Many recent studies of service members returning from deployment
have focused on the health impacts of mild traumatic brain injury
(mTBI), including persistent postconcussive symptoms
(PCS). However, cross-sectional study designs have made it difficult to understand the role of mental health
in the etiology of persistent PCS.
Participants were 3319 military
personnel (primarily men [90%] of 25–34 years [54%]) who had completed health surveys at basic training and after deployment
, on average, 4.6 years later. Negative binomial regression was used to assess the association of PCS with demographic covariates, premilitary mental health
and somatic symptoms, combat experiences and mTBI during deployment
, in addition to postdeployment mental health
and non-PCS somatic symptoms.
Premilitary mental health
and somatic symptoms predicted PCS even when adjusting for other variables, yielding an elevated incidence rate ratio (IRR) for posttraumatic stress disorder (PTSD; IRR = 1.23, 95% confidence interval [CI] = 1.06–1.41) and somatic symptoms (mild versus minimal somatic symptoms: IRR = 1.43, 95% CI = 1.31–1.55; moderate/severe versus minimal somatic symptoms: IRR = 1.69, 95% CI = 1.43–2.06), but not for depressive symptoms. When postdeployment mental health
and somatic symptom measures were added to the model, the effect of premilitary somatic symptoms remained significant.
Findings point to potential etiological contributions of premilitary characteristics, particularly a tendency to experience somatic symptoms and PTSD, as well as mTBI and combat experiences, to the development of PCS. PCS were also strongly related to concurrent postdeployment mental health