Association between mild traumatic brain injury and mental healthproblems and self-reported cognitive dysfunction in Iraq andAfghanistan Veterans

摘要

The Department of Veterans Affairs traumatic braininjury (TBI) screening program is intended to detect and expeditetreatment for TBI and postconcussive symptoms. BetweenApril 14, 2007, and May 31, 2012, of 66,089 Iraq and AfghanistanVeterans who screened positive on firstlevel TBI screeningand later completed comprehensive TBI evaluation that includesthe Neurobehavioral Symptoms Inventory, 72% reported moderateto very severe cognitive impairment (problems with attention,concentration, memory, etc.) that interfered with dailyactivities. This included 42% who were found not to have sustainedcombatrelated mild TBI (mTBI). In contrast, 70.0%received a posttraumatic stress disorder (PTSD) diagnosis and45.8% received a depression diagnosis. Compared with Veteranswithout mTBI, PTSD, or depression diagnoses, the lowestrisk for selfreported cognitive impairment was in Veterans withconfirmed mTBI only; a greater risk was found in those withPTSD diagnoses, with the greatest risk in Veterans with PTSD,depression, and confirmed mTBI, suggesting only a weaklyadditive effect of mTBI. These findings suggest that Veteranswith multiple mental health comorbidities, not just those withTBI, report moderate to very severe cognitive impairment. Mentalhealth treatment for conditions such as PTSD and depression(with or without TBI) may result in improvements in cognitivefunctioning and/or include assessment and support for Veteransexperiencing cognitive problems.