Rates of new-onset mental health conditions higher in US soldiers with history of TBI
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Key takeaways:
- Study examined more than 860,000 U.S. soldiers, including more than 108,000 with history of traumatic brain injury.
- Rates of new-onset mental health conditions were higher in those with TBI than those without.
Rates of new-onset mental health conditions were higher in U.S. soldiers with a history of military-related traumatic brain injury, while increased risk for suicide was both directly and indirectly associated with TBI history.
“Although researchers, health care practitioners and those with a history of frequently co-occurring conditions have long been aware of the complicated relationships among TBI, mental health conditions and negative outcomes, clinical and data-related challenges have created significant research roadblocks, which in turn have impeded advancement of evidence-based care,” Lisa A. Brenner, PhD, director of Rocky Mountain Mental Illness Research Education and Clinical Center, and colleagues wrote in JAMA Network Open.
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Researchers sought to examine whether military-related TBI was associated with rates of new-onset mental health conditions, such as anxiety, mood, PTSD and substance use disorders, as well as suicide risk.
They utilized demographic, military and health data from the Substance Use and Psychological Injury Combat Study (SUPIC) database of 860,892 soldiers (37.2% aged 18-24 years at end of index deployment; 89% men), 12.6% of whom had at least one documented TBI on their military health record. Participants included U.S. Army soldiers who returned from deployment in Afghanistan or Iraq.
The primary outcome of interest was suicide, while secondary outcomes were incidence of new-onset mental health conditions. Researchers grouped mental health diagnoses into six categories (anxiety, mood, PTSD, adjustment, alcohol use and substance use disorders), which, along with the two or more categories variable, were considered separately as potential mediators.
According to results, greater increases in mental health diagnoses were reported for all conditions following a documented TBI compared with matched dates for soldiers without TBI. Among the most notable increases were mood (67.7% vs. 37.5%) and substance use (100% vs. 14.5%).
After controlling for several demographic factors, researchers reported the time to suicide was 21.3% faster (deceleration factor, 0.787; 95% CI, 0.715-0.866) for soldiers with a history of TBI. Further, the time-to-suicide direct effect estimate was 16.7% faster (deceleration factor, 0.833; 95% CI, 0.756-0.912) than for those without TBI, when considering new-onset adjustment disorders.
Researchers also reported “substantial” indirect effect estimates of associations with TBI, with the largest effect seen in association with new-onset substance use disorder, which had a time to suicide 63.8% faster (deceleration factor, 0.372; 95% CI, 0.322-0.433) for soldiers with TBI history.
“These findings support adopting methodological strategies aimed at evaluating risk over an individual’s lifetime, with a focus on how events and conditions accumulate both proximally and distally,” the authors wrote.
In a related editorial, Ross D. Zafonte, DO, and colleagues wrote that these study findings underscore “the burden of suicide and multidimensionality of suicide risk among military personnel and veterans.”
They continued, “Taken together, this work suggests a need to further longitudinally examine the biopsychosocial risks of TBI, especially among individuals serving in the military, so that early interventions can be developed for those on a more deleterious path.”