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Mild Traumatic Brain Injury and PTSD: A Synthesis of the Evidence


FINDINGS:

  • The prevalence of comorbid traumatic brain injury (TBI) and PTSD in published studies varies widely, ranging from 0% to 89%. However, in three large studies evaluating OEF/OIF Veterans, the prevalence of probable mild TBI ranged from 5% to 7%; among Veterans with probable mild TBI, the prevalence of probable PTSD ranged from 33% to 39%.
  • 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.
  • There also were no published studies that evaluated the effectiveness and harms of therapies in adults with these comorbid conditions.
  • Future efforts are needed to improve the evidence on which the assessment and treatment of mild TBI and PTSD are based.

BACKGROUND:
Mild traumatic brain injury is the most frequent type of TBI among civilians and OEF/OIF soldiers and Veterans. Research suggests that up to 23% of OEF/OIF soldiers have experienced TBI, with a majority being mild TBI. Studies also suggest that PTSD is prevalent among OEF/OIF soldiers and Veterans. HSR&D’s Evidence-based Synthesis Program (ESP) recently produced an important report on TBI and PTSD. This article summarizes that report, in which investigators examined data from 32 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:

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

LIMITATIONS:

  • Many of the studies included in this review were not designed to answer the investigators’ questions, but were included because they provided data on the frequency of PTSD or TBI in their respective study populations.

AUTHOR/FUNDING INFORMATION:
This study was supported by HSR&D. Drs. Carlson, Kehle, and Meis are part of HSR&D’s Center for Chronic Disease Outcomes Research in Minneapolis, MN.

View the full ESP report online.


PubMed Logo Carlson K, Kehle S, Meis L, et al. Prevalence, Assessment, and Treatment of Mild Traumatic Brain Injury and Post-traumatic Stress Disorder: A Systematic Review of the Evidence. Journal of Head Trauma Rehabilitation July 13, 2010;e-pub ahead of print.

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What are HSR&D Publication Briefs?

HSR&D requires notification by HSR&D-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR&D and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR&D based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR&D published articles. Visit the HSR&D citations database for a complete listing of HSR&D articles and presentations.