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Prevalence and Severity of Psychiatric Disorders and Suicidal Behavior in Service Members and Veterans With and Without Traumatic Brain Injury

Systematic Review

Greer, Nancy PhD; Sayer, Nina A. PhD; Spoont, Michele PhD; Taylor, Brent C. PhD; Ackland, Princess E. PhD, MSPH; MacDonald, Roderick MS; McKenzie, Lauren MPH; Rosebush, Christina MPH; Wilt, Timothy J. MD, MPH

The Journal of Head Trauma Rehabilitation: April 25, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/HTR.0000000000000478
Original Article: PDF Only

Objectives: Assess prevalence and severity of posttraumatic stress disorder, suicidal behavior, and depressive, substance use, and anxiety disorders in US service members or Veterans with and without a deployment-related mild traumatic brain injury (TBI) (mTBI).

Design: Systematic review using multiple databases (January 2000 to October 2017). We included national or geographically diverse samples.

Main Measure: Prevalence and severity of psychiatric conditions based on diagnostic codes, clinician assessments, and self-report measures with results stratified by sample type.

Results: We identified 11 studies on the basis of national samples and 22 studies on the basis of geographically diverse samples. Traumatic brain injury severity was not always ascertained or reported. In national studies, posttraumatic stress disorder, depressive disorder, substance use disorder, and anxiety disorder prevalence were higher in those with TBI than in those without. One national sample reported prevalence of suicide attempts. Across psychiatric conditions, strength of evidence ranged from insufficient to moderate. In geographically diverse samples, the pattern of findings was similar. National studies provided insufficient evidence on psychiatric condition severity; geographically diverse studies found greater severity of posttraumatic stress disorder symptoms with mixed results for symptoms of depressive or substance use disorders.

Conclusions: Service members and Veterans with TBI history have higher prevalence and possibly severity of selected psychiatric conditions.

Center for Care Delivery and Outcomes Research (CCDOR), Minneapolis VA Health Care System, Minneapolis, Minnesota (Drs Greer, Sayer, Spoont, Taylor, Ackland, and Wilt, Mr MacDonald, and Mss McKenzie and Rosebush); Minneapolis VA Evidence-Based Synthesis Program Center, Minneapolis VA Health Care System, Minneapolis, Minnesota (Drs Greer and Wilt, Mr MacDonald, and Mss McKenzie and Rosebush); Departments of Medicine (Drs Sayer, Spoont, Taylor, Ackland, and Wilt) and Psychiatry (Dr Sayer) and Division of Epidemiology and Community Health (Dr Taylor), University of Minnesota, Minneapolis; and US Department of Veterans Affairs National Center for PTSD, Honolulu, Hawaii (Dr Spoont).

Corresponding Author: Nancy Greer, PhD, Center for Care Delivery and Outcomes Research (CCDOR), Minneapolis VA Health Care System, 1 Veterans Dr, Minneapolis, MN 55417 (

This study was funded by Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Quality Enhancement Research Initiative.

The views expressed in this article are those of the authors and do not reflect the position or policy of the United States Department of Veterans Affairs or the United States Government.

PROSPERO registration: CRD42018083990

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

The authors declare no conflicts of interest.

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