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Herrold AA, High WM, Smith BM, Evans (Mayfield) C, Urban A, Noblett K, Pape TL, Babcock-Parziale JL. Effects Of Alcohol Use On Patient Outcomes In Veterans With Mild TBI and/or Behavioral Health Symptoms. Paper presented at: Federal Interagency Conference on Traumatic Brain Injury; 2011 Jun 13; Washington, DC.
Distinguishing mild traumatic brain injury (mTBI) and other behavioral, combat-related conditions such as post traumatic stress disorder (PTSD) is challenging. Diagnosis is reliant upon overlapping, self-reported symptoms and can be further complicated by alcohol use. Given the paucity of evidence regarding the effects of alcohol on mTBI and behavioral outcomes, we abstracted a pilot sample from a larger study to describe self-reported alcohol use for persons with confirmed (1) mTBI (N = 4), (2) behavioral health conditions (BH) (N = 14), (3) mTBI + BH (N = 10) and (4) healthy controls with similar exposures but without current symptoms (N = 10). Secondly, we determined the prevalence of functional impairments, sleep disturbances, anxiety, and depression, according to self-reported alcohol use. The larger study enrolls military personnel deployed to Afghanistan or Iraq with a target sample of 720 and we abstracted the first 50 participants for our pilot sample. The majority of the sample is young (mean age = 32 1 year) males (86%). Group assignment is based on an evaluation that includes a structured neuropsychological interview, Clinically Administered PTSD Scale, Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI), Alcohol Use Disorders Identification Test (Audit-C), World Health Organization Disability Assessment Schedule (WHODAS-II) and Insomnia Severity Index (ISI). Findings indicate that half the sample (25/50) tested positive on the Audit-C for alcohol use disorder. Higher WHODAS total scores, for mTBI + BH group (32 27), indicated greater functional difficulty when compared to controls (9 10, ANOVA with post-hoc Tukey, P < 0.05). Persons in the BH and mTBI + BH groups had worse depression (BDI for BH = 13 6, for mTBI+BH = 17 9) and anxiety scores (BAI for BH = 12 7, for mTBI+BH = 13 9) relative to controls (BDI = 5 4, BAI = 2 2; ANOVA with post-hoc Tukey, P < 0.05). mTBI + BH with alcohol use disorder had less difficulty sleeping (ISI mean = 14 4) compared to Audit-C negative subjects in the same group (21 5, t-test, P < 0.05). Overall, alcohol use disorder is prevalent (50%) amongst veterans returning from the current conflicts. While this pilot analysis is not powered to detect significant between group differences, results suggest that abstracting a larger sample is warranted.
