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The Association Between Posttraumatic Stress Disorder and Perceptions of Deployment-Related Injury in Veterans With and Without Mild Traumatic Brain Injury

Bahraini, Nazanin H. PhD; Monteith, Lindsey L. PhD; Gerber, Holly R. BA; Forster, Jeri E. PhD; Hostetter, Trisha A. MPH; Brenner, Lisa A. PhD, ABPP

The Journal of Head Trauma Rehabilitation: March/April 2018 - Volume 33 - Issue 2 - p E7–E15
doi: 10.1097/HTR.0000000000000307
TBI in the Military 2018

Objectives: To examine whether the association between posttraumatic stress disorder (PTSD) and injury perceptions (ie, consequences, emotional representations, and coherence) differs for Veterans with mild traumatic brain injury (mTBI) compared with Veterans with non-TBI (ie, orthopedic).

Participants: Eighty Veterans injured during post-9/11 deployments.

Design: Observational, 2×2 factorial design.

Main Measures: Injury histories ascertained using the Ohio State University TBI-Identification Method and Deployment Injury Questionnaire; Injury Perception Questionnaire-Revised (injury perceptions); Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (PTSD diagnosis); and PTSD Symptom Checklist-Civilian Version (PTSD symptoms).

Results: The association between PTSD diagnosis and injury perceptions did not differ between Veterans with mTBI and those with non-TBIs, adjusting for age, subjective pain, and depressive symptoms. PTSD symptom severity was significantly associated with injury consequences (P < .0001) and emotional representations (P < .0001), irrespective of injury type (mTBI vs non-TBI). Only injury coherence was associated with a significant interaction between PTSD symptom severity and mTBI (P = .04).

Conclusion: PTSD symptom severity influences perceptions about mTBI and non-TBIs sustained during deployment. Altering injury perceptions may be an important treatment target for Veterans with co-occurring PTSD and deployment-related injuries.

Rocky Mountain Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs, Denver, Colorado (Drs Bahraini, Monteith, Forster, and Brenner and Mss Gerber and Hostetter); and Department of Psychiatry (Drs Bahraini, Monteith, and Brenner), Department of Physical Medicine and Rehabilitation (Drs Bahraini, Forster and Brenner), and Department of Neurology (Dr Brenner), University of Colorado Anschutz Medical Campus, Aurora.

Corresponding Author: Nazanin H. Bahraini, PhD, Rocky Mountain MIRECC, 1055 Clermont St, Denver, CO 80220 (

This study was funded by the Department of Veterans Affairs, Rehabilitation Research & Development Service. The authors are solely responsible for the content of this article, which does not necessarily reflect the views of the Department of Veterans Affairs.

The authors declare no conflicts of interest.

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.