Majority of OEF/OIF Veterans with Traumatic Brain Injury also Diagnosed with Mental Illness and Head, Neck or Back Pain
BACKGROUND:
VA is the single largest provider of healthcare services to OEF/OIF Veterans. These Veterans who receive VA healthcare carry a high burden of mental disorders, with PTSD being the most common. Survey findings also suggest that 15% to 20% may have mild traumatic brain injury (TBI), and pain is another high-frequency problem among this VA patient population. However, little is known about the co-occurrence of TBI, psychiatric disorders, and pain on a national level. Using VA data, this observational study examined the prevalence and VA healthcare costs of TBI with and without comorbid psychiatric illness and pain among 327,388 OEF/OIF Veterans who used VA healthcare services (inpatient or outpatient) during FY09. Investigators compared demographics and co-occurring mental health, head, neck or back pain diagnoses by clinician-diagnosed TBI status, as well as average costs.
FINDINGS:
- In 2009, 22,053 (6.7%) of the 327,388 OEF/OIF Veterans who used VA healthcare received a diagnosis of TBI. Among this patient subgroup, the vast majority (89%) also had a psychiatric diagnosis (most frequently PTSD: 73%), and 70% had a diagnosis of head, neck or back pain. More than half had both PTSD and pain (54%). Overall, depression was the second most common (45%) mental health diagnosis.
- Annual costs for OEF/OIF Veterans with TBI were four times greater than for those without TBI ($5,831 vs. $1,547), and costs increased as clinical complexity increased. For example, Veterans with TBI, PTSD, and pain demonstrated the highest median cost per patient ($7,974).
LIMITATIONS:
- Findings are based on administrative data and, therefore, may be biased by documentation errors.
- Data were not available on diagnoses for the 54% of OEF/OIF Veterans who did not use VA care.
- Average cost estimates were based on VA healthcare use only.
NOTE:
The �Fiscal Year 2009 VA Utilization Report for OEF/OIF Veterans Diagnosed with TBI�, utilizing the data reported in this article, is available on the VA Intranet (VA network access only — http://vaww.queri.research.va.gov/ptbri/docs/FY09-TBI-Diagnosis-HCU-Report-Final.pdf).
AUTHOR/FUNDING INFORMATION:
This study was funded through VA/HSR&D�s Polytrauma and Blast-Related Injuries Quality Enhancement Research Initiative (QUERI). Drs. Taylor and Sayer, and Ms. Hagel and Ms. Cutting are part of HSR&D�s Center for Chronic Disease Outcomes Research, Minneapolis, MN. Dr. Sayer also is Director of PT/BRI-QUERI. Dr. Carlson is a VA HSR&D Career Development Awardee (CDA 08-025). Dr. Cifu is VA�s National Director for Physical Medicine and Rehabilitation Services.
Taylor B, Hagel E, Carlson K, Cifu D, Cutting A, Bidelspach D, and Sayer N. Prevalence and Costs of Co-Occurring Traumatic Brain Injury with and without Psychiatric Disturbance and Pain among Afghanistan and Iraq War Veteran VA Users. Medical Care January 4, 2012;e-pub ahead of print.
