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Mild Traumatic Brain Injury (Concussion), Posttraumatic Stress Disorder, and Depression in U.S. Soldiers Involved in Combat Deployments

Association With Postdeployment Symptoms

Wilk, Joshua E., PhD; Herrell, Richard K., PhD; Wynn, Gary H., MD; Riviere, Lyndon A., PhD; Hoge, Charles W., MD

doi: 10.1097/PSY.0b013e318244c604
Original Articles

Objectives Several studies have examined the relationship between concussion/mild traumatic brain injury (mTBI), posttraumatic stress disorder (PTSD), depression, and postdeployment symptoms. These studies indicate that the multiple factors involved in postdeployment symptoms are not accounted for in the screening processes of the Department of Defense/Veteran’s Affairs months after concussion injuries. This study examined the associations of single and multiple deployment-related mTBIs on postdeployment health.

Methods A total of 1502 U.S. Army soldiers were administered anonymous surveys 4 to 6 months after returning from deployment to Iraq or Afghanistan assessing history of deployment-related concussions, current PTSD, depression, and presence of postdeployment physical and neurocognitive symptoms.

Results Of these soldiers, 17% reported an mTBI during their previous deployment. Of these, 59% reported having more than one. After adjustment for PTSD, depression, and other factors, loss of consciousness was significantly associated with three postconcussive symptoms, including headaches (odds ratio [OR] = 1.5, 95% confidence interval [CI] = 1.1–2.3). However, these symptoms were more strongly associated with PTSD and depression than with a history of mTBI. Multiple mTBIs with loss of consciousness increased the risk of headache (OR = 4.0, 95% CI = 2.4–6.8) compared with a single occurrence, although depression (OR = 4.2, 95% CI = 2.6–6.8) remained as strong a predictor.

Conclusions These data indicate that current screening tools for mTBI being used by the Department of Defense/Veteran’s Affairs do not optimally distinguish persistent postdeployment symptoms attributed to mTBI from other causes such as PTSD and depression. Accumulating evidence strongly supports the need for multidisciplinary collaborative care models of treatment in primary care to collectively address the full spectrum of postwar physical and neurocognitive health concerns.

Abbreviations TBI = traumatic brain injury; mTBI = mild traumatic brain injury; LOC = loss of consciousness; AOC = alteration of consciousness; DOD = U.S. Department of Defense; VA = U.S. Department of Veterans Affairs; PTSD = posttraumatic stress disorder; PCS = postconcussive symptom(s); PHQ-15 = 15-item Patient Health Questionnaire; PCL = PTSD Checklist; CES = Combat Exposure Scale

From the Division of Psychiatry and Neuroscience, Walter Reed Army Institute of Research, U.S. Army Medical Research and Materiel Command, Silver Spring, Maryland.

Address correspondence and reprint requests to Joshua E. Wilk, PhD, Department of Military Psychiatry, Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, MD 20910. E-mail:

This article has been reviewed by the Walter Reed Army Institute of Research. There is no objection to its presentation and/or publication. The opinions or assertions contained herein are the private views of the authors and arenot to be construed as official or as reflecting true views of the Department of the Army or the Department of Defense. No outside support was received. All authors report no conflicts of interest.

Received for publication May 10, 2011; revision received November 1, 2011.

Copyright © 2012 by American Psychosomatic Society
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