Original research| Volume 99, ISSUE 2, SUPPLEMENT , S50-S57, February 2018

Long-Term Neurobehavioral Symptoms and Return to Productivity in Operation Enduring Freedom/Operation Iraqi Freedom Veterans With and Without Traumatic Brain Injury

Published:January 13, 2017DOI:



      To describe Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans who underwent the Comprehensive Traumatic Brain Injury Evaluation (CTBIE), differences between the traumatic brain injury (TBI) and non-TBI subgroups, and factors associated with return to productivity (RTP).


      Retrospective medical record review.


      Medical center.


      Medical records of OEF/OIF veterans (N=236) who underwent the CTBIE between 2009 and 2013.


      Not applicable.

      Main Outcome Measures

      Demographic characteristics, injury history, clinical presentation, and factors associated with RTP.


      Veteran sample included 90.7% men, was 45.3% white and 34.7% black, with half of Hispanic origin, and had a mean age of 33 years. The mean time since injury was approximately 4 years. Reported symptoms were high, with >90% reporting anxiousness, irritability, sleep difficulty, forgetfulness, and headaches. TBI diagnosis was found in 163 veterans (69%). The TBI subgroup was younger (TBI: 32.5y vs non-TBI: 34.9y; P=.02), reported a greater number of injuries (P<.001), and had significantly higher rates of half of the reported symptoms. Greatest differences were noted with forgetfulness (TBI: 95.7% vs non-TBI: 79.5%; P<.001), poor concentration (TBI: 90.2% vs non-TBI: 76.7%; P=.007), and headaches (TBI: 93.9% vs non-TBI: 83.6%; P=.014). RTP was 60.6% for the total veteran population. Factors associated with RTP were race (white) (odds ratio [OR], 2.00; 95% confidence interval [CI], 1.13–3.55; P=.018), sensitivity to light (OR, 2.58; 95% CI, 1.17–5.66; P=.018), and fatigue (OR, 3.68; 95% CI, 1.51–8.95; P=.004). Veterans that did RTP were 3 times less likely to report depression (OR, .32; 95% CI, .12–.85; P=.022).


      Veterans reported a substantial number of lingering symptoms, with a higher prevalence in veterans with TBI. Veterans with reported depression were less likely to RTP. Future research should focus on the relation between depression and non-RTP and the effectiveness of Department of Veterans Affairs services.


      List of abbreviations:

      CI (confidence interval), CTBIE (Comprehensive Traumatic Brain Injury Evaluation), mTBI (mild traumatic brain injury), NSI (Neurobehavioral Symptom Inventory), OEF/OIF (Operation Enduring Freedom/Operation Iraqi Freedom), OR (odds ratio), PTSD (posttraumatic stress disorder), RTP (return to productivity), TBI (traumatic brain injury), VA (Department of Veterans Affairs)
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