Long-term negative emotional outcomes of warzone TBI

Authors

Jennifer J. Vasterling, VA Boston Healthcare System, Boston & Boston University School of Medicine, Boston & VA Boston Healthcare SystemFollow
Mihaela Aslan, VA Cooperative Studies Program & Yale University, New Haven
Susan P. Proctor, U.S. Army Research Institute of Environmental Medicine, Natick & VA Boston Healthcare System, Boston
John Ko, VA Cooperative Studies Program
Xenia Leviyah, VA Boston Healthcare System
John Concato, Yale University, New Haven & Food and Drug Administration, Silver Spring

Date of this Version

2020

Document Type

Article

Citation

THE CLINICAL NEUROPSYCHOLOGIST 2020, VOL. 34, NO. 6, 1088–1104

https://doi.org/10.1080/13854046.2020.1749935

Comments

2020 Author(s)

Abstract

Objective: Many veterans of the Iraq and Afghanistan Wars have experienced traumatic brain injury (TBI). Although prior work has examined associations between TBI and development of psychi- atric syndromes, less is known about associations between TBI and component emotions constituting these syndromes, especially in the long term. The purpose of this study was to examine the long-term emotional consequences of deployment-related TBI.

Methods: As part of VA Cooperative Studies Program #566, we assessed a sample of n1⁄4456US Army soldiers prior to an index deployment to Iraq, and again an average of 8.3 years (SD1⁄42.4years) after their deployment for a long-term follow-up assessment. In this report, we used adjusted regression analyses to examine the relationship of deployment TBI to depression, anxiety, and stress symptom severity measured at the long-term follow-up assessment. A structured interview was used to determine TBI history; the Depression, Anxiety, and Stress Scale, 21-item version (DASS-21) was used to determine emotional status at the follow-up evaluation.

Results: Warzone TBI events, particularly when greater than mild in severity, were independently associated with depression, anx- iety, and stress severity at long-term follow-up, even after taking into account variance attributable to pre-deployment emotional distress and war-zone stress. Post-hoc analyses did not detect independent associations of either number of events or injury mechanism with outcomes.

Conclusions: These findings highlight the potentially enduring and multi-faceted emotional effects of deployment TBI, underscor- ing the need for early assessment of negative affectivity in war- zone veterans reporting TBI.