Concussion Raises PTSD Risk for Iraq Vets

WEDNESDAY Jan. 30, 2008 -- Researchers report that soldiers who have suffered concussions during their time in Iraq are more likely to experience post-traumatic stress disorder and other physical health problems.

"There was indeed a higher rate of PTSD and/or health problems among those who had concussions versus those with other injuries," said study author Dr. Christopher Hoge, director of psychiatry and neuroscience at Walter Reed Army Institute of Research, in Washington, D.C. His study is published in the Jan. 31 issue of the New England Journal of Medicine.

"This is probably one of a very few studies which has begun to enumerate the incidence of mild traumatic brain injury [i.e. concussion] in returning veterans," said David Hovda, director of the Brain Injury Research Center at UCLA's Geffen School of Medicine, in Los Angeles.

According to background information in the study, more than 1.5 million U.S. military personnel have been deployed to Iraq or Afghanistan since 2001. Thanks to better protective gear, many of these men and women are surviving injuries that before would have killed them.

Head and neck injuries have been reported in one quarter of troops evacuated from these areas. The proportion of soldiers with concussion may be as high as 18 percent.

Hoge and his colleagues surveyed 2,525 U.S. Army infantry soldiers three to four months after they had returned home a yearlong deployment in Iraq. Soldiers reporting concussion (defined as an injury with loss of consciousness or altered mental status such as being dazed or confused) were compared with soldiers reporting other injuries. The soldiers were from two brigades only.

Almost 44 percent of soldiers reporting an injury involving loss of consciousness met the criteria for PTSD versus only 27.3 percent of those reporting an injury involving altered mental status, 16.2 percent of those with other injuries and 9.1 percent of those with no injury.

Soldiers who had suffered concussion, and especially those who had suffered concussion with loss of consciousness, were significantly more likely to report poor general health, missed workdays, visits to health-care providers and sleep problems.

After adjustments, PTSD and depression appeared to be the primary problem. This makes a certain amount of sense as concussion often occurs in the context of a traumatic event involving psychological stress, pointed out an accompanying commentary.

"This has implications for treatment, because obviously there's a big difference in how we treat someone if they're labeled as brain-injured versus identifying that they, in fact, have PTSD," Hoge said.

It's also critical that soldiers be properly evaluated in the combat theater at the time of injury, Hoge added.

The findings should help raise awareness for a generally underappreciated condition, Hovda said. "There's no face for that injury, so it really is a silent epidemic," he said. "And these military individuals are extremely dedicated and want to get back to service so they [may be playing down their injuries]."

A second study in the same issue of the journal confirmed that violence has been a major cause of death for Iraqis, and the main cause of death for Iraqi men aged 15 to 59 during the first three years following the 2003 invasion.

This is lower than previous estimates, said the authors, from Children's Hospital Boston, but still constitutes a huge death toll.

More information

Visit the government's National Center for PTSD for more on this condition.

Posted: January 2008


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