Mild TBI outcomes in US veterans worse if sustained during traumatic event
Key takeaways:
- Veterans with peritraumatic mild TBI had greater PTSD severity, post-concussive symptoms and disability.
- Those with peritraumatic mTBI saw greater trauma exposure vs. groups with non-peritraumatic and no TBI.
Among post-9/11 United States military veterans, mild traumatic brain injury was associated with unfavorable long-term outcomes, such as severe PTSD, when occurring around a traumatic event, researchers wrote in JAMA Network Open.
“The high prevalence of mild traumatic brain injury, often termed concussion, among post-9/11 U.S. veterans has generated marked concern regarding the long-term physical, psychiatric, and functional outcomes of this condition,” Emily J. Van Etten, PhD, a postdoctoral fellow in neuropsychology at the Translational Research Center for TBI and Stress Disorders at Harvard Medical School, and colleagues wrote.
As little is known regarding the long-term association of mild TBI and PTSD in United States military veterans, Van Etten and colleagues sought to compare the long-term outcomes of mTBI that occurred in the context of psychological trauma with mTBI that did not.
Their retrospective cohort study examined data from post-9/11 veterans culled from the Translational Research Center for Traumatic Brain Injury and Stress Disorders (TRACTS) study at the Veterans Affairs Boston Healthcare System from its 2009 commencement through 2024.
A total of 567 individuals (mean age, 33.72 years, 89.4% men) were included for analysis, 183 of whom suffered no TBI, 189 with non-peritraumatic mTBI and 195 with peritraumatic mTBI. All head injuries sustained prior to the study were assessed through the Boston Assessment of Traumatic Brain Injury-Lifetime (BAT-L) test, while Van Etten and colleagues retrospectively reviewed participants’ BAT-L records to assess the context of each injury. They additionally employed the Posttraumatic Diagnostic Scale (PDS-5) as a framework to identify possible peritraumatic contexts.
The study’s main outcomes were severity of PTSD as a result of mTBI as measured by the Clinician-Administered PTSD Scale–4th edition, post-concussive symptoms measured by the Neurobehavioral Symptom Inventory. Veteran-reported disability was assessed via a series of self-reported questionnaires including the Traumatic Life Events Questionnaire (TLEQ) and World Health Organization Disability Assessment Schedule II.
Covariance analysis included variables such as age, gender, lifetime TBI and TLEQ total score.
According to the results, veterans with a history of peritraumatic mTBI logged greater PTSD severity, post-concussive symptoms and overall disability compared with both the non-peritraumatic mTBI and no TBI groups. The researchers noted that the analysis uncovered no significant difference in outcomes between the non-peritraumatic mTBI and no TBI groups.
The researchers also reported significant gender-based distribution between TBI groups, with women comprising the greater proportion in the “non TBI” group (n = 31) compared with non-peritraumatic mTBI (n = 14) and peritraumatic (n = 15); however, they noted there was no significant difference in distribution of gender between the latter two groups.
Data further showed that those with peritraumatic mTBI experienced greater trauma exposure compared with non-peritraumatic and no TBI groups. (mean TLEQ scores: 22.93 vs. 17.38 vs. 13.97, respectively), while those in the peritraumatic cohort registered more lifetime TBI compared with those who sustained non-peritraumatic mTBI.
“The findings from the current study have important theoretical and clinical implications, providing a possible explanation for the decades of contradictory results published in the literature on long-term outcomes of [mild traumatic brain injury],” Van Etten and colleagues wrote.