Hostname: page-component-586b7cd67f-tf8b9 Total loading time: 0 Render date: 2024-11-22T23:02:24.090Z Has data issue: false hasContentIssue false
  • English
  • Français

The Contributions of Self-reported Injury Characteristics and Psychiatric Symptoms to Cognitive Functioning in OEF/OIF Veterans with Mild Traumatic Brain Injury

Published online by Cambridge University Press:  06 March 2012

Lauren L. Drag ,
Robert J. Spencer ,
Sara J. Walker ,
Percival H. Pangilinan  and
Linas A. Bieliauskas
Lauren L. Drag*
Affiliation:
Research Service, VA Palo Alto Healthcare System, Palo Alto, California
Robert J. Spencer
Affiliation:
Mental Health Service, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
Sara J. Walker
Affiliation:
Department of Psychiatry, University of Michigan Health System, Ann Arbor, Michigan
Percival H. Pangilinan
Affiliation:
Department of Physical Medicine and Rehabilitation, VA Ann Arbor Healthcare System, Ann Arbor, Michigan Department of Physical Medicine and Rehabilitation, University of Michigan Health System, Ann Arbor, Michigan
Linas A. Bieliauskas
Affiliation:
Mental Health Service, VA Ann Arbor Healthcare System, Ann Arbor, Michigan Department of Psychiatry, University of Michigan Health System, Ann Arbor, Michigan
*
Correspondence and reprint requests to: Lauren L. Drag, 3801 Miranda Avenue (118J), Palo Alto, CA 94304. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Mild traumatic brain injury (mTBI) affects a significant number of combat veterans returning from Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF). Although resolution of mTBI symptoms is expected over time, some individuals continue to report lingering cognitive difficulties. This study examined the contributions of self-reported mTBI injury characteristics (e.g., loss of consciousness, post-traumatic amnesia) and psychiatric symptoms to both subjective and objective cognitive functioning in a sample of 167 OEF/OIF veterans seen in a TBI clinic. Injury characteristics were not associated with performance on neuropsychological tests but were variably related to subjective ratings of cognitive functioning. Psychiatric symptoms were highly prevalent and fully mediated most of the relationships between injury characteristics and cognitive ratings. This indicates that mTBI characteristics such as longer time since injury and loss of consciousness or post-traumatic amnesia can lead to increased perceived cognitive deficits despite having no objective effects on cognitive performance. Psychiatric symptoms were associated with both cognitive ratings and neuropsychological performance, illustrating the important role that psychiatric treatment can potentially play in optimizing functioning. Finally, subjective cognitive ratings were not predictive of neuropsychological performance once psychiatric functioning was statistically controlled, suggesting that neuropsychological assessment provides valuable information that cannot be gleaned from self-report alone. (JINS, 2012, 18, 576–584)

Keywords

NeuropsychologyHead injuriesAnxietyDepressionPTSDMilitary
Type
Research Articles
Information
Journal of the International Neuropsychological Society , Volume 18 , Issue 3 , May 2012 , pp. 576 - 584
Copyright
Copyright © The International Neuropsychological Society 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Arnstein, P., Caudill, M., Mandle, C., Norris, A., Beasley, R. (1999). Self efficacy as the mediator of the relationship between pain intensity, disability, and depression in chronic pain patients. Pain, 80, 483–491. doi:10.1016/S0304-3959(98)00220-6CrossRefGoogle ScholarPubMed
Austin, M., Mitchell, P., Goodwin, G. (2001). Cognitive deficits in depression: Possible implications for functional neuropathology. The British Journal of Psychiatry, 178, 200–206. doi:10.1192/bjp.178.3.200CrossRefGoogle ScholarPubMed
Axelrod, B., Fichtenberg, N., Millis, S., Wertheimer, J. (2006). Detecting incomplete effort with Digit Span from the Wechsler Adult Intelligence Scale – Third Edition. The Clinical Neuropsychologist, 20, 513–523. doi:10.1080/13854040590967117CrossRefGoogle ScholarPubMed
Belanger, H., Curtiss, G., Demery, J., Lebowitz, B., Vanderploeg, R. (2005). Factors moderating neuropsychological outcomes following mild traumatic brain injury: A meta-analysis. Journal of the International Neuropsychological Society, 11, 215–227. doi:10.1017/S1355617705050277CrossRefGoogle ScholarPubMed
Belanger, H., Uomoto, J., Vanderploeg, R. (2009). The Veterans Health Administration system of care for mild traumatic brain injury: Costs, benefits, and controversies. Journal of Head Trauma Rehabilitation, 24, 4–13. doi:10.1097/HTR.0b013e3181957032CrossRefGoogle ScholarPubMed
Binder, L., Rohling, M., Larrabee, G. (1997). A review of mild head trauma. Part I: Meta-analytic review of neuropsychological studies. Journal of Clinical and Experimental Neuropsychology, 19, 421–431. doi:10.1080/01688639708403870CrossRefGoogle ScholarPubMed
Carlson, K., Nelson, D., Orazem, R., Nugent, S., Cifu, D., Sayer, N. (2010). Psychiatric diagnoses among Iraq and Afghanistan war veterans screened for deployment-related traumatic brain injury. Journal of Traumatic Stress, 23(1), 17–24. doi:10.1002/jts.20483CrossRefGoogle ScholarPubMed
Carroll, L., Cassidy, D., Peloso, P., Borg, J., von Holst, H., Holm, L., … WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury. (2004). Prognosis for mild traumatic brain injury: Results of the WHO Collaborating Centre Task Force on mild traumatic brain injury. Journal of Rehabilitation Medicine, 43(Suppl), 84–105. doi:10.1080/16501960410023859CrossRefGoogle Scholar
Chamelian, L., Feinstein, A. (2006). The effect of major depression on subjective and objective cognitive deficits in mild to moderate traumatic brain injury. Journal of Neuropsychiatry and Clinical Neuroscience, 18, 33–38. doi:10.1176/appi.neuropsych.18.1.33CrossRefGoogle ScholarPubMed
Cicerone, K., Kalmar, K. (1995). Persistent postconcussion syndrome: The structure of subjective complaints after mild traumatic brain injury. The Journal of Head Trauma Rehabilitation, 10(3), 1–17. doi:10.1097/00001199-199510030-00002CrossRefGoogle Scholar
Comunian, A. (1989). Some characteristics of relations among depression, anxiety, and self-efficacy. Perceptual Motor Skills, 69, 755–764. doi:10.2466/pms.1989.69.3.755CrossRefGoogle ScholarPubMed
Defense and Veterans Brain Injury Center. (2011). Department of Defense numbers for traumatic brain injury. Retrieved from http://www.dvbic.org/tbi-numbers.aspxGoogle Scholar
Fox, D., Lees-Haley, P., Earnest, K., Dolezal-Wood, S. (1995). Base rates of postconcussive symptoms in health maintenance organization patients and controls. Neuropsychology, 9, 606–611. doi:10.1037/0894-4105.9.4.606CrossRefGoogle Scholar
Golier, J., Yehuda, R. (2002). Neuropsychological processes in post-traumatic stress disorder. Psychiatric Clinics of North America, 25, 295–315. doi:10.1016/S0193-953X(01)00004-1CrossRefGoogle ScholarPubMed
Government Accountability Office. (2005). VA disability benefits: Routine monitoring of disability decisions could improve consistency. Retrieved from http://democrats.veterans.house.gov/hearings/schedule109/oct05/10-20-05/gao.pdfGoogle Scholar
Government Accountability Office. (2008). Mild traumatic brain injury screening and evaluation implemented for OEF/OIF veterans but challenges remain. Retrieved from http://www.gao.gov/new.items/d08276.pdfGoogle Scholar
Guskiewicz, K., McCrea, M., Marshall, S., Cantu, R., Randolph, C., Barr, W., Kelly, J. (2003). Cumulative effects associated with recurrent concussion in collegiate football players: The NCAA Concussion Study. Journal of the American Medical Association, 290, 2549–2555. doi:10.1001/jama.290.19.2549CrossRefGoogle ScholarPubMed
Hoge, C., Goldberg, H., Castro, C. (2009). Care of war veterans with mild traumatic brain injury – flawed perspectives. New England Journal of Medicine, 360, 1588–1591. doi:10.1056/NEJMp0810606CrossRefGoogle ScholarPubMed
Hoge, C., McGurk, D., Thomas, J., Cox, A., Engel, C., Castro, C. (2008). Mild traumatic brain injury in U.S. soldiers returning from Iraq. New England Journal of Medicine, 358, 453–463. doi:10.1056/NEJMoa072972CrossRefGoogle ScholarPubMed
Iverson, G. (2005). Outcome from mild traumatic brain injury. Current Opinion in Psychiatry, 18, 301–317. doi:10.1097/01.yco.0000165601.29047.aeCrossRefGoogle ScholarPubMed
Iverson, G., Caplan, B., Bogner, J. (2010). Clinical and methodological challenges with assessing mild traumatic brain injury in the military. Journal of Head Trauma Rehabilitation, 25, 313–319. doi:10.1097/HTR.0b013e3181d6f9bdCrossRefGoogle ScholarPubMed
Iverson, G., Lange, R. (2003). Examination of “postconcussion-like” symptoms in a healthy sample. Applied Neuropsychology, 10, 137–144. doi:10.1207/S15324826AN1003_02CrossRefGoogle Scholar
Iverson, G., Lovell, M., Smith, S. (2000). Does brief loss of consciousness affect cognitive functioning after mild head injury? Archives of Clinical Neuropsychology, 15, 643–648. doi:10.1016/S0887-6177(99)00048-7CrossRefGoogle ScholarPubMed
Iverson, G., Zasler, N., Lange, R. (2006). Post-concussive disorder. In Zasler, N., Katz, D., Zafonte, R. (Eds.), Brain injury medicine principles and practice (pp 373–405). New York, NY: Demos Medical Publishing.Google Scholar
Kay, T., Harrington, J., Adams, R., Anderson, T., Berrol, S., Cicerone, K., Malec, J. (1993). Definition of mild traumatic brain injury: Report from the Mild Traumatic Brain Injury Committee of the Head Injury Interdisciplinary Special Interest Group of the American Congress of Rehabilitation. Journal of Head Trauma and Rehabilitation, 8, 86–87. doi:10.1097/00001199-199309000-00009Google Scholar
Langenecker, S.A., Lee, H.J., Bieliauskas, L.A. (2009). Neuropsychology of depression and related mood disorders. In Grant, I. Adams, K.M. (Eds.), Neuropsychological assessment of neuropsychiatric disorders (3rd ed., pp. 523–559). New York, NY: Oxford University Press.Google Scholar
Lees-Haley, P., Fox, D., Courtney, J. (2001). A comparison of complaints by mild brain injury claimants and other claimants describing subjective experiences immediately following their injury. Archives of Clinical Neuropsychology, 16, 689–695. doi:10.1016/S0887-6177(00)00092-5CrossRefGoogle ScholarPubMed
Lovell, M., Iverson, G., Collins, M., McKeag, D., Maroon, J. (1999). Does loss of consciousness predict neuropsychological decrements after concussion? Clinical Journal of Sport Medicine, 9, 193–198. doi:10.1097/00042752-199910000-00002CrossRefGoogle ScholarPubMed
McCracken, L., Iverson, G. (2001). Predicting complaints of impaired cognitive functioning in patients with chronic pain. Journal of Pain and Symptom Management, 21, 392–396. doi:10.1016/S0885-3924(01)00267-6CrossRefGoogle ScholarPubMed
McCrea, M., Kelly, J., Randolph, C., Cisler, R., Berger, L. (2002). Immediate neurocognitive effects of concussion. Neurosurgery, 50, 1032–1042. doi:10.1227/00006123-200205000-00017Google ScholarPubMed
McLean, S., Kirsch, N., Tan-Schriner, C., Sen, A., Frederiksen, S., Harris, R., Majo, R. (2009). Health status, not head injury, predicts concussion symptoms after minor injury. American Journal of Emergency Medicine, 27, 182–190. doi:10.1016/j.ajem.2008.01.054CrossRefGoogle Scholar
Meyers, J., Meyers, K. (1995). Rey Complex Figure Test and Recognition Trial: Professional manual. Odessa, FL: Psychological Assessment Resources.Google Scholar
Mittenberg, W., DiGiulio, D.V., Perrin, S., Bass, A.E. (1992). Symptoms following mild head injury: Expectation as aetiology. Journal of Neurology, Neurosurgery, and Psychiatry, 55, 200–204. doi:10.1136/jnnp.55.3.200CrossRefGoogle ScholarPubMed
Polusny, M., Kehle, S., Nelson, N., Erbes, C., Arbisi, P., Thuras, P. (2011). Longitudinal effects of mild traumatic brain injury and posttraumatic stress disorder comorbidity on postdeployment outcomes in National Guard soldiers deployed to Iraq. Archives of General Psychiatry, 68(1), 79–89. doi:10.1001/archgenpsychiatry.2010.172CrossRefGoogle ScholarPubMed
Randolph, C. (1998). Repeatable battery for the assessment of neuropsychological status manual. San Antonio, TX: Psychological Corporation.Google Scholar
Rey, A. (1964). L'examen Clinique en psychologie. Paris: Presses Universitaires de France.Google Scholar
Rohling, M., Binder, L., Demakis, G., Larrabee, G., Ploetz, D., Langhinrichsen-Rohling, J. (2011). A meta-analysis of neuropsychological outcome after mild traumatic brain injury: Re-analyses and reconsiderations of Binder et al. (1997), Frencham et al. (2005), and Pertab et al. (2009). The Clinical Neuropsychologist, 24, 608–623. doi:10.1080/13854046.2011.565076CrossRefGoogle Scholar
Ruff, R., Iverson, G., Barth, J., Bush, S., Broshek, D., NAN Policy and Planning Committee (2009). Recommendations for diagnosing a mild traumatic brain injury: A National Academy of Neuropsychology Education Paper. Archives of Clinical Neuropsychology, 24, 3–10. doi:10.1093/arclin/acp006CrossRefGoogle ScholarPubMed
Schneiderman, A., Braver, E., Kang, H. (2008). Understanding sequelae of injury mechanisms and mild traumatic brain injury incurred during the conflicts in Iraq and Afghanistan: Persistent postconcussive symptoms and posttraumatic stress disorder. American Journal of Epidemiology, 167(12), 1446–1452. doi:10.1093/aje/kwn068CrossRefGoogle ScholarPubMed
Schretlen, D., Shapiro, A. (2003). A quantitative review of the effects of traumatic brain injury on cognitive functioning. International Review of Psychiatry, 15, 341–349. doi:10.1080/09540260310001606728CrossRefGoogle ScholarPubMed
Silver, J., McAllister, T., Arciniegas, D. (2009). Depression and cognitive complaints following mild traumatic brain injury. American Journal of Psychiatry, 166, 653–661. doi:10.1176/appi.ajp.2009.08111676CrossRefGoogle ScholarPubMed
Southwick, S.M., Morgan, C.A., Nicolaou, A.L., Charney, D.S. (1997). Consistency of memory for combat-related traumatic events in veterans of Operation Desert Storm. The American Journal of Psychiatry, 154, 173–177 Retrieved from http://ajp.psychiatryonline.org/journal.aspx?journalid=13Google ScholarPubMed
Southwick, S., Yehuda, R., Giller, E. (1991). Characterization of depression in war-related posttraumatic stress disorder. The American Journal of Psychiatry, 148, 179–183.Google ScholarPubMed
Spencer, R., Drag, L., Walker, S., Bieliauskas, L. (2010). Self-reported cognitive symptoms following mild traumatic brain injury are poorly associated with neuropsychological performance in OIF/OEF veterans. Journal of Rehabilitation Research & Development, 47, 521–530. doi:10.1682/JRRD.2009.11.0181CrossRefGoogle ScholarPubMed
Strauss, E., Sherman, E., Spreen, O. (2006). A compendium of neuropsychological tests: Administration, norms, and commentary (3rd ed.) New York, NY: Oxford University Press.Google Scholar
Suhr, J., Gunstad, J. (2005). Further exploration of the effect of “diagnosis threat” on cognitive performance in individuals with mild head injury. Journal of the International Neuropsychological Society, 11, 23–29. doi:10.1017/S1355617705050010CrossRefGoogle ScholarPubMed
Sullivan, M., D'Eon, J. (1990). Relation between catastrophizing and depression in chronic pain patients. Journal of Abnormal Psychology, 99, 260–263. doi:10.1037/0021-843X.99.3.260CrossRefGoogle ScholarPubMed
Tanielian, T., Jaycox, L. (2008). Invisible wounds of war: Psychological and cognitive injuries, their consequences, and services to assist recovery. Santa Monica, CA: RAND Corp.Google Scholar
Vasterling, J., Duke, L., Brailey, K., Constans, J., Allain, A., Sutker, P. (2002). Attention, learning, and memory performances and intellectual resources in Vietnam veterans: PTSD and no disorder comparisons. Neuropsychology, 16(1), 5–14. doi:10.1037/0894-4105.16.1.5CrossRefGoogle ScholarPubMed
Wearden, A., Appleby, L. (1996). Research on cognitive complaints and cognitive functioning in patients with chronic fatigue syndrome (CFS): What conclusions can we draw? Journal of Psychosomatic Research, 41, 197–211. doi:10.1037/0894-4105.16.1.5CrossRefGoogle ScholarPubMed
Weathers, F., Litz, B., Herman, D., Huska, J., Keane, T. (1993). The PTSD Checklist (PCL): Reliability, validity, and diagnostic utility. Paper presented at the Annual Convention of the International Society for Traumatic Stress Studies: San Antonio, TX.Google Scholar
Wechsler, D. (2008). WAIS-IV: Administration and scoring manual. New York, NY: The Psychological Corporation.Google Scholar
Zachary, R. (2000). Shipley Institute of Living Scale: Revised manual. Los Angeles, CA: Western Psychological Services.Google Scholar
Zigmond, A., Snaith, R. (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica, 67, 361–370. doi:10.1111/j.1600-0447.1983.tb09716.xCrossRefGoogle ScholarPubMed