Association of Traumatic Brain Injury Severity and Self-Reported Neuropsychiatric Symptoms in Wounded Military Service Members

Sharon Y Kim; Alyssa A Soumoff; Sorana Raiciulescu; Patricia A Kemezis; Elizabeth A Spinks; David L Brody; Vincent F Capaldi; Robert J Ursano; David M Benedek; Kwang H Choi

doi:10.1089/neur.2022.0063

Association of Traumatic Brain Injury Severity and Self-Reported Neuropsychiatric Symptoms in Wounded Military Service Members

Neurotrauma Rep. 2023 Jan 10;4(1):14-24. doi: 10.1089/neur.2022.0063. eCollection 2023.

Authors

Sharon Y Kim¹, Alyssa A Soumoff^{2

3}, Sorana Raiciulescu⁴, Patricia A Kemezis³, Elizabeth A Spinks³, David L Brody^{5

6}, Vincent F Capaldi^{1

2

7}, Robert J Ursano^{1

2

7}, David M Benedek^{1

2

7}, Kwang H Choi^{1

2

7}

Affiliations

¹ Program in Neuroscience, Uniformed Services University, Bethesda, Maryland, USA.
² Department of Psychiatry, Uniformed Services University, Bethesda, Maryland, USA.
³ Behavioral Health Directorate, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.
⁴ Department of Preventive Medicine and Biostatistics, Biostatistics Consulting Center, Uniformed Services University, Bethesda, Maryland, USA.
⁵ Center for Neuroscience and Regenerative Medicine, Uniformed Services University, Bethesda, Maryland, USA.
⁶ Department of Neurology, Uniformed Services University, Bethesda, Maryland, USA.
⁷ Center for the Study of Traumatic Stress, Uniformed Services University, Bethesda, Maryland, USA.

Abstract

The impact of traumatic brain injury (TBI) severity and loss of consciousness (LOC) on the development of neuropsychiatric symptoms was studied in injured service members (SMs; n = 1278) evacuated from combat settings between 2003 and 2012. TBI diagnoses of mild TBI (mTBI) or moderate-to-severe TBI (MS-TBI) along with LOC status were identified using International Classification of Diseases, Ninth Revision (ICD-9) codes and the Defense and Veterans Brain Injury Center Standard Surveillance Case Definition for TBI. Self-reported psychiatric symptoms were evaluated for post-traumatic stress disorder (PTSD) with the PTSD Checklist, Civilian Version for PTSD, the Patient Health Questionnaire-9 for major depressive disorder (MDD), and the Patient Health Questionnaire-15 for somatic symptom disorder (SSD) in two time periods post-injury: Assessment Period 1 (AP1, 0.0-2.5 months) and Assessment Period 2 (AP2, 3-12 months). mTBI, but not MS-TBI, was associated with increased neuropsychiatric symptoms: PTSD in AP1 and AP2; MDD in AP1; and SSD in AP2. A subgroup analysis of mTBI with and without LOC revealed that mTBI with LOC, but not mTBI without LOC, was associated with increased symptoms as compared to non-TBI: PTSD in AP1 and AP2; MDD in AP1; and SSD in AP1 and AP2. Moreover, mTBI with LOC was associated with increased MDD symptoms in AP2, and SSD symptoms in AP1 and AP2, compared to mTBI without LOC. These findings reinforce the need for the accurate characterization of TBI severity and a multi-disciplinary approach to address the devastating impacts of TBI in injured SMs.

Keywords: combat exposure stress; loss of consciousness (LOC); major depressive disorder (MDD); post-traumatic stress disorder (PTSD); somatic symptom disorder (SSD); traumatic brain injury (TBI).