USA — Study Ties Problems to Post-traumatic Stress

WASHINGTON — Ser­vice mem­bers who suf­fer mild trau­mat­ic brain injuries in com­bat and then strug­gle with depres­sion, irri­tabil­i­ty, alco­hol abuse and sim­i­lar prob­lems after they return home most like­ly are expe­ri­enc­ing post-trau­mat­ic stress, rather than brain injury symp­toms, accord­ing to a new study.

The study, spon­sored by the Defense and Vet­er­ans Affairs depart­ments and pub­lished in this month’s Archives of Gen­er­al Psy­chi­a­try, a Jour­nal of the Amer­i­can Med­ical Asso­ci­a­tion pub­li­ca­tion, tracked Min­neso­ta Nation­al Guard sol­diers dur­ing the last month of their 16-month deploy­ment to Iraq, then again a year after they returned home.

The find­ings, based on the self-report­ing of 953 sol­diers with fol­low-ups from the clin­i­cians, showed “very lit­tle evi­dence for a long-term neg­a­tive impact” from con­cus­sions or mild TBI on “psy­cho-social out­comes” –- anx­i­ety, depres­sion, drug and alco­hol abuse and the like — after account­ing for post-trau­mat­ic stress, said Melis­sa A. Polus­ny, a clin­i­cal psy­chol­o­gist at the Min­neapo­lis Vet­er­ans Affairs Health Care Sys­tem and a pro­fes­sor at Uni­ver­si­ty of Min­neso­ta Med­ical School.

Polus­ny wrote the study along with five oth­er clin­i­cal psy­chol­o­gists, and in col­lab­o­ra­tion with Army Col. (Dr.) Michael Rath, a sur­geon with the 34th Infantry Divi­sion brigade that par­tic­i­pat­ed in the study.

“After we sta­tis­ti­cal­ly con­trolled for PTSD symp­toms, there were vir­tu­al­ly no long-term symp­toms from con­cus­sive and mild TBI,” she said.

Polus­ny empha­sized that the study only inves­ti­gat­ed mild TBI, which may cause a per­son to be momen­tar­i­ly dazed or con­fused or lose con­scious­ness for few­er than 20 min­utes, but caus­es no actu­al injury to the brain or skull. Also, the study did not con­sid­er repeat­ed head trau­ma -– the sub­ject of oth­er stud­ies that have sug­gest­ed long-term effects -– in the sol­diers, 95 per­cent of whom were on their first deploy­ment to Iraq in 2005, she said.

The study’s focus on mild TBI is sig­nif­i­cant for today’s warfight­ers, Polus­ny said, because “the vast major­i­ty of reports of TBI are mild.”

The study’s find­ings, she added, are “very inter­est­ing and not exact­ly what we expect­ed.”

The find­ings show that ser­vice mem­bers are much more like­ly to report con­cus­sions and mild trau­mat­ic brain injuries after they return home than they are in the com­bat the­ater. Of those sur­veyed, only 9 per­cent report­ed con­cus­sions or TBI in the­ater, but 22 per­cent report­ed inci­dents after rede­ploy­ment.

Sim­i­lar­ly, 9 per­cent report­ed symp­toms of post-trau­mat­ic stress dis­or­der in the­ater, com­pared to 14 per­cent at home; and 9 per­cent report­ed symp­toms of depres­sion, com­pared to 18 per­cent at home.

Many of the sol­diers who answered that they did not have mild TBI or post-trau­mat­ic stress dis­or­der symp­toms actu­al­ly did, the VA’s pub­li­ca­tion brief of the study says. Of those, 64 per­cent report­ed hav­ing prob­lems with dis­tractibil­i­ty and irri­tabil­i­ty, 60 per­cent report­ed mem­o­ry prob­lems, 57 per­cent report­ed ring­ing in the ears, and 23 per­cent had bal­ance prob­lems.

Anoth­er notable find­ing, Polus­ny said, is that after their return home, more than 40 per­cent of the Iraq war vet­er­ans report­ed some lev­els of alco­hol abuse.

“There’s been a lot of atten­tion paid to PTSD and mild TBI and even sui­cide risk, but the preva­lence of prob­lem drink­ing appears to be much high­er among return­ing ser­vice mem­bers than any of these oth­er prob­lems,” she said.

Researchers were sur­prised at the wide dif­fer­ence in report­ing from the war the­ater to home, Polus­ny said. They believe the dis­par­i­ty may be due to ser­vice mem­bers’ reluc­tance to report prob­lems while deployed, or that they have a dif­fer­ent impres­sion of events when they return home, she said. The dif­fer­ences may reflect a need for bet­ter post-deploy­ment ques­tion­ing of vet­er­ans, she added.

“One of the real­ly impor­tant impli­ca­tions of the find­ings is that we need to be care­ful­ly screen­ing for PTSD, and make sure vet­er­ans receive treat­ment,” Polus­ny said.

Polus­ny added that the find­ings caused con­cern that com­bat vet­er­ans may mis­at­tribute the rea­son for their prob­lems, which could ham­per treat­ment or cause a ser­vice mem­ber to not seek treat­ment.

“If a vet­er­an is hav­ing irri­tabil­i­ty and mem­o­ry prob­lems, and assumes he had a con­cus­sion when maybe he is suf­fer­ing from PTSD symp­toms, … we need to make sure we are treat­ing vet­er­ans for the right prob­lems,” she said. The study did not inves­ti­gate the cause of the PTSD or whether the TBI trig­gered it.

“The events that sur­round a con­cus­sion or mild TBI in the­ater — being exposed to a blast or being in a fire­fight — those kinds of events already place some­one at risk of PTSD,” Polus­ny said. “Is that due to injury to the brain, or the sit­u­a­tion they are in? We can’t piece that apart yet.”

U.S. Depart­ment of Defense
Office of the Assis­tant Sec­re­tary of Defense (Pub­lic Affairs)

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