Research Reports - Risk for broad-spectrum neuropsychiatric disorders after mild traumatic brain injury

Occup Environ Med. 2015 Apr 20

Miller SC(1), Whitehead CR(2), Otte CN(3), Wells TS(4), Webb TS(3), Gore RK(5),
Maynard C(6)

BACKGROUND: Military personnel are at increased risk for traumatic brain injury
(TBI) from combat and non-combat exposures. Sequelae of moderate-to-severe TBI
are well described, but the literature remains conflicted regarding whether mild
TBI (mTBI) results in lasting brain injury and functional impairments. This study
assessed risk for a range of neuropsychiatric disorders presenting after mTBI
while adjusting for the potential confounds of depression and post-traumatic
stress disorder (PTSD).
METHODS: A historical prospective association study was conducted utilising
electronic demographic, medical and military-specific data for over 49 000 active
duty US Air Force service members (Airmen). This study utilised diagnostic codes
considered by an expert panel to be indicative of mTBI to identify cases. Cox
proportional hazards modelling calculated HRs for neuropsychiatric outcomes while
controlling for varying lengths of follow-up and potentially confounding
RESULTS: Airmen with mTBI were at increased risk for specific neuropsychiatric
disorders compared with a similarly injured non-mTBI control group. HRs for
memory loss/amnesia, cognitive disorders, schizophrenia, PTSD, and depression
were significantly elevated and remained so for at least 6 months post-mTBI, even
after eliminating those with previous neuropsychiatric diagnoses.
CONCLUSIONS: mTBI was positively associated with neuropsychiatric disorders in
this population of primarily young adult males; with increased HRs 6 months
post-mTBI. The results support that mTBI is distinguished from moderate-to-severe
TBI in terms of risk for developing neuropsychiatric disorders. Further, these
findings suggest the importance of screening for psychiatric and cognitive
disorders post-mTBI in general medical practice.

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