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Publication Briefs

Study Shows Veterans Diagnosed with Traumatic Brain Injury Significantly More Likely to Experience Mental Illness


  • Among 836 Veterans with confirmed traumatic brain injury (TBI), 85% had at least one psychiatric diagnosis, and 64% had two or more distinct diagnoses.
  • Compared to Veterans with negative TBI screens (n=10,922), those with positive screens but without confirmed TBI (n=1,443) were three times more likely to have PTSD - and were two times more likely to have depression and substance-related diagnoses.
  • Veterans with clinically confirmed TBI were more likely than those with positive screens but no confirmed TBI to have diagnoses of PTSD, anxiety, and adjustment disorders.
  • Nearly half of all OEF/OIF Veterans screened for TBI in VISN 23 (n=6,283) had at least one psychiatric disorder, with PTSD (25.9%) and depression (25.6%) being the most common.

VA implemented national screening for symptomatic TBI resulting from combat exposure in April 2007. This screening program targets new Veterans with TBI that would otherwise go undetected, and is prompted by an automated clinical reminder. Although little is known about the specific management of individuals with comorbid symptomatic TBI and psychiatric disorders, they may require a longer period of recovery, potential modification of existing treatments, and a greater focus on coordinated, interdisciplinary care. Therefore, it is important that they be identified. Using VA data for 13,201 OEF/OIF Veterans who were screened for TBI in VISN 23, investigators examined rates of psychiatric disorders in relation to both TBI screening results and post-screening confirmation of TBI status. This study focused on Veterans who were screened for TBI between 4/07 and 10/08.


  • Investigators relied on VA administrative data to identify Veterans with TBI and mental illness.
  • Available data on the rate of TBI evaluation in VISN 23 indicated that 32% of those with positive TBI screens were not fully evaluated for TBI.
  • There is a lack of empirical evidence on the sensitivity and specificity of the VA TBI screening tool.


  • Authors suggest that functional problems reported by OEF/OIF Veterans may be driven by symptomatic TBI as well as concomitant or secondary psychiatric disorders.
  • Authors also suggest further research to determine how or whether service delivery and clinical best practices for symptomatic mild TBI and psychiatric disorders need to be modified for Veterans who experience both.

This study was funded through VA/HSR&D's Polytrauma and Blast-Related Injuries Quality Enhancement Research Initiative (PT/BRI-QUERI). Dr. Sayer is part of PT/BRI-QUERI.

PubMed Logo Carlson K, Nelson D, Orazem R, Nugent S, Cifu D, and Sayer N. Psychiatric Diagnoses among Iraq and Afghanistan War Veterans Screened for Deployment-Related Traumatic Brain Injury. Journal of Traumatic Stress February 1, 2010;23(1):17-24.

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HSR requires notification by HSR-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR published articles. Visit the HSR citations database for a complete listing of HSR articles and presentations.

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