Supplemental Material for TBI-CareQOL Military Health Care Frustration in Caregivers of Service Members/Veterans With Traumatic Brain Injury

ABSTRACT Objective To understand the prevalence of comorbidities associated with traumatic brain injury (TBI) patients among active and reserve service members in the U.S. Military. Methods Active and reserve SMs diagnosed with an incident TBI from January 2017 to October 2019 were selected. Nineteen comorbidities associated with TBI as identified in the literature and by clinical subject matter experts were described in this article. Each patient’s medical encounters were evaluated from 6 months before to 2 years following the initial TBI diagnoses date in the Military Data Repository, if data were available. Time-to-event analyses were conducted to assess the cumulative prevalence over time of each comorbidity to the incident TBI diagnosis. Results We identified 47,299 TBI patients, of which most were mild (88.8%), followed by moderate (10.5%), severe (0.5%), and of penetrating (0.2%) TBI severity. Two years from the initial TBI diagnoses, the top five comorbidities within our cohort were cognitive disorders (51.9%), sleep disorders (45.0%), post-traumatic stress disorder (PTSD; 36.0%), emotional disorders (22.7%), and anxiety disorders (22.6%) across severity groups. Cognitive, sleep, PTSD, and emotional disorders were the top comorbidities seen within each TBI severity group. Comorbidities increased pre-TBI to post-TBI; the more severe the TBI, the greater the prevalence of associated comorbidities. Conclusion A large proportion of our TBI patients are afflicted with comorbidities, particularly post-TBI, indicating many have a complex profile. The military health system should continue tracking comorbidities associated with TBI within the U.S. Military and devise clinical practices that acknowledge the complexity of the TBI patient.

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Correlates of Depression in U.S. Military Service Members With a History of Mild Traumatic Brain Injury

Military Medicine ◽

10.1093/milmed/usy321 ◽

2019 ◽

Vol 184 (Supplement_1) ◽

pp. 148-154 ◽

Cited By ~ 2

Author(s):

Jan E Kennedy ◽

Lisa H Lu ◽

Matthew W Reid ◽

Felix O Leal ◽

Douglas B Cooper

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Military Service ◽

Depressive Disorders ◽

Service Members ◽

Data Repository ◽

Military Health ◽

Increased Risk ◽

History Of ◽

Combat Deployments

AbstractObjectivesPost-traumatic stress disorder (PTSD) and traumatic brain injury (TBI) are identified as signature injuries of the Wars in Iraq and Afghanistan. Statistics have confirmed a high incidence of PTSD among military personnel with mild TBI (mTBI) who served in these conflicts. Although receiving less attention, individuals with a history of mTBI are also at increased risk for depressive disorders. This study examines the incidence and correlates of depression in service members with a history of mTBI received an average of 4–1/2 years prior to evaluation.MethodsRetrospective analysis of 184 service members with a history of mTBI extracted from a data repository maintained at a military medical center.ResultsOne-third of the sample (34.2%) was clinically diagnosed with a depressive disorder in the month preceding evaluation. Of those with depression, 81% (51 of 63) were also diagnosed with PTSD. Proportionately more women than men had depression. Depression was more common among those who were undergoing a Military Evaluation Board and those who served in more than three combat deployments.ConclusionsResults confirm chronically elevated the rates of depressive disorders and PTSD comorbidity among service members with a history of mTBI. Depression screening and treatment within the Military Health System should remain a priority for service members reporting a remote history of mTBI. Individuals with chronic PTSD, women, service members undergoing MEB and those who served in greater than three combat deployments are at particular risk.

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Association Between Mental Health Conditions Diagnosed During Initial Eligibility for Military Health Care Benefits and Subsequent Deployment, Attrition, and Death by Suicide Among Active Duty Service Members

Military Medicine ◽

10.7205/milmed-d-12-00051 ◽

2012 ◽

Vol 177 (10) ◽

pp. 1149-1156 ◽

Cited By ~ 14

Author(s):

Robert R. Ireland ◽

Amii M. Kress ◽

Lucinda Z. Frost

Keyword(s):

Mental Health ◽

Health Care ◽

Active Duty ◽

Health Conditions ◽

Service Members ◽

Military Health ◽

Mental Health Conditions ◽

Military Health Care ◽

Health Care Benefits

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Race/Ethnicity and Traumatic Brain Injury: Are There Disparities in Positive Screenings and Diagnoses Among Service Members Returning From Afghanistan and Iraq?

Armed Forces & Society ◽

10.1177/0095327x18761852 ◽

2018 ◽

Vol 45 (1) ◽

pp. 155-176 ◽

Cited By ~ 1

Author(s):

Ashleigh Kysar-Moon ◽

Sarah Mustillo

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Health Assessment ◽

Service Members ◽

Lower Probability ◽

Military Health ◽

Lower Odds ◽

Race Ethnicity ◽

Using Data ◽

Racial Ethnic

The authors examine racial/ethnic differences in screening positive for traumatic brain injury (TBI) and in diagnosis among service members upon returning from war in Afghanistan and Iraq. Using data from the Post-Deployment Health Assessment and Re-Assessment, and military health-care encounters from 2008 to 2009, they estimate logistic regressions in a sample of 46,488 service members. Hispanic and Asian service members do not differ from White service members in screening positive for TBI but have 19% and 33% lower odds of diagnosis, respectively. Compared to White service members, Black service members are less likely to screen positive for TBI immediately after deployment and about as likely 3–6 months later, yet have 27% lower odds of diagnosis. Further, racial/ethnic minority service members have a lower probability of TBI diagnosis than White service members at all self-reported symptom levels, suggesting there is a discrepancy between symptoms and diagnosis related to race/ethnicity.

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Continuum of care: Military health care providers and the traumatic brain injured service members

Neurorehabilitation ◽

10.3233/nre-2010-0564 ◽

2010 ◽

Vol 26 (3) ◽

pp. 285-290

Author(s):

Selina Doncevic ◽

Heidi L. Boerman

Keyword(s):

Health Care ◽

Health Care Providers ◽

Continuum Of Care ◽

Service Members ◽

Care Providers ◽

Military Health ◽

Brain Injured ◽

Military Health Care ◽

Traumatic Brain Injured

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Assessment of Cognitive-Communicative Disorders of Mild Traumatic Brain Injury Sustained in Combat

Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders ◽

10.1044/nnsld19.2.47 ◽

2009 ◽

Vol 19 (2) ◽

pp. 47-57 ◽

Cited By ~ 10

Author(s):

Christine Parrish ◽

Carole Roth ◽

Brooke Roberts ◽

Gail Davie

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Mild Traumatic Brain Injury ◽

Psychological Health ◽

Communication Disorders ◽

Service Members ◽

Patient Questionnaire ◽

Speech Language Pathologists ◽

Test Protocol ◽

Communication Deficits

Abstract Background: Mild traumatic brain injury (mTBI) is recognized as the signature injury of the current conflicts in Iraq and Afghanistan, yet there remains limited understanding of the persisting cognitive deficits of mTBI sustained in combat. Speech-language pathologists (SLPs) have traditionally been responsible for evaluating and treating the cognitive-communication disorders following severe brain injuries. The evaluation instruments historically used are insensitive to the subtle deficits found in individuals with mTBI. Objectives: Based on the limited literature and clinical evidence describing traditional and current tests for measuring cognitive-communication deficits (CCD) of TBI, the strengths and weaknesses of the instruments are discussed relative to their use with mTBI. It is necessary to understand the nature and severity of CCD associated with mTBI for treatment planning and goal setting. Yet, the complexity of mTBI sustained in combat, which often co-occurs with PTSD and other psychological health and physiological issues, creates a clinical challenge for speech-language pathologists worldwide. The purpose of the paper is to explore methods for substantiating the nature and severity of CCD described by service members returning from combat. Methods: To better understand the nature of the functional cognitive-communication deficits described by service members returning from combat, a patient questionnaire and a test protocol were designed and administered to over 200 patients. Preliminary impressions are described addressing the nature of the deficits and the challenges faced in differentiating the etiologies of the CCD. Conclusions: Speech-language pathologists are challenged with evaluating, diagnosing, and treating the cognitive-communication deficits of mTBI resulting from combat-related injuries. Assessments that are sensitive to the functional deficits of mTBI are recommended. An interdisciplinary rehabilitation model is essential for differentially diagnosing the consequences of mTBI, PTSD, and other psychological and physical health concerns.

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