Journal of Rehabilitation Research & Development (JRRD)

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Volume 53 Number 2, 2016
   Pages 185 — 198

Abstract — Association between mild traumatic brain injury and mental health problems and self-reported cognitive dysfunction in Iraq and Afghanistan Veterans

Karen H. Seal, MD, MPH;1–2 Daniel Bertenthal, MPH;1 Kristin Samuelson, PhD;1,3 Shira Maguen, PhD;1–2 Sant Kumar, BA;1 Jennifer J. Vasterling, PhD4

1San Francisco Department of Veterans Affairs (VA) Health Care System, San Francisco, CA; 2University of California, San Francisco, San Francisco, CA; 3California School of Professional Psychology, Alliant International University, San Francisco, CA; 4VA Boston Healthcare System, Boston, MA; and Boston University School of Medicine, Boston, MA

Abstract — The Department of Veterans Affairs traumatic brain injury (TBI) screening program is intended to detect and expedite treatment for TBI and postconcussive symptoms. Between April 14, 2007, and May 31, 2012, of 66,089 Iraq and Afghanistan Veterans who screened positive on first-level TBI screening and later completed comprehensive TBI evaluation that includes the Neurobehavioral Symptoms Inventory, 72% reported moderate to very severe cognitive impairment (problems with attention, concentration, memory, etc.) that interfered with daily activities. This included 42% who were found not to have sustained combat-related mild TBI (mTBI). In contrast, 70.0% received a posttraumatic stress disorder (PTSD) diagnosis and 45.8% received a depression diagnosis. Compared with Veterans without mTBI, PTSD, or depression diagnoses, the lowest risk for self-reported cognitive impairment was in Veterans with confirmed mTBI only; a greater risk was found in those with PTSD diagnoses, with the greatest risk in Veterans with PTSD, depression, and confirmed mTBI, suggesting only a weakly additive effect of mTBI. These findings suggest that Veterans with multiple mental health comorbidities, not just those with TBI, report moderate to very severe cognitive impairment. Mental health treatment for conditions such as PTSD and depression (with or without TBI) may result in improvements in cognitive functioning and/or include assessment and support for Veterans experiencing cognitive problems.

Key words: cognitive dysfunction, concussion, depression, mental health, mild traumatic brain injury, population-based screening, postdeployment, posttraumatic stress disorder, primary care, recovery expectations, Veterans.


View HTML ¦ View PDF ¦ Contents Vol. 53, No.2

This article and any supplementary material should be cited as follows:
Seal KH, Bertenthal D, Samuelson K, Maguen S, Kumar S, Vasterling JJ. Association between mild traumatic brain injury and mental health problems and self-reported cognitive function in Iraq and Afghanistan Veterans. J Rehabil Res Dev. 2016;53(2):185–98.
http://dx.doi.org/10.1682/JRRD.2014.12.0301
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