The relation between posttraumatic stress disorder and mild traumatic brain injury acquired during operations enduring freedom and iraqi freedom

Jeffrey J. Bazarian, Kerry Donnelly, Derick R. Peterson, Gary C. Warner, Tong Zhu, Jianhui Zhong

Research output: Contribution to journalArticlepeer-review

100 Scopus citations

Abstract

OBJECTIVE: To understand the relations of mild traumatic brain injury (TBI), blast exposure, and brain white matter structure to severity of posttraumatic stress disorder (PTSD). DESIGN: Nested cohort study using multivariate analyses. PARTICIPANTS: Fifty-two OEF/OIF veterans who served in combat areas between 2001 and 2008 were studied approximately 4 years after the last tour of duty. MAIN MEASURES: PTSD Checklist-Military; Combat Experiences Survey, interview questions concerning blast exposure and TBI symptoms; anatomical magnetic resonance imaging (MRI), and diffusion tensor imaging (DTI) scanning of the brain. RESULTS: PTSD severity was associated with higher 1st percentile values of mean diffusivity on DTI (regression coefficient [r] = 4.2, P = .039), abnormal MRI (r = 13.3, P = .046), and the severity of exposure to combat events (r = 5.4, P = .007). Mild TBI was not significantly associated with PTSD severity. Blast exposure was associated with lower 1st percentile values of fractional anisotropy on DTI (odds ratio [OR] = 0.38 per SD; 95% confidence interval [CI], 0.15-0.92), normal MRI (OR = 0.00, 95% likelihood ratio test CI, 0.00-0.09), and the severity of exposure to traumatic events (OR = 3.64 per SD; 95% CI, 1.40-9.43). CONCLUSIONS: PTSD severity is related to both the severity of combat stress and underlying structural brain changes on MRI and DTI but not to a clinical diagnosis of mild TBI. The observed relation between blast exposure and abnormal DTI suggests that subclinical TBI may play a role in the genesis of PTSD in a combat environment.

Original languageEnglish
Pages (from-to)1-12
Number of pages12
JournalJournal of Head Trauma Rehabilitation
Volume28
Issue number1
DOIs
StatePublished - Jan 2013

Keywords

  • Blast exposure
  • Combat intensity
  • Diffusion tensor imaging
  • Magnetic resonance imaging
  • Mild traumatic brain injury
  • Operation Enduring Freedom
  • Operation Iraqi Freedom
  • Posttraumatic stress disorder

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