What is the Impact of Combat-associated TBI on Mental Health Conditions?

Research Paper Title

Mental Health Outcomes Among Military Service Members After Severe Injury in Combat and TBI.

Background

Studies examining the mental health outcomes of military personnel deployed into combat zones have focused on the risk of developing post-traumatic stress disorder conferred by mild or moderate traumatic brain injury (TBI).

However, other mental health outcomes among veterans who sustained critical combat injuries have not been described.

Methods

The researchers examined the associations of moderate and severe TBI and combat injury with the risk for anxiety and mood disorders, adjustment reactions, schizophrenia and other psychotic disorders, cognitive disorders, and post-traumatic stress disorder.

They conducted a retrospective cohort study of US military service members critically injured in combat during military operations in Iraq and Afghanistan from 01 February 2002 to 01 February 2011.

Health care encounters from (1) the Department of Defence (DoD) Trauma Registry (TR), (2) acute and ambulatory care in military facilities, and (3) civilian facilities are reimbursed by Tricare.

Service members who sustained severe combat injury require critical care.

The researchers estimated the risk of mental health outcomes using risk-adjusted logit models for demographic and clinical factors, and they explored the relationship between TBI and the total number of mental health diagnoses.

Results

Of the 4,980 subjects who met inclusion criteria, most injuries occurred among members of the Army (72%) or Marines (25%), with mean (SD) age of 25.5(6.1) years.

The prevalence of moderate or severe TBI was 31.6% with explosion as the most common mechanism of injury (78%).

The researchers found 71% of the cohort was diagnosed with at least one poor mental health condition, and the adjusted risk conferred by TBI ranged from a modest increase for anxiety disorder (odds ratio, 1.27; 95% confidence interval [CI], 1.11-1.45) to a large increase for cognitive disorder (odds ratio, 3.24; 95% CI, 2.78-3.77).

They also found TBI was associated with an increased number of mental health diagnoses (incidence rate ratio, 1.52; 95% CI, 1.42-1.63).

Conclusions

Combat-associated TBI may have a broad effect on several mental health conditions among critically injured combat casualties.

Early recognition and treatment for trauma-associated mental health are crucial to improving outcomes among service personnel as they transition to post-deployment care in the DoD, Department of Veterans Affairs, or community health systems.

Reference

Chin, D.L. & Zeber, J.E. (2020) Mental Health Outcomes Among Military Service Members After Severe Injury in Combat and TBI. Military Medicine. 185(5-6), pp.e711-e718. doi: 10.1093/milmed/usz440.

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