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Traumatic Brain Injuries in Veterans Ups Mental Health Risk

Screening for a TBI Is Vital in Returning Veterans

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Updated February 26, 2010

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

Many soldiers returning from the wars in Iraq and Afghanistan (or OEF/OIF) are suffering from the effects of traumatic brain injuries (or TBI). In fact, it is estimated that anywhere between 12 and 20% of OEF/OIF veterans have experienced a TBI. This is a serious problem because the experience of a TBI, even a mild one, may contribute to or exacerbate mental health problems among returning veterans.

What Is a TBI?

A TBI refers to any type of trauma to the head that results in a disruption in brain functioning. This can range from a brief change in or loss of consciousness to a more extended period of unconsciousness, amnesia, or dysfunction. Because of advances in explosive weapons, more soldiers are placed at risk for TBIs than in previous wars or conflicts. Although most OEF/OIF veterans experience mild TBIs (a loss of consciousness that lasts for 30 minutes or less or a period of amnesia that lasts for less than 24 hours), this does not mean that the TBI will not have an effect on the person's functioning or mental health.

The Relationship between TBIs and Mental Health

Veterans who had screened positive for a TBI were much more likely to be diagnosed with a mental health disorder than those who screened negative, according to research conducted by researchers who looked at rates of mental health diagnoses among a large sample of OEF/OIF veterans who were screened for a TBI.

In addition, veterans with a positive (versus negative) TBI screen were more likely to have been diagnosed with PTSD, substance use disorders, depression, other anxiety disorders besides PTSD, adjustment disorders, psychoses, bipolar disorders, and psychosexual disorders.

Although it can't really be determined from this study whether the mental health disorder or TBI occurred first, the study still provides convincing evidence that there is a strong relationship between TBIs and the experience of additional difficulties in the form of mental health problems.

What Is Being Done to Address This Problem?

The VA has recognized that many returning veterans are suffering from mild TBIs and mental health problems. Therefore, the VA has implemented a screening program to identify returning veterans with mild TBIs. This screen asks questions about situations that may have resulted in a TBI, as well as TBI-related symptoms (for example, loss of consciousness, amnesia, balance problems, sensitivity to light, headaches, etc.). Veterans who screen positive are then referred for a full evaluation to determine the severity of the TBI, as well as connect them to the appropriate services.

If You Suspect You Have a TBI

If you are a OEF/OIF veteran, and you suspect that you may have a TBI, it is very important that you go to your local VA for a screening. Even mild TBIs can have a major impact on a person's functioning. To obtain more information on TBIs, you should visit an informational website maintained by the Vermont Department of Veterans Affairs. It provides information on TBIs, including its symptoms and how it is identified. The website also provides resources for how to cope with the experience of a TBI.

Sources:

American Congress of Rehabilitation Medicine, Mild Traumatic Brain Injury committee of the Head Injury Interdisciplinary Special Interest Group (1993). The definition of mild traumatic brain injury. Journal of Head Trauma Rehabilitation, 8, 86-87.

Carlson, K.F., Nelson, D., Orazem, R.J., Nugent, S., Cifu, D.X., & Sayer, N.A. (2010). Psychiatric diagnoses among Iraq and Afghanistan War Veterans screened for deployment-related traumatic brain injury. Journal of Traumatic Stress, 23, 17-24.

Carroll, L.J., Cassidy, J.D., Holm, L., Kraus, J., & Coronado, V.G. (2004). Methodological issues and research recommendations for mild traumatic brain injury: The WHO Collaborating Center Task Force on Mild Traumatic Brain Injury. Journal of Rehabilitation Medicine, 43 (S1), 113-125.

Department of Veterans Affairs, Veterans Health Administration (2007). VHA Directive 2007-013. Screening and Evaluation of Possible Traumatic Brain Injury in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) Veterans. Washington, DC: Author.

Hoge, C.W., Goldberg, H.M., & Castro, C.A. (2009). Care of war veterans with mild traumatic brain injury - Flawed perspectives. New England Journal of Medicine, 360, 1588-1591.

Hoge, C.W., McGurk, D., Thomas, J.L., Cox, A.L., Engel, C.C., & Castro, C.A. (2008). Mild traumatic brain injury in US soldiers returning from Iraq. New England Journal of Medicine, 358, 453-463.

Okie, S. (2005). Traumatic brain injury in the war zone. New England Journal of Medicine, 352, 2043-2047.

Schneiderman, A.I., Braver, E.R., & Kang, H.K. (2008). Understanding sequelae of injury mechanisms and mild traumatic brain injury incurred during the conflicts in Iraq and Afghanistan: Persistent postconcussive symptoms and posttraumatic stress disorder. American Journal of Epidemiology, 167, 1446-1452.

Tanielian, T., & Jaycox, L.H. (Eds.). Invisible wounds of war: Psychological and cognitive injuries, their consequences, and services to assist recovery. RAND Center for Military Health and Policy. Santa Monica, CA.

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