Hostname: page-component-8448b6f56d-c4f8m Total loading time: 0 Render date: 2024-04-18T19:55:41.395Z Has data issue: false hasContentIssue false
  • English
  • Français

Chronic Postconcussion Symptoms and Functional Outcomes in OEF/OIF Veterans with Self-Report of Blast Exposure

Published online by Cambridge University Press:  25 October 2012

Mieke Verfaellie ,
Ginette Lafleche ,
Avron Spiro III ,
Carlos Tun  and
Kathryn Bousquet
Mieke Verfaellie*
Affiliation:
Memory Disorders Research Center, VA Boston Healthcare System and Boston University School of Medicine, Boston, Massachusetts
Ginette Lafleche
Affiliation:
Memory Disorders Research Center, VA Boston Healthcare System and Boston University School of Medicine, Boston, Massachusetts
Avron Spiro III
Affiliation:
Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System and Boston University Schools of Public Health and Medicine, Boston, Massachusetts
Carlos Tun
Affiliation:
Polytrauma Network Site, VA Boston Healthcare System and Harvard Medical School, Boston, Massachusetts
Kathryn Bousquet
Affiliation:
Memory Disorders Research Center, VA Boston Healthcare System and Boston University School of Medicine, Boston, Massachusetts
*
Correspondence and reprint requests to: Mieke Verfaellie, Memory Disorders Research Center (151A), VA Boston Healthcare System, 150 S Huntington Avenue, Boston, MA 02130. E-mail: verf@bu.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Postconcussion symptoms (PCS) and functional outcomes were evaluated in 91 OEF/OIF outpatient veterans with reported histories of blast-exposure, with the goal of evaluating (1) the association between these outcomes and a clinical diagnosis of mild traumatic brain injury (mTBI) with or without loss of consciousness (LOC); and (2) the influence of post-traumatic stress disorder (PTSD) and depression on PCS reporting and perceived functional limitations. Individuals who reported mTBI with LOC had greater PCS complaints than individuals who reported mTBI without LOC or individuals without mTBI. However, after adjusting for severity of PTSD and depression symptoms, this group difference disappeared. Functional limitations were particularly prominent in the psychosocial domain. Again, PTSD was significantly associated with functional outcomes, but the mTBI with LOC group had greater psychosocial limitations than the other two groups, even when PTSD and depression symptoms were taken into account. These findings highlight the role of mental health in both outcomes, but additionally point to the impact of mTBI with LOC on long-term psychosocial adjustment. (JINS, 2013, 19, 1–10)

Keywords

TBIBlast-injuriesPTSDDepressionPostconcussion symptomsQuality of life
Type
Research Articles
Information
Journal of the International Neuropsychological Society , Volume 19 , Issue 1 , January 2013 , pp. 1 - 10
Copyright
Copyright © The International Neuropsychological Society 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Congress of Rehabilitation Medicine. (1993). Definition of mild traumatic brain injury. Journal of Head Trauma Rehabilitation, 8, 86–87.CrossRefGoogle Scholar
American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders (revised 4th ed.). Washington, DC: American Psychiatric Association.Google Scholar
Barona, A., Reynolds, C.R., Chastain, R. (1984). A demographically based index of pre-morbid intelligence for the WAIS-R. Journal of Consulting and Clinical Psychology, 52, 885–887.CrossRefGoogle Scholar
Beck, A.T. (1996). Beck Depression Inventory. San Antonio, TX: The Psychological Corporation.Google Scholar
Belanger, H.G., Kretzmer, T., Vanderploeg, R.D., French, L.M. (2010). Symptom complaints following combat-related traumatic brain injury: Relationship to traumatic brain injury and posttraumatic stress disorder. Journal of the International Neuropsychological Society, 16, 194–199.CrossRefGoogle ScholarPubMed
Belanger, H.G., Proctor-Weber, Z., Kretzmer, T., Kim, M., French, L.M., Vanderploeg, R.D. (2011). Symptom complaints following reports of blast versus non-blast mild TBI: Does mechanism of injury matter? Clinical Neuropsychologist, 25, 702–715.CrossRefGoogle ScholarPubMed
Belanger, H.G., Spiegel, E., Vanderploeg, R.D. (2010). Neuropsychological performance following a history of multiple self-reported concussions: A meta-analysis. Journal of the International Neuropsychological Society, 16, 262–267.CrossRefGoogle ScholarPubMed
Bigler, E.D. (2008). Neuropsychology and clinical neuroscience of persistent post-concussive symptoms. Journal of the International Neuropsychological Society, 14, 1–22.CrossRefGoogle Scholar
Bigler, E.D., Maxwell, W.L. (2012). Understanding mild traumatic brain injury: Neuropathology and neuroimaging. In J. J. Vasterling, R. A. Bryant, & T. M. Keane (Eds.), PTSD and mild traumatic brain injury (pp. 15–36). New York: Guilford Press.Google Scholar
Blake, D., Weathers, F.W., Nagy, L.M., Kaloupek, D.G., Gusman, F.D., Charney, D.S., Keane, T.M. (1995). The development of a clinician-administered PTSD scale. Journal of Traumatic Stress, 8, 75–90.Google ScholarPubMed
Brenner, L.A., Ivins, B.J., Schwab, K., Warden, D., Nelson, L.A., Jaffee, M., Terrio, H. (2010). Traumatic brain injury, posttraumatic stress disorder, and postconcussive symptom reporting among troops returning from Iraq. Journal of Head Trauma Rehabilitation, 25, 307–312.CrossRefGoogle ScholarPubMed
Brenner, L.A., Vanderploeg, R.D., Terrio, H. (2009). Assessment and diagnosis of mild traumatic brain injury, posttraumatic stress disorder, and other polytrauma conditions: Burden of adversity hypothesis. Rehabilitation Psychology, 54, 239–246.CrossRefGoogle ScholarPubMed
Bryant, R.A., Castro, C.A., Iverson, G.L. (2012). Implications for service delivery in the military. In J. J. Vasterling, R. A. Bryant, & T. M. Keane (Eds.), PTSD and mild traumatic brain injury (pp. 235–259). New York: Guilford Press.Google Scholar
Bryant, R.A., O'Donnell, M.L., Creamer, M., McFarlane, A.C., Clark, C.R., Silove, D. (2010). The psychiatric sequelae of traumatic brain injury. The American Journal of Psychiatry, 167, 312–320.CrossRefGoogle Scholar
Caroll, L.J., Cassidy, J.D., Peloso, P.M., Borg, J., von Holst, H., Holm, L., Pepin, M. (2004). Prognosis for mild traumatic brain injury: Results of the WHO Collaborating Center Task Force on mild traumatic brain injury. Journal of Rehabilitation Medicine, 43(Suppl.), 84–105.CrossRefGoogle Scholar
Cernak, I., Noble-Haeusslein, L.J. (2010). Traumatic brain injury: An overview of pathobiology with emphasis on military populations. Journal of Cerebral Blood Flow and Metabolism, 30, 255–266.CrossRefGoogle ScholarPubMed
Collins, M.W., Grindel, S.H., Lovell, M.R., Ded, D.E., Moser, D.J., Phalin, B.R., McKeag, D.B. (1999). Relationship between concussion and neuropsychological performance in college football players. Journal of the American Medical Association, 282, 964–970.CrossRefGoogle ScholarPubMed
Cooper, D.B., Nelson, L., Armistehad-Jehle, P., Bowles, A.O. (2011). Utility of the mild brain injury atypical symptoms scale as a screening measure for symptom over-reporting in Operation Enduring Freedom/Operation Iraqi Freedom service members with post-concussive complaints. Archives of Clinical Neuropsychology, 26, 718–727.CrossRefGoogle ScholarPubMed
Corrigan, J.D., Bogner, J. (2007). Screening and identification of TBI. Journal of Head Trauma Rehabilitation, 22, 315–317.CrossRefGoogle ScholarPubMed
Dikmen, S., McLean, A., Temkin, N. (1986). Neuropsychological and psychosocial consequences of minor head injury. Journal of Neurology, Neurosurgery, and Psychiatry, 49, 1227–1232.CrossRefGoogle ScholarPubMed
Fear, N.T., Jones, E., Groom, M., Greenberg, N., Hull, L., Hodgetts, T.J., Wesseley, S. (2009). Symptoms of post-concussional syndrome are non-specifically related to mild traumatic brain injury in UK Armed Forces personnel on return from deployment in Iraq: An analysis of self-reported data. Psychological Medicine, 39, 1379–1387.CrossRefGoogle ScholarPubMed
First, M.B., Spitzer, R.L., Gibbon, M., Williams, J.B.W. (2002). Structured Clinical interview for DSM-IV-TR axis I disorders, research version, patient edition (SCIP-I/P). New York: Biometrics Research, New York State Psychiatric Institute.Google Scholar
Friedland, J.F., Dawson, D.R. (2001). Function after motor vehicle accidents: A prospective study of mild head injury and posttraumatic stress. The Journal of Nervous and Mental Disease, 189, 426–434.CrossRefGoogle ScholarPubMed
Hill, J.J., Mobo, B.H.P., Cullen, M.R. (2009). Separating deployment-related traumatic brain injury and posttraumatic stress disorder in veterans. American Journal of Physical Medicine and Rehabilitation, 88, 605–614.CrossRefGoogle ScholarPubMed
Hoge, C.W., McGurk, D., Thomas, J.L., Cox, A.L., Engel, C.C., Castro, C.A. (2008). Mild traumatic brain injury in U.S. soldiers returning from Iraq. The New England Journal of Medicine, 358, 453–463.CrossRefGoogle ScholarPubMed
Iverson, G.L. (2006). Misdiagnosis of persistent postconcussion syndrome in patients with depression. Archives of Clinical Neuropsychology, 21, 303–310.CrossRefGoogle ScholarPubMed
Iverson, G.L., Gaetz, M., Lovell, M.R., Collins, M.W. (2004). Cumulative effects of concussion in amateur athletics. Brain Injury, 18, 433–443.CrossRefGoogle Scholar
Iverson, G.L., Langlois, J.A., McCrea, M.A., Kelly, J.P. (2009). Challenges associated with post-deployment screening for mild traumatic brain injury in military personnel. The Clinical Neuropsychologist, 23, 1299–1314.CrossRefGoogle ScholarPubMed
Kehle, S.M., Reddy, M.K., Ferrier-Auerbach, A.G., Erbes, C.R., Arbisi, P.A., Polusny, M.A. (2011). Psychiatric diagnoses, comorbidity, and functioning in National Guard troops deployed to Iraq. Journal of Psychiatric Research, 45, 126–132.CrossRefGoogle ScholarPubMed
King, N.S., Crawford, S., Wenden, F.J., Moss, N.E.G., Wade, D.T. (1995). The Rivermead Post Concussion Symptoms Questionnaire: A measure of symptoms commonly experienced after head injury and its reliability. Journal of Neurology, 242, 587–592.CrossRefGoogle ScholarPubMed
Lippa, S.M., Pastorek, N.J., Benge, J.F., Thornton, G.M. (2010). Postconcussive symptoms after blast and non-blast related mild traumatic brain injuries in Afghanistan and Iraq war veterans. Journal of the International Neuropsychological Society, 16, 856–866.CrossRefGoogle Scholar
Luis, C.A., Vanderploeg, R.D., Curtiss, G. (2003). Predictors of postconcussion symptom complex in community dwelling male veterans. Journal of the International Neuropsychological Society, 9, 1001–1015.CrossRefGoogle ScholarPubMed
McCauley, S.R., Boake, C., Levin, H.S., Contant, C.F., Song, J.X. (2001). Postconcussional disorder following mild to moderate traumatic brain injury: Anxiety, depression, and social support as risk factors and comorbidities. Journal of Clinical and Experimental Neuropsychology, 23, 792–808.CrossRefGoogle ScholarPubMed
McCrae, M.A. (2008). Mild traumatic brain injury and postconcussion syndrome. New York: Oxford University Press.Google Scholar
McDowell, I., Newell, C. (1996). Measuring health outcomes. New York: Oxford University Press.Google Scholar
Melzack, R. (1975). The McGill Pain Questionnaire: Major properties and scoring methods. Pain, 1, 277–299.CrossRefGoogle ScholarPubMed
Meares, S., Shores, A., Taylor, A.J., Batchelor, J., Bryant, R.A., Baguley, I.J., Marosszeky, J.E. (2011). The prospective course of postconcussion syndrome: The role of mild traumatic brain injury. Neuropsychology, 25, 454–465.CrossRefGoogle ScholarPubMed
Molica, R.F., Henderson, D.C., Tor, S. (2002). Psychiatric effects of traumatic brain injury events in Cambodian survivors of mass violence. British Journal of Psychiatry, 181, 339–347.CrossRefGoogle Scholar
Nelson, N.W., Hoelzle, J.B., McGuire, K.A., Ferrier-Auerbach, A.G., Charlesworth, M.J., Sponheim, S.R. (2010). Evaluation context impacts neuropsychological performance of OEF/OIF veterans with reported combat-related concussion. Archives of Clinical Neuropsychology, 25, 713–723.CrossRefGoogle ScholarPubMed
Nelson, N.W., Hoelzle, J.B., McGuire, K.A., Ferrier-Auerbach, A.G., Charlesworth, M.J., Sponheim, S.R. (2011). Neuropsychological evaluation of blast-related concussion: Illustrating the challenges and complexities through OEF/OIF case studies. Brain Injury, 25, 511–525.CrossRefGoogle ScholarPubMed
O'Donnell, M.L., Creamer, M., Pattison, P. (2004). Posttraumatic stress disorder and depression following trauma: Understanding co-morbidity. American Journal of Psychiatry, 161, 1390–1396.CrossRefGoogle Scholar
Peskind, E.R., Petrie, E.C., Cross, D.J., Pagulayan, K., McCraw, K., Hoff, D., Minsohima, S. (2011). Cerebrocerebellar hypometabolism associated with repetitive blast exposure mild traumatic brain injury in 12 Iraq war Veterans with persistent post-concussion symptoms. Neuroimage, 54(Suppl. 1), 576–582.CrossRefGoogle Scholar
Pietrzak, R.H., Johnson, D.C., Goldstein, M.B., Malley, J.C., Soutwick, S.M. (2009). Posttraumatic stress disorder mediates the relationship between mild traumatic brain injury and health and psychosocial functioning in veterans of operation Enduring Freedom and Iraqi Freedom. The Journal of Nervous and Mental Disease, 197, 748–753.CrossRefGoogle ScholarPubMed
Polusny, M.A., Kehle, S.M., Nelson, M.W., Erbes, C.R., Arbisi, P.A., Thuras, P. (2011). Longitudinal effects of mild traumatic brain injury and posttraumatic stress disorder comorbidity on postdeployment outcomes in national guard soldiers deployed to Iraq. Archives of General Psychiatry, 68, 79–89.CrossRefGoogle ScholarPubMed
Ponsford, J., Willmott, C., Rothwell, A., Cameron, P., Kelly, A.M., Nelms, R., Curran, C. (2002). Impact of early intervention on outcome following mild traumatic brain injury in adults. Journal of Neurology, Neurosurgery, and Psychiatry, 73, 330–332.CrossRefGoogle Scholar
Ponsford, J., Willmott, C., Rothwell, A., Cameron, P., Kelly, A.M., Nelms, R., Ng, K. (2000). Factors influencing outcome following mild traumatic brain injury in adults. Journal of the International Neuropsychological Society, 6, 568–579.CrossRefGoogle ScholarPubMed
Sbordone, R.J., Ruff, R.M. (2010). Re-examination of the controversial coexistence of traumatic brain injury and posttraumatic stress disorder: Misdiagnosis and self-report measures. Psychological Injury and Law, 3, 63–76.CrossRefGoogle ScholarPubMed
Schneiderman, A.I., Braver, E.R., Kang, H.K. (2008). Understanding sequelae of injury mechanisms and mild traumatic brain injury incurred during the conflicts in Iraq and Afghanistan: Persistent postconcussive symptoms and posttraumatic stress disorder. American Journal of Epidemiology, 167, 1446–1452.CrossRefGoogle ScholarPubMed
Schnurr, P.P., Lunney, C.A., Bovin, M.J., Marx, B.P. (2009). Posttraumatic stress disorder and quality of life: Extension of findings to veterans of the wars in Iraq and Afghanistan. Clinical Psychology Review, 29, 727–735.CrossRefGoogle ScholarPubMed
Smith-Seemiller, L., Fow, N.R., Kant, R., Franzen, M.D. (2003). Presence of post-concussion syndrome symptoms in patients with chronic pain vs mild traumatic brain injury. Brain Injury, 17, 199–206.CrossRefGoogle ScholarPubMed
Spencer, R.J., Drag, L.L., Walker, S.J., Bieliauskas, L.A. (2010). Self-reported cognitive symptoms following mild traumatic brain injury are poorly associated with neuropsycholgoical performance in OIF/OEF veterans. Journal of Rehabilitation Research and Development, 47, 521–530.CrossRefGoogle Scholar
Stalnacke, B.M. (2007). Community integration, social support and life satisfaction in relation to symptoms 3 years after mild traumatic brain injury. Brain Injury, 21, 933–942.CrossRefGoogle ScholarPubMed
Terrio, H., Brenner, L.A., Ivins, B.J., Cho, J.M., Helmick, K., Schwab, K., Warden, D.L. (2009). Traumatic brain injury screening: Preliminary findings in a US army brigade combat team. Journal of Head Trauma Rehabilitation, 24, 14–23.CrossRefGoogle Scholar
Tombaugh, T.N. (1996). Test of memory malingering. Toronto, Ontario: Multi-Health Systems.Google Scholar
Vanderploeg, R.D., Belanger, H.G., Curtiss, G. (2009). Mild traumatic brain injury and posttraumatic stress disorder and their associations with health symptoms. Archives of Physical and Medical Rehabilitation, 90, 1084–1093.CrossRefGoogle ScholarPubMed
Vanderploeg, R.D., Curtiss, G., Luis, C.A., Salazar, A.M. (2007). Long-term morbidities following self-reported mild traumatic brain injury. Journal of Clinical and Experimental Neuropsychology, 29, 585–598.CrossRefGoogle ScholarPubMed
Vasterling, J.J., Verfaellie, M., Sullivan, K. (2009). Mild traumatic brain injury and posttraumatic stress disorder in returning veterans: Perspectives from cognitive neuroscience. Clinical Psychology Review, 29, 674–684.CrossRefGoogle ScholarPubMed
Verfaellie, M., Amick, M.M., Vasterling, J.J. (2012). Effects of traumatic brain injury-associated neurocognitive alterations on posttraumatic stress disorder. In J. J. Vasterling, R. A. Bryant, & T. M. Keane (Eds.), PTSD and mild traumatic brain injury (pp. 82–102). New York: Guilford Press.Google Scholar
Whittaker, R., Kemp, S., House, A. (2007). Illness perception and outcome in mild head injury: A longitudinal study. Journal of Neurology, Neurosurgery, and Psychiatry, 78, 644–646.CrossRefGoogle ScholarPubMed
Wilk, J.E., Thomas, J.L., McGurk, D.M., Riviere, L.A., Castro, C.A., Hoge, C.W. (2010). Mild traumatic brain injury (concussion) during combat: Lack of association of blast mechanism with persistent postconcussive symptoms. Journal of Head Trauma Rehabilitation, 25, 9–14.CrossRefGoogle ScholarPubMed