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Separating Deployment-Related Traumatic Brain Injury and Posttraumatic Stress Disorder in Veterans: Preliminary Findings from the Veterans Affairs Traumatic Brain Injury Screening Program

Hill, James J. III MD, MPH; Mobo, Ben Hur P. Jr MD, MPH; Cullen, Mark R. MD

American Journal of Physical Medicine & Rehabilitation: August 2009 - Volume 88 - Issue 8 - p 605-614
doi: 10.1097/PHM.0b013e3181ae0f83
Original Research Article: Brain Injury

Hill JJ III, Mobo BHP Jr., Cullen MR: Separating deployment-related traumatic brain injury and posttraumatic stress disorder in veterans: Preliminary findings from the Veterans Affairs traumatic brain injury screening program.

Objective: Traumatic brain injury in returning Iraq and Afghanistan combat veterans has been the subject of numerous articles by the popular press and congressional inquires. Recent research has questioned the accuracy of the traumatic brain injury diagnosis in veterans with depression and/or posttraumatic stress disorder and the validity of the Veterans Affairs traumatic brain injury screening tool to identify traumatic brain injury in returning combat veterans.

Design: Medical records of all combat veterans in the Veterans Affairs Connecticut Healthcare System who both screened positive for traumatic brain injury and received clinical evaluation for traumatic brain injury during the first year of the Veterans Affairs traumatic brain injury screening program were reviewed to explore the relationship between posttraumatic stress disorder and self-reported symptoms attributed to deployment-related traumatic brain injury.

Results: Ninety-four combat veterans identified from positive traumatic brain injury screens were seen in the Veterans Affairs Connecticut Healthcare System from April 1, 2007, to March 30, 2008. Eighty-five percent of the veterans with positive screens met the American Congress of Rehabilitation Medicine definition of probable traumatic brain injury. Symptom reporting was similar for veterans with and without a history of traumatic brain injury. Veterans with both posttraumatic stress disorder and traumatic brain injury were more likely to report falling as a mechanism of injury and indicated that they had suffered a head injury during deployment (P ≤ 0.10). Veterans with both posttraumatic stress disorder and traumatic brain injury reported more exposures and symptoms compared with veterans with a history of traumatic brain injury.

Conclusions: Veterans who screen positive for mild traumatic brain injury by the Veterans Affairs traumatic brain injury screening tool have high rates of posttraumatic stress disorder, which suggests that interdisciplinary rehabilitation teams need to include mental health professionals with expertise in posttraumatic stress disorder. Because both traumatic brain injury and posttraumatic stress disorder are defined, in part, by the same events and the same self-reported symptoms, the Veterans Affairs traumatic brain injury screening tool does not distinguish between these two commonly reported diagnoses in Operation Enduring Freedom/Operation Iraqi Freedom combat veterans.

From the Yale Occupational and Environmental Medicine Program (JJH, BHPM, MRC), Departments of Internal Medicine and Epidemiology and Public Health (MRC), Yale University School of Medicine, New Haven, Connecticut; and Veterans Affairs Connecticut Healthcare System (JJH, BHPM), West Haven, Connecticut.

All correspondence and requests for reprints should be addressed to James Hill, MD, MPH, Yale Occupational and Environmental Medicine Program, Yale University School of Medicine, 135 College Street, 3rd Floor, New Haven, CT 06510.

Disclosures: An abstract related to this work was accepted as the Electrode Store Best Paper Award Fellow Category for the AAP Annual Meeting in February 2009 in Colorado Springs, Colorado. The views expressed herein are the views of the authors and do not necessarily represent the views of the Department of Veterans Affairs or the United States government.

© 2009 Lippincott Williams & Wilkins, Inc.