Postconcussion symptoms reported by Operation Enduring Freedom/Operation Iraqi Freedom veterans with and without blast exposure, mild traumatic brain injury, and posttraumatic stress disorder

ABSTRACT

Objective: This study examined symptom reporting related to the 10th Edition of the International Statistical Classification of Diseases and Related Health Problems (ICD–10) criteria for postconcussional syndrome (PCS) in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) Veterans. Our aims were to: (a) examine relationships among PCS symptoms by identifying potential subscales of the British Columbia Postconcussion Symptom Inventory (BC-PSI); and (b) examine group differences in BC-PSI items and subscales in Veterans with and without blast exposure, mild traumatic brain injury (mTBI), and posttraumatic stress disorder (PTSD). Method: Our sample included Veterans with blast-related mTBI history (n = 47), with blast exposure but no mTBI history (n = 20), and without blast exposure (n = 23). Overall, 37 Veterans had PTSD, and 53 did not. We conducted an exploratory factor analysis (EFA) of the BC-PSI followed by multivariate analysis of variance to examine differences in BC-PSI subscale scores by blast exposure, mTBI history, and PTSD. Results: BC-PSI factors were interpreted as cognitive, vestibular, affective, anger, and somatic. Items and factor scores were highest for Veterans with blast exposure plus mTBI, and lowest for controls. Vestibular, affective, and somatic factors were significantly higher for Veterans with blast exposure plus mTBI than for controls, but not significantly different for those with blast exposure but no mTBI. These results remained significant when PTSD symptom severity was included as a covariate. Cognitive, anger, and somatic subscales were significantly higher for Veterans with PTSD, though there was no interaction effect of PTSD and mTBI or blast history. Conclusions: EFA-derived subscales of the BC-PSI differentiated Veterans based on blast exposure, mTBI history, and PTSD.

KEYWORDS:

• Blast exposure
• Concussion
• Factor analysis
• Head trauma
• Posttraumatic stress disorder
• Traumatic brain injury
• Veterans Affairs

Acknowledgments

The corresponding author (M.E.O.) declares she had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by the U.S. Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Rehabilitation Research and Development, VA Merit Review Award [grant number B5060R to D.S.]; U.S. Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Health Services Research and Development, Center of Innovation [grant number CIN 13–404]; Agency for Healthcare Research and Quality [grant number 1 K12 HS019456 01]; and an Agency for Healthcare Research and Quality PCOR K12 award to M.E.O. [grant number K12HS022981]. This material is the result of work supported with resources and the use of facilities at the Veterans Affairs Portland Health Care System, Portland, Oregon. G.L.I. acknowledges support from the INTRuST Posttraumatic Stress Disorder and Traumatic Brain Injury Clinical Consortium funded by the Department of Defense Psychological Health/Traumatic Brain Injury Research Program [grant number X81XWH-07-CC-CSDoD]. The contents do not represent the views of the U.S. Department of Veterans Affairs or the United States Government. G.L.I. developed the BC-PSI and holds the copyright. The test is not sold commercially. No additional competing financial interests exist. G.L.I. has been reimbursed by the government, professional scientific bodies, and commercial organizations for discussing or presenting research relating to mTBI and sport-related concussion at meetings, scientific conferences, and symposiums. He has a clinical practice in forensic neuropsychology involving individuals who have sustained mild TBIs. He has received grant funding from pharmaceutical companies to do psychometric research using neuropsychological tests. He has received research support from neuropsychological test publishing companies in the past (not in the past 5 years). All other authors declare no conflicts of interests involved in the research presented in the manuscript.