Mild Traumatic Brain Injury and Posttraumatic Stress Disorder and Their Associations With Health Symptoms

Abstract 

Vanderploeg RD, Belanger HG, Curtiss G. Mild traumatic brain injury and posttraumatic stress disorder and their associations with health symptoms.

Objective

To determine the association of various symptoms and psychiatric diagnoses with a remote history of mild traumatic brain injury (MTBI) and a current diagnosis of posttraumatic stress disorder (PTSD).

Design

Cross-sectional cohort study.

Setting

Nonclinical.

Participants

Three groups of randomly selected community dwelling male U.S. Army Vietnam-era veterans: healthy control (n=3218), those injured in a motor vehicle collision (MVC) but without a head injury (MVC injury control; n=548), and those who had an MTBI (n=278).

Interventions

None.

Main Outcome Measures

Prevalence of psychiatric diagnoses, physical, cognitive, and emotional symptoms, and course of PTSD across time.

Results

Logistic regression procedures were used to determine group association with symptoms and psychiatric diagnosis after controlling for demographic variables, combat intensity, medical disorders, and other current psychiatric conditions. MTBI was associated with headaches, memory problems, sleep problems, and fainting even after controlling for current psychiatric problems (including PTSD), as well as demographic variables, combat intensity, and comorbid medical conditions. MTBI also was associated with a current diagnosis of PTSD even controlling for other demographic, psychiatric, and medical covariates. MTBI did not moderate or mediate the relationship between PTSD and current symptomatology. However, MTBI did adversely affect long-term recovery from PTSD (odds ratio=1.59, 95% CI, 1.07–2.37). PTSD also was associated with physical, cognitive, and emotional symptoms, and had a larger effect size than MTBI.

Conclusions

MTBI, even in the chronic phase years postinjury, is not a benign condition. It is associated with increased rates of headaches, sleep problems, and memory difficulties. Furthermore, it can complicate or prolong recovery from preexisting or comorbid conditions such as PTSD. Similarly, PTSD is a potent cocontributor to physical, cognitive, and emotional symptoms.

Key Words: Brain concussion, Mental disorders, Neurobehavioral manifestations, Rehabilitation, Social support

List of Abbreviations: CI, confidence interval, DSM-IV, Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, LOC, loss of consciousness, MTBI, mild traumatic brain injury, MVC, motor vehicle collision, OIF, Operation Iraqi Freedom, OR, odds ratio, PCS, postconcussion syndrome, PTSD, posttraumatic stress disorder, TBI, traumatic brain injury