Long-term physical and mental health outcomes associated with traumatic brain injury severity in post-9/11 veterans: A retrospective cohort study.
Alicia A Swan, Megan E Amuan, Sandra B Morissette and 4 others
PMID 30273517WHAT IT FOUND
Veterans with moderate/severe TBI still reported worse somatization, PTSD, and depression after accounting for other factors.
Mild TBI mostly did not. Overall health and current pain were not different after adjustment.
Key findings
01After adjustment for demographics, health-condition clusters, and deployment experiences, moderate/severe TBI remained associated with higher somatization, PTSD, and depression scores than No TBI.
02After the same adjustment, overall health and current pain did not differ by TBI severity; mild TBI was mostly not independently associated with poorer overall outcomes, although it had higher pain symptoms on the somatization pain factor.
03Screen-positive and unclassified TBI groups also had adjusted symptom differences: screen-positive higher somatization and depression, unclassified higher PTSD.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The survey response rate was 21.7%, and respondents differed from non-respondents by age, marital status, sex, race/ethnicity, rank, and service component, so the sample may not represent the full cohort. The outcomes were self-reported symptom scales, not measured functional outcomes. The study is observational and used survey follow-up, so it cannot show that TBI caused the symptoms. TBI severity was derived from administrative and screening data, and some groups were screen positive or unclassified rather than clinically confirmed severity categories. Comorbidity phenotypes were probabilistic diagnostic patterns, not mutually exclusive categories. Adjustment changed many before-adjustment differences, so TBI severity alone may not explain the symptom reporting.
Declared interests
The supplied metadata lists non-U.S. Government research support, but the article text does not include a funding or conflict-of-interest declaration.
The easy way to misread this
Do not read mild TBI as a direct cause of worse long-term symptoms. After adjustment, overall health and current pain did not differ by TBI severity, and mild TBI was mostly not independently associated with poorer outcomes.