTBI, and PTSD in returning OEF/OIF veterans, the evidence base for best practices in the identification or treatment of both mTBI and mTBI/PTSD comorbidity remains in its infancy. The primary goal of this project was to longitudinally examine rates of mTBI/PTSD comorbidity and associated TBI/PTSD screening and health care utilization experiences in new veterans one year following deployment to Iraq.

OBJECTIVE(S):
The primary objectives of this study were to describe the scope of mTBI/PTSD comorbidity among returning National Guard OIF veterans and to identify the extent to which these problems impacted veterans' psychosocial functioning, physical health, and quality of life over time. We also examined variation in new OIF veterans' experiences with VA by mTBI and probable PTSD status.

METHODS:
We conducted a follow-up survey of an existing representative sample of National Guard soldiers deployed to Iraq who provided in-theater screening data on blast exposure and PTSD symptoms one month before returning home (Time 1). Approximately one year following soldiers' return from OIF (Time 2), we used standard mailed survey methodology to collect valid and reliable self-report measures of deployment related experiences including combat exposure, exposure to explosive blasts and injuries sustained during deployment, mTBI and post-concussive symptoms, current psychosocial functioning and physical health. We assessed veterans' self-reported access and use of VA health care services as well as their screening and referral experiences. Prevalence and proportions were examined using Chi-square analyses. A series of one-way ANOVAs (no mTBI or PTSD, mTBI only, PTSD only, and mTBI + PTSD) were used to examine differences in primary post-deployment outcomes.

FINDINGS/RESULTS:
Of the 1,892 veterans surveyed, 953 (50%) responded at Time 2. Time 2 respondents and nonrespondents did not differ at Time 1 on gender, ethnicity, in-theater blast exposure, or PTSD symptoms. Half of OIF veterans reported exposure to explosive blast in theater. The rate of self-reported mTBI (injury with altered mental status or loss of consciousness) was 9% at Time 1; the rate of self-reported mTBI increased to nearly 21% at Time 2. Rates of probable PTSD (7% at Time 1 and 14% at Time 2) and probable depression (9% at Time 1 and 18% at Time 2) both doubled during the one year following deployment. One year post-deployment, 40% reported problematic drinking while 29% reported clinically significant somatic complaints. Those with probable PTSD, regardless of mTBI status, reported greater depressive symptoms, greater problematic alcohol use, more somatic complaints, lower quality of life, and poorer social adjustment. There were minimal differences between those reporting mTBI and those with no mTBI/PTSD on psychosocial outcomes. The majority had accessed the VA within the first year after their return from deployment (70%), and higher rates of self-reported VA care were also observed among those OIF veterans reporting mTBI and/or probable PTSD. High rates of screening and referral were observed across post-deployment concerns. Minimal differences were observed across OIF veterans' VA experiences based on mTBI/PTSD status.

IMPACT:
Self-reported rates of mTBI and mental health problems increased during the year following deployment. OIF veterans with probable PTSD, regardless of mTBI status, reported poorer psychosocial functioning across multiple domains.

PUBLICATIONS:

Journal Articles

  1. Nelson NW, Anderson CR, Thuras P, Kehle-Forbes SM, Arbisi PA, Erbes CR, Polusny MA. Factors associated with inconsistency in self-reported mild traumatic brain injury over time among military personnel in Iraq. The British Journal of Psychiatry; The Journal of Mental Science. 2015 Mar 1; 206(3):237-44.
  2. Polusny MA, Kehle SM, Nelson NW, Erbes CR, Arbisi PA, Thuras P. Longitudinal effects of mild traumatic brain injury and posttraumatic stress disorder comorbidity on postdeployment outcomes in national guard soldiers deployed to Iraq. Archives of general psychiatry. 2011 Jan 1; 68(1):79-89.
  3. Gewirtz AH, Polusny MA, DeGarmo DS, Khaylis A, Erbes CR. Posttraumatic stress symptoms among National Guard soldiers deployed to Iraq: associations with parenting behaviors and couple adjustment. Journal of consulting and clinical psychology. 2010 Oct 1; 78(5):599-610.
  4. Ferrier-Auerbach AG, Erbes CR, Polusny MA, Rath CM, Sponheim SR. Predictors of emotional distress reported by soldiers in the combat zone. Journal of psychiatric research. 2010 May 1; 44(7):470-6.
Conference Presentations

  1. Polusny MA, Kehle SM, Nelson N, Erbes CR, Arbisi PA, Thuras P. Longitudinal Effects of Mild TBI and PTSD Comorbidity on Post-Deployment Outcomes in National Guard Soldiers Deployed to Iraq. Presented at: Association for Behavioral and Cognitive Therapies Annual Convention; 2010 Nov 18; San Francisco, CA.


DRA: Mental, Cognitive and Behavioral Disorders
DRE: none
Keywords: none
MeSH Terms: none

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