Relationship of Screen-Based Symptoms for Mild Traumatic Brain Injury and Mental Health Problems in Iraq and Afghanistan Veterans: Distinct or Overlapping Symptoms?

By Maguen, Shira; Lau, Karen M. et al. | Journal of Rehabilitation Research & Development, July 2012 | Go to article overview

Relationship of Screen-Based Symptoms for Mild Traumatic Brain Injury and Mental Health Problems in Iraq and Afghanistan Veterans: Distinct or Overlapping Symptoms?


Maguen, Shira, Lau, Karen M., Madden, Erin, Seal, Karen, Journal of Rehabilitation Research & Development


INTRODUCTION

Traumatic brain injury (TBI) has received greater public attention because of the conflicts in Iraq and Afghanistan (Operation Iraqi Freedom [OIF]/Operation Enduring Freedom [OEF]) [1]. An estimated 22 percent of servicemembers returning from OIF have reported experiencing TBIs and concussions [2], and of injured OIF/OEF servicemembers, 31 percent have been diagnosed with a TBI [3]. Although TBIs range in severity, mild TBI comprises roughly 77 percent of all head injuries among OIF/OEF veterans and is most challenging to diagnose because of symptom overlap with mental health disorders: posttraumatic stress disorder (PTSD) and depression, in particular [4-5].

In an attempt to increase early detection of mild TBI in returning combat veterans entering the Department of Veterans Affairs (VA) system, the VA implemented the first-level TBI screen in April 2007 [6]. The VA considers OIF/OEF veterans to be at risk for having had a possible mild TBI if, on the first-level VA TBI screen, they report a head injury with loss of consciousness or altered mental status and postconcussive symptoms (PCSs, immediately following the exposure and within 1 wk prior to screening) [7]. This definition is sensitive and identifies at-risk OIF/OEF veterans but is not necessarily specific for a TBI diagnosis because mental health conditions, such as PTSD and depression, have also led to positive responses on the VA TBI screen [8]. OIF/OEF veterans who screen positive on the VA first-level TBI screen are therefore referred for second-level TBI screening to conduct a more in-depth assessment for a history of a TBI exposure.

Given that TBI results from exposure to a traumatic event, such as a blast, symptoms of TBI commonly co-occur with both PTSD and depression [9]. TBI can increase the risk of developing PTSD and other mental health conditions because the event associated with the head injury was potentially life-threatening and was associated with other traumatic war zone exposures [10-11]. In recent studies among OIF/OEF veterans with mild TBI, an estimated 33 to 44 percent also met criteria for PTSD and 33 to 62 percent also met criteria for depression [12-14].

Particularly challenging is the fact that many of the cardinal features of mild TBI, such as memory problems, diminished attention and concentration, irritability, and insomnia, are also hallmark symptoms of PTSD and depression [10,12]. Schneiderman et al. found that PTSD was one of the factors most strongly associated with TBI-related PCSs [15]. Indeed, in one published study of OIF servicemembers with mild TBI, after controlling for the effects of PTSD, headaches were the only distinguishing feature associated with loss of consciousness in the battlefield [12]. Nevertheless, a gap exists in identifying other symptoms that differentiate TBI, PTSD, and depression.

The purpose of this study was to address this gap by identifying distinguishing features of each disorder in order to more accurately discriminate between screen-based symptoms of TBI, PTSD, and depression in OIF/ OEF veterans. Because the symptoms of TBI, PTSD, and depression can overlap clinically, problems with triage and appropriate referral for specialty care can ensue, creating delays in diagnosis and treatment [15-17]. Specifically, using factor analytic techniques, we sought to identify symptoms from TBI, PTSD, and depression screens that were overlapping and, in contrast, symptoms that were uniquely associated with a positive TBI screen (and not better accounted for by PTSD or depression). We focused on VA screen results because they represent the level of information that clinicians use to make initial decisions about diagnosis and treatment of their patients. To our knowledge, no study to date has used the VA post-deployment mental health and TBI screens to evaluate symptom discrimination in OIF/OEF veterans. A better understanding of the symptoms that differentiate among TBI, PTSD, and depression in the initial screening stage may facilitate triage, more accurate diagnosis, and early symptom management of OIF/OEF veterans. …

The rest of this article is only available to active members of Questia

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Buy instant access to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

Relationship of Screen-Based Symptoms for Mild Traumatic Brain Injury and Mental Health Problems in Iraq and Afghanistan Veterans: Distinct or Overlapping Symptoms?
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Help
Full screen

matching results for page

    Questia reader help

    How to highlight and cite specific passages

    1. Click or tap the first word you want to select.
    2. Click or tap the last word you want to select, and you’ll see everything in between get selected.
    3. You’ll then get a menu of options like creating a highlight or a citation from that passage of text.

    OK, got it!

    Cited passage

    Style
    Citations are available only to our active members.
    Buy instant access to cite pages or passages in MLA, APA and Chicago citation styles.

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

    1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

    Cited passage

    Thanks for trying Questia!

    Please continue trying out our research tools, but please note, full functionality is available only to our active members.

    Your work will be lost once you leave this Web page.

    Buy instant access to save your work.

    Already a member? Log in now.

    Oops!

    An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.