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Study finds link between TBI during deployment, increased risk for PTSD

Traumatic brain injury during deployment to Afghanistan was associated with an increased risk for PTSD following redeployment to the United States, according to study findings in the American Journal of Psychiatry.

“Numerous questions about the association between [traumatic brain injury (TBI)] and PTSD remain unanswered. Among them are uncertainties about the specificity of this association. Is PTSD a unique or particularly prevalent outcome of TBI, or is risk of developing (certain) other mental disorders comparable?” Murray B. Stein, MD, MPH, of the University of California San Diego, and colleagues wrote. “Another area of controversy pertains to the importance of the severity of TBI, particularly with regard to whether ‘very mild’ (ie, dazed but no loss of consciousness or amnesia) TBI have a salient impact on subsequent mental health.”

To assess the association between deployment-acquired traumatic brain injury (TBI) and subsequent posttraumatic stress and related disorders, researchers conducted a prospective, longitudinal study of soldiers in three Brigade Combat Teams 1 to 2 months prior to deployment to Afghanistan, upon redeployment to the United States, 3 months following redeployment and 9 months following redeployment to the United States. Information was available for 4,645 soldiers.

Approximately one in five (18%) soldiers reported exposure to mild or more-than-mild (1.2%) TBIs during index deployment.

When adjusting for other risk factors, including pre-deployment mental health status, severity of deployment stress and prior TBI history, deployment-acquired TBI was associated with increased adjusted odds for PTSD and generalized anxiety disorder 3 and 9 months following redeployment to the United States.

Deployment-acquired TBI was also associated with increased adjusted odds for a major depressive episode 3 months following redeployment.

Risk for suicidality appeared increased 3 months following redeployment but did not reach statistical significance.

“[W]e found in this large, prospective cohort study of military personnel about to be deployed to Afghanistan that mild TBI is common during deployment and that it is associated with substantially increased risk for PTSD observed 3 and 9 months after redeployment to the United States,” Stein and colleagues wrote. “We also found that the risk for mental health problems following mild TBI is not restricted to PTSD, implying that the focus on surveillance and intervention needs to be broadened to include other anxiety and depressive disorders.” – by Amanda Oldt

Disclosure: Stein reports serving as a consultant for Healthcare Management Technologies, Janssen, Pfizer, and Tonix Pharmaceuticals in the past 3 years; and that he is co-editor-in-chief of UpToDate in Psychiatry and deputy editor of Biological Psychiatry. Please see the full study for a list of all authors’ relevant financial disclosures.