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The Clinical Neuropsychologist Volume 34, 2020 - Issue 6: Special Issue on Military Neuropsychology: Serving Those Who Serve
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Original Articles

Longitudinal trajectories and risk factors for persistent postconcussion symptom reporting following uncomplicated mild traumatic brain injury in U.S. Military service members

Rael T. Langea Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, MD, USA; ;b National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA; ;c University of British Columbia, Vancouver, Canada; Correspondence[email protected]
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Sara M. Lippaa Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, MD, USA; ;b National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA;
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Jason M. Bailiee Defense and Veterans Brain Injury Center, Naval Hospital Camp Pendleton, CA, USA
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Megan Wrighta Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, MD, USA; ;b National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA;
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Angela Driscolla Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, MD, USA; ;b National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA;
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Jamie Sullivana Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, MD, USA; ;b National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA;
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Rachel Gartnera Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, MD, USA; ;b National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA;
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Daniel Ramina Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, MD, USA; ;b National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA;
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Gabrielle Robinsona Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, MD, USA; ;b National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA;
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Yasmine Esheraa Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, MD, USA; ;b National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA;
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Kelly Gillowa Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, MD, USA; ;b National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA;
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Louis M. Frencha Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, MD, USA; ;b National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA; ;d Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, USA;
&
Tracey A. Brickella Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, MD, USA; ;b National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA; ;d Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, USA;
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Pages 1134-1155 | Received 22 Oct 2019, Accepted 19 Mar 2020, Published online: 14 Apr 2020
 
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Abstract

Objective

The purpose of this study was to examine individual postconcussion symptom [PCSx] trajectories following mild traumatic brain injury (MTBI), and to examine risk factors for persistent PCSx reporting.

Method

Participants were 138 U.S. military service members and veterans (SMVs) prospectively enrolled in the Defense and Veterans Brain Injury Center, 15-Year Longitudinal TBI study. Participants were classified into three groups: uncomplicated MTBI (n = 54), injured controls (IC, n = 26), and non-injured controls (NIC, n = 58). Participants completed the Neurobehavioral Symptom Inventory, PTSD Checklist, and Traumatic Brain Injury Quality of Life at baseline (<8 months post-injury) and at follow-up (2–4 years post-injury).

Results

The prevalence of those who met DSM-IV-TR symptom criteria for Postconcussional Disorder (PCD) was high in all three groups (e.g., 44.8–63.0%) and did not significantly change from baseline to follow-up (all ps>.05). However, there was substantial variability in individual symptom trajectories over time. The majority of participants had symptom trajectories classified as either ‘persistent’ (∼32–55%) or ‘asymptomatic’ (∼30–36%), with a substantial minority classified as ‘improved’ (∼7–12%) or ‘developed’ (∼7–19%). Factors associated with ‘persistent’ PCD trajectories included cognitive complaints, PTSD, depression, anxiety, pain, and headaches at baseline; but not the presence/absence of MTBI. Factors associated with ‘developed’ PCD trajectories included PTSD and the number of lifetime exposures to blast.

Conclusions: Reporting of ‘new’ PCSx over time was common in individuals with and without MTBI. It would be erroneous to assume uncritically that PCSx reported many years post-injury reflect only persistent symptomatology, or can be solely attributable to the direct consequences of a brain injury.

Acknowledgments

The authors would like to thank the service members and veterans for their time and commitment to participating in the research. The authors would also like to acknowledge the efforts of the larger team of research coordinators, research associates, research assistants, program managers, and senior management who contribute to the DVBIC 15-Year Longitudinal TBI Study.

Disclaimer

The views expressed in this manuscript are those of the authors and do not necessarily represent the official policy or position of the Defense Health Agency, Department of Defense, or any other U.S. government agency. This work was prepared under Contract HT0014-19-C-0004 with DHA Contracting Office (CO-NCR) HT0014 and, therefore, is defined as U.S. Government work under Title 17 U.S.C.§101. Per Title 17 U.S.C.§105, copyright protection is not available for any work of the U.S. Government. For more information, please contact [email protected].

Disclosure statement

No potential conflict of interest is reported by all authors.

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