1017 — PTSD Status Differentiates Neurobehavioral Symptom Inventory (NSI) Responses and Attention Scores in OEF/OIF Veterans Who Screen Positive for TBI

Donnelly KT (VA WNY Healthcare System), King PR (University at Buffalo/SUNY), Alt M (VA WNY Healthcare System)

Objectives:
To identify response patterns on the NSI (a measure of post-concussive symptoms [PCS]) and on attention tests among TBI-positive veterans with and without PTSD.

Methods:
75 OEF/OIF veterans who screened positive for TBI, based on the VA TBI Clinical Reminder, were assessed with a test battery including the NSI, Digit Span, Trail Making Test, and Timed Automatic Recitation (TAR). PTSD status was determined by DSM-IV criteria as measured by the PTSD Checklist (PCL). Forty-eight veterans were positive for PTSD (PCL mean score of 62.58, SD = 10.68) and 27 were not (PCL mean score of 34.84, SD = 9.04).

Results:
Mean NSI total scores were higher for veterans with PTSD (M = 45.65, SD = 14.5) than for those who did not meet criteria for the disorder (M = 29.67, SD = 12.34; t = -4.825, p < .001). Items reported as severe or very severe by the group with PTSD included irritability (85%), difficulty falling or staying asleep (80%), anxiety (70%), poor frustration tolerance (67%), and forgetfulness (65%). In all, the PTSD group endorsed 12 of the 22 NSI items as moderate, severe, or very severe. Veterans who did not meet full criteria for a diagnosis of PTSD endorsed forgetfulness (37%), poor concentration (33%), and irritability (33%) as severe or very severe. None of the other NSI items for this group exceeded mean scores of 2.0 (moderate). The PTSD group performed worse than veterans without PTSD on several measures of attention, including digit span (t = 2.07, p < .05), TAR (t = -2.4, p < .05), and both forms of the Trail Making Test (A: t = -2.24, p < .05; B: t = -2.21, p < .05). Processing speed and attentional efficiency were more impaired for the PTSD group.

Implications:
Items on the NSI overlap significantly with PTSD symptoms, and high scores on the NSI might be more reflective of PTSD than of PCS among veterans who screen positive for TBI. This group also performed more poorly on several measures of attention.

Impacts:
The co-morbidity of TBI and PTSD yields multiple, severe, and intertwined symptoms significantly beyond those experienced by veterans with TBI alone. Such symptoms do not appear to be solely due to PCS and might represent a broader trauma complex that requires careful diagnosis and more aggressive behavioral health treatment.