Carlson KF (Center for Chronic Disease Outcomes Research), Sayer NA
(Center for Chronic Disease Outcomes Research), Nelson DB
(Center for Chronic Disease Outcomes Research), Nugent SM
(Center for Chronic Disease Outcomes Research), Orazem RJ
(Center for Chronic Disease Outcomes Research)
Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) veterans are at risk for both post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI). The purpose of this study was to examine the co-occurrence of PTSD and TBI in OEF/OIF veterans who received services in an upper Midwest VISN.
Analyses were based on administrative data from VISTA for OEF/OIF veterans who received medical care at a VISN 23 facility between April 2007, when TBI screening was implemented within VA, and August 2008. Data included basic demographics, responses to TBI screening, and ICD-9 TBI and psychiatric diagnosis codes. Relative risks (RR) and 95% confidence intervals (CI) of psychiatric diagnoses were calculated.
There were 11,990 OEF/OIF veterans screened for TBI at a VISN 23 facility during the study period; 2,033 (17%) screened positive for TBI and, of these, 744 (37%) were given a TBI diagnosis within the study period. The majority of patients with TBI were male (95%), Caucasian (77%), and service-connected (76%). Mean age was 30.4 years (SD = 8.4). Psychiatric comorbidities were identified for 85% of patients with TBI. PTSD was the most frequent comorbidity, with 65% of TBI patients having a diagnosis, followed by substance use disorders (26%) and major depressive disorders (19%). More than half of TBI patients (52%) were assigned two or more psychiatric diagnoses. The relative risk of a psychiatric diagnosis was greater for patients who screened positive for TBI compared to those who screened negative (RR = 2.0; CI: 1.9-2.0). Patients with positive TBI screenings who were subsequently diagnosed with TBI had slightly greater risk of a psychiatric diagnosis than those who screened positive but were not diagnosed with TBI (RR = 1.1; CI: 1.1-1.2).
Psychiatric comorbidity is common among OEF/OIF veterans diagnosed with TBI following a positive TBI screen. PTSD was the most frequently diagnosed psychiatric disorder.
These findings demonstrate the clinical complexity of OEF/OIF veterans diagnosed with TBI. VA needs to determine whether existing models of care and services meet the needs of patients with TBI and psychiatric disorders, particularly PTSD.