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The Boston Assessment of Traumatic Brain Injury–Lifetime (BAT-L) Semistructured Interview: Evidence of Research Utility and Validity

Fortier, Catherine Brawn PhD; Amick, Melissa M. PhD; Grande, Laura PhD; McGlynn, Susan PhD; Kenna, Alexandra PhD; Morra, Lindsay BA; Clark, Alexandra BA; Milberg, William P. PhD; McGlinchey, Regina E. PhD

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

Journal of Head Trauma Rehabilitation: January/February 2014 - Volume 29 - Issue 1 - p 89–98
doi: 10.1097/HTR.0b013e3182865859
Original Articles

Objective: Report the prevalence of lifetime and military-related traumatic brain injuries (TBIs) in Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) veterans and validate the Boston Assessment of TBI–Lifetime (BAT-L).

Setting: The BAT-L is the first validated, postcombat, semistructured clinical interview to characterize head injuries and diagnose TBIs throughout the life span.

Participants: Community-dwelling convenience sample of 131 OEF/OIF veterans.

Design: TBI criteria (alteration of mental status, posttraumatic amnesia, and loss of consciousness) were evaluated for all possible TBIs, including a novel evaluation of blast exposure.

Main Measures: BAT-L, Ohio State University TBI Identification Method (OSU-TBI-ID).

Results: About 67% of veterans incurred a TBI in their lifetime. Almost 35% of veterans experienced at least 1 military-related TBI; all were mild in severity, 40% of them were due to blast, 50% were due to some other (ie, blunt) mechanism, and 10% were due to both types of injuries. Predeployment TBIs were frequent (45% of veterans). There was strong correspondence between the BAT-L and the OSU-TBI-ID (Cohen κ = 0.89; Kendall τ-b = 0.95). Interrater reliability of the BAT-L was strong (κs >0.80).

Conclusions: The BAT-L is a valid instrument with which to assess TBI across a service member's lifetime and captures the varied and complex nature of brain injuries across OEF/OIF veterans' life span.

Supplemental Digital Content is Available in the Text.

Translational Research Center for TBI and Stress Disorders and Geriatric Research, Education and Clinical Center (Drs Fortier, Amick, Kenna, Milberg, and McGlinchey and Mss Clark and Morra), Psychology Service (Dr Grande), and Physical Medicine & Rehabilitation Service (Dr McGlynn), VA Boston Healthcare System; Department of Psychiatry, Harvard Medical School (Drs Fortier, Milberg, and McGlinchey); and Department of Psychiatry, Boston University Medical School (Drs Amick, Grande, and McGlynn), Boston, Massachusetts.

Corresponding Author: Catherine Brawn Fortier, PhD, Translational Research Center for TBI and Stress Disorders and Geriatric Research, Education and Clinical Center (182), VA Boston Healthcare System, 150 S Huntington Ave, Boston, MA 02130 (

To download the full BAT-L semi-structured clinical interview go to:

This research was support by the Translational Research Center for TBI and Stress Disorders, a VA Rehabilitation Research and Development Traumatic Brain Injury Center of Excellence (B6796-C), NIH NIA K01AG024898, and VA Merit Review Award to Regina McGlinchey. We thank Wally Musto for his championship of our work among military personnel and his tireless recruitment efforts on our behalf. We also acknowledge the contributions of Drs Heidi Terrio and Doug Katz for their guidance in the development and analysis of the BAT-L.

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.

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins