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The Relationship Between Postconcussive Symptoms and Quality of Life in Veterans With Mild to Moderate Traumatic Brain Injury

Schiehser, Dawn M. PhD; Twamley, Elizabeth W. PhD; Liu, Lin PhD; Matevosyan, Adelina MA; Filoteo, J. Vincent PhD; Jak, Amy J. PhD; Orff, Henry J. PhD; Hanson, Karen L. PhD; Sorg, Scott F. PhD; Delano-Wood, Lisa PhD

Journal of Head Trauma Rehabilitation: July/August 2015 - Volume 30 - Issue 4 - p E21–E28
doi: 10.1097/HTR.0000000000000065
Original Articles

Objective: To assess the relationship between postconcussive symptoms and quality of life (QOL) in Veterans with mild to moderate traumatic brain injury (TBI).

Methods: Sixty-one Operation Enduring Freedom/Operation Iraqi Freedom/Persian Gulf War Veterans with a history of mild or moderate TBI, more than 6 months postinjury, and 21 demographically matched Veteran controls were administered self-report measures of QOL (World Health Organization Quality of Life–BREF) and postconcussive symptom severity (Neurobehavioral Symptom Inventory).

Results: Perceived QOL was significantly worse in Veterans with mild-moderate TBI than in controls. In the TBI group, QOL was predominantly associated with affective symptoms, and moderate to strong correlations with fatigue and depression were evident across all QOL areas. Multivariate analyses revealed depression and fatigue to be the best predictors of Psychological, Social, and Environmental QOL, whereas sleep difficulty best predicted Physical QOL in mild-moderate TBI.

Conclusion: Veterans with post–acute mild-moderate TBI evidence worse QOL than demographically matched Veteran controls. Affective symptoms, and specifically those of fatigue, depression, and sleep difficulty, appear to be the most relevant postconcussive symptoms predicting QOL in this population. These findings underscore the importance of examining specific symptoms as they relate to post–acute TBI QOL and provide guidance for treatment and intervention studies.

VA San Diego Healthcare System (VASDHS), San Diego, California (Drs Schiehser, Twamley, Jak, Hanson, Delano-Wood, and Filoteo, and Ms Matevosyan); Departments of Psychiatry (Drs Schiehser, Twamley, Jak, Hanson, Delano-Wood, Filoteo and Orff) and Family and Preventive Medicine (Dr Liu), School of Medicine, University of California San Diego, La Jolla, California; Center of Excellence for Stress and Mental Health, VASDHS, San Diego, California (Drs Twamley, Jak, Hanson, Delano-Wood and Orff); and VA Puget Sound Health Care System, Seattle, Washington (Dr Sorg).

Corresponding Author: Dawn M. Schiehser, PhD, VA San Diego Healthcare System (151B), 3350 La Jolla Village Dr, San Diego, CA 92161 (

This study was supported by VA Career Development (D.M.S. and L.D-W.) and Department of Defense (L.D-W.) awards. The authors thank Russell Kim, Elisa Lanni, and Norman Luc for their help with data collection and compilation. They also thank the patients, staff, and volunteers associated with the VA San Diego Healthcare System for their involvement in this study.

The authors declare no conflicts of interest.

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