Mild Traumatic Brain Injury (Concussion), Posttraumatic Stress Disorder, and Depression in US Soldiers Involved in Combat Deployments: Association With Postdeployment Symptoms

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 [Cl] = 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% Cl = 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.