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Traumatic Brain Injury, Posttraumatic Stress Disorder, and Postconcussive Symptom Reporting Among Troops Returning From Iraq

Brenner, Lisa A. PhD; Ivins, Brian J. MS; Schwab, Karen PhD; Warden, Deborah MD; Nelson, Lonnie A. PhD; Jaffee, Michael MD; Terrio, Heidi MD, MPH

Section Editor(s): Caplan, Bruce PhD, ABPP; Issue Editor; Bogner, Jennifer PhD, ABPP; Issue Editor

Journal of Head Trauma Rehabilitation: September/October 2010 - Volume 25 - Issue 5 - p 307–312
doi: 10.1097/HTR.0b013e3181cada03

Objectives: Analyze the contribution of mild traumatic brain injury (mTBI) and/or posttraumatic stress disorder (PTSD) to the endorsement of postconcussive (PC) symptoms during Post Deployment Health Assessment. Determine whether a combination of mTBI and PTSD was more strongly associated with symptoms than either condition alone.

Methods: Cross-sectional study design where both the exposure, mTBI and/or PTSD, and the outcomes of interest, PC symptoms, were ascertained after return from deployment. Subjects were injured soldiers (n = 1247) from one Fort Carson Brigade Combat Team (n = 3973).

Main Outcome Measures: Positive history of PC symptoms.

Results: PTSD and mTBI together were more strongly associated with having PC symptoms (adjusted prevalence ratio 6.27; 95% CI: 4.13–9.43) than either mTBI alone (adjusted prevalence ratio = 4.03; 95% CI: 2.67–6.07) or PTSD alone (adjusted prevalence ratio = 2.74; 95% CI: 1.58–4.74) after adjusting for age, gender, education, rank, and Military Occupational Specialty.

Conclusions: In soldiers with histories of physical injury, mTBI and PTSD were independently associated with PC symptom reporting. Those with both conditions were at greater risk for PC symptoms than those with either PTSD, mTBI, or neither. Findings support the importance of continued screening for both conditions with the aim of early identification and intervention.

VA VISN 19 Mental Illness Research Education and Clinical Center, Denver, Colorado (Dr Brenner); University of Colorado Denver, School of Medicine, Departments of Psychiatry, Neurology, and Physical Medicine and Rehabilitation (Dr Brenner); The Defense and Veterans Brain Injury Center, District of Columbia (Mr Ivins, Drs Schwab, Warden, Nelson, Jaffe, and Terrio); and Department of Deployment Health, Evans Army Community Hospital, Fort Carson, Colorado (Drs Nelson and Terrio).

Corresponding Author: Lisa A. Brenner, PhD, VA VISN 19 Mental Illness Research Education and Clinical Center, 1055 Clermont St, Denver, CO 80220 (

The views expressed in this article are those of the authors and do not necessarily represent the official policy or position of Evans Army Community Hospital, the Defense and Veteran's Brain Injury Center, the Department of the Army, the Department of Defense, the Department of Veterans Affairs, or the US Government.

The authors thank Angela Coughlin, who assisted with data collection.

© 2010 Lippincott Williams & Wilkins, Inc.