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Assessment of Co-Occurring Disorders in Veterans Diagnosed With Traumatic Brain Injury

Cernich, Alison N. PhD; Chandler, Lauren PsyD; Scherdell, Traci PsyD; Kurtz, Shira PhD

The Journal of Head Trauma Rehabilitation: July/August 2012 - Volume 27 - Issue 4 - p 253–260
doi: 10.1097/HTR.0b013e3182585cd5
Original Articles

Aims: The co-occurrence of psychiatric disorders and other somatic disorders poses a significant challenge for the individual clinician working with veterans who report a history of mild traumatic brain injury (mTBI). In this article, common co-occurring symptoms and disorders will be described in relation to the population of veterans with mTBI, using a retrospective analysis of data from initial screening and secondary level evaluation for traumatic brain injury (TBI) in an urban Veteran's Affairs Medical Center.

Participants: Four hundred two veterans of the recent conflicts who received secondary level evaluation for TBI following positive TBI screening.

Outcomes: Significant differences were detected in symptom reporting between those who screened positive and those who screened negative on psychiatric screening. Those with positive posttraumatic stress disorder and depression screens endorsed more cognitive and affective symptoms; individuals screening positive for alcohol abuse did not report significantly more symptoms. Individuals without positive psychiatric screens reported fewer symptoms than those with positive screens. Consideration of these data in the context of a clinical case will be used to elucidate the challenge this presents to the clinical team.

Conclusion: The presence of co-occurring disorders should be considered in the etiology of a veteran's continued symptomatic complaints following TBI.

Department of Veteran's Affairs Office of Rehabilitation Services, Washington, District of Columbia (Dr Cernich); Defense Centers of Excellence in Psychological Health and Traumatic Brain Injury, Silver Spring, Maryland (Dr Cernich); VA Maryland Health Care System, Baltimore, Maryland (Drs Cernich, Chandler, Scherdell, and Kurtz); and Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland (Dr Cernich).

Corresponding Author: Alison Cernich, PhD, Defense Centers of Excellence, 9th Floor, 1355 East-West Highway, Silver Spring, MD 20910 (

Previous Presentation Presented in part at the annual meeting of the International Brain Injury Association, Washington, DC, June, 2010, and the International Neuropsychological Society, Boston, MA, February, 2011.

The views expressed herein are those of the authors and do not necessarily reflect the views of the US Department of Veteran's Affairs or the US Department of Defense.

The authors thank Drs Patricia Roger, S. Marc Testa, and Jessica Clark for their contributions to this project.

The authors declare no conflicts of interest.

© 2012 Lippincott Williams & Wilkins, Inc.