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Published Online: 4 September 2015

Prospective Longitudinal Evaluation of the Effect of Deployment-Acquired Traumatic Brain Injury on Posttraumatic Stress and Related Disorders: Results From the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS)

Murray B. Stein, M.D., M.P.H., Ronald C. Kessler, Ph.D., Steven G. Heeringa, Ph.D., Sonia Jain, Ph.D., Laura Campbell-Sills, Ph.D., Lisa J. Colpe, Ph.D., M.P.H., Carol S. Fullerton, Ph.D., … Show All … , Matthew K. Nock, Ph.D., Nancy A. Sampson, B.A., Michael Schoenbaum, Ph.D., Xiaoying Sun, M.S., Michael L. Thomas, Ph.D., and Robert J. Ursano, M.D. On behalf of the Army STARRS collaboratorsAuthors Info & Affiliations
Publication: American Journal of Psychiatry
Volume 172, Number 11
https://doi.org/10.1176/appi.ajp.2015.14121572
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Abstract

Objective:

Traumatic brain injury (TBI) is increasingly recognized as a risk factor for deleterious mental health and functional outcomes. The purpose of this study was to examine the strength and specificity of the association between deployment-acquired TBI and subsequent posttraumatic stress and related disorders among U.S. Army personnel.

Method:

A prospective, longitudinal survey of soldiers in three Brigade Combat Teams was conducted 1–2 months prior to an average 10-month deployment to Afghanistan (T0), upon redeployment to the United States (T1), approximately 3 months later (T2), and approximately 9 months later (T3). Outcomes of interest were 30-day prevalence postdeployment of posttraumatic stress disorder (PTSD), major depressive episode, generalized anxiety disorder, and suicidality, as well as presence and severity of postdeployment PTSD symptoms.

Results:

Complete information was available for 4,645 soldiers. Approximately one in five soldiers reported exposure to mild (18.0%) or more-than-mild (1.2%) TBI(s) during the index deployment. Even after adjusting for other risk factors (e.g., predeployment mental health status, severity of deployment stress, prior TBI history), deployment-acquired TBI was associated with elevated adjusted odds of PTSD and generalized anxiety disorder at T2 and T3 and of major depressive episode at T2. Suicidality risk at T2 appeared similarly elevated, but this association did not reach statistical significance.

Conclusions:

The findings highlight the importance of surveillance efforts to identify soldiers who have sustained TBIs and are therefore at risk for an array of postdeployment adverse mental health outcomes, including but not limited to PTSD. The mechanism(s) accounting for these associations need to be elucidated to inform development of effective preventive and early intervention programs.

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Information & Authors

Information

Published In

Go to American Journal of Psychiatry
Go to American Journal of Psychiatry
American Journal of Psychiatry
Volume 172 • Number 11 • November 01, 2015
Pages: 1101 - 1111
PubMed: 26337036

History

Received: 19 December 2014
Revision received: 12 April 2015
Revision received: 21 May 2015
Accepted: 22 May 2015
Published online: 4 September 2015
Published in print: November 01, 2015

Authors

Details

Murray B. Stein, M.D., M.P.H.
From the Department of Psychiatry, University of California San Diego, La Jolla, Calif.; the Department of Family Medicine and Public Health, University of California San Diego, La Jolla, Calif.; the VA San Diego Healthcare System, San Diego; the Department of Health Care Policy, Harvard Medical School, Boston; the University of Michigan, Institute for Social Research, Ann Arbor, Mich.; the National Institute of Mental Health, Bethesda, Md.; the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Md.; and the Department of Psychology, Harvard College, Cambridge, Mass.
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Ronald C. Kessler, Ph.D.
From the Department of Psychiatry, University of California San Diego, La Jolla, Calif.; the Department of Family Medicine and Public Health, University of California San Diego, La Jolla, Calif.; the VA San Diego Healthcare System, San Diego; the Department of Health Care Policy, Harvard Medical School, Boston; the University of Michigan, Institute for Social Research, Ann Arbor, Mich.; the National Institute of Mental Health, Bethesda, Md.; the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Md.; and the Department of Psychology, Harvard College, Cambridge, Mass.
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Steven G. Heeringa, Ph.D.
From the Department of Psychiatry, University of California San Diego, La Jolla, Calif.; the Department of Family Medicine and Public Health, University of California San Diego, La Jolla, Calif.; the VA San Diego Healthcare System, San Diego; the Department of Health Care Policy, Harvard Medical School, Boston; the University of Michigan, Institute for Social Research, Ann Arbor, Mich.; the National Institute of Mental Health, Bethesda, Md.; the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Md.; and the Department of Psychology, Harvard College, Cambridge, Mass.
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Sonia Jain, Ph.D.
From the Department of Psychiatry, University of California San Diego, La Jolla, Calif.; the Department of Family Medicine and Public Health, University of California San Diego, La Jolla, Calif.; the VA San Diego Healthcare System, San Diego; the Department of Health Care Policy, Harvard Medical School, Boston; the University of Michigan, Institute for Social Research, Ann Arbor, Mich.; the National Institute of Mental Health, Bethesda, Md.; the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Md.; and the Department of Psychology, Harvard College, Cambridge, Mass.
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Laura Campbell-Sills, Ph.D.
From the Department of Psychiatry, University of California San Diego, La Jolla, Calif.; the Department of Family Medicine and Public Health, University of California San Diego, La Jolla, Calif.; the VA San Diego Healthcare System, San Diego; the Department of Health Care Policy, Harvard Medical School, Boston; the University of Michigan, Institute for Social Research, Ann Arbor, Mich.; the National Institute of Mental Health, Bethesda, Md.; the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Md.; and the Department of Psychology, Harvard College, Cambridge, Mass.
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Lisa J. Colpe, Ph.D., M.P.H.
From the Department of Psychiatry, University of California San Diego, La Jolla, Calif.; the Department of Family Medicine and Public Health, University of California San Diego, La Jolla, Calif.; the VA San Diego Healthcare System, San Diego; the Department of Health Care Policy, Harvard Medical School, Boston; the University of Michigan, Institute for Social Research, Ann Arbor, Mich.; the National Institute of Mental Health, Bethesda, Md.; the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Md.; and the Department of Psychology, Harvard College, Cambridge, Mass.
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Carol S. Fullerton, Ph.D.
From the Department of Psychiatry, University of California San Diego, La Jolla, Calif.; the Department of Family Medicine and Public Health, University of California San Diego, La Jolla, Calif.; the VA San Diego Healthcare System, San Diego; the Department of Health Care Policy, Harvard Medical School, Boston; the University of Michigan, Institute for Social Research, Ann Arbor, Mich.; the National Institute of Mental Health, Bethesda, Md.; the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Md.; and the Department of Psychology, Harvard College, Cambridge, Mass.
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Matthew K. Nock, Ph.D.
From the Department of Psychiatry, University of California San Diego, La Jolla, Calif.; the Department of Family Medicine and Public Health, University of California San Diego, La Jolla, Calif.; the VA San Diego Healthcare System, San Diego; the Department of Health Care Policy, Harvard Medical School, Boston; the University of Michigan, Institute for Social Research, Ann Arbor, Mich.; the National Institute of Mental Health, Bethesda, Md.; the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Md.; and the Department of Psychology, Harvard College, Cambridge, Mass.
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Nancy A. Sampson, B.A.
From the Department of Psychiatry, University of California San Diego, La Jolla, Calif.; the Department of Family Medicine and Public Health, University of California San Diego, La Jolla, Calif.; the VA San Diego Healthcare System, San Diego; the Department of Health Care Policy, Harvard Medical School, Boston; the University of Michigan, Institute for Social Research, Ann Arbor, Mich.; the National Institute of Mental Health, Bethesda, Md.; the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Md.; and the Department of Psychology, Harvard College, Cambridge, Mass.
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Michael Schoenbaum, Ph.D.
From the Department of Psychiatry, University of California San Diego, La Jolla, Calif.; the Department of Family Medicine and Public Health, University of California San Diego, La Jolla, Calif.; the VA San Diego Healthcare System, San Diego; the Department of Health Care Policy, Harvard Medical School, Boston; the University of Michigan, Institute for Social Research, Ann Arbor, Mich.; the National Institute of Mental Health, Bethesda, Md.; the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Md.; and the Department of Psychology, Harvard College, Cambridge, Mass.
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Xiaoying Sun, M.S.
From the Department of Psychiatry, University of California San Diego, La Jolla, Calif.; the Department of Family Medicine and Public Health, University of California San Diego, La Jolla, Calif.; the VA San Diego Healthcare System, San Diego; the Department of Health Care Policy, Harvard Medical School, Boston; the University of Michigan, Institute for Social Research, Ann Arbor, Mich.; the National Institute of Mental Health, Bethesda, Md.; the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Md.; and the Department of Psychology, Harvard College, Cambridge, Mass.
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Michael L. Thomas, Ph.D.
From the Department of Psychiatry, University of California San Diego, La Jolla, Calif.; the Department of Family Medicine and Public Health, University of California San Diego, La Jolla, Calif.; the VA San Diego Healthcare System, San Diego; the Department of Health Care Policy, Harvard Medical School, Boston; the University of Michigan, Institute for Social Research, Ann Arbor, Mich.; the National Institute of Mental Health, Bethesda, Md.; the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Md.; and the Department of Psychology, Harvard College, Cambridge, Mass.
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Robert J. Ursano, M.D.
From the Department of Psychiatry, University of California San Diego, La Jolla, Calif.; the Department of Family Medicine and Public Health, University of California San Diego, La Jolla, Calif.; the VA San Diego Healthcare System, San Diego; the Department of Health Care Policy, Harvard Medical School, Boston; the University of Michigan, Institute for Social Research, Ann Arbor, Mich.; the National Institute of Mental Health, Bethesda, Md.; the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Md.; and the Department of Psychology, Harvard College, Cambridge, Mass.
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On behalf of the Army STARRS collaborators
From the Department of Psychiatry, University of California San Diego, La Jolla, Calif.; the Department of Family Medicine and Public Health, University of California San Diego, La Jolla, Calif.; the VA San Diego Healthcare System, San Diego; the Department of Health Care Policy, Harvard Medical School, Boston; the University of Michigan, Institute for Social Research, Ann Arbor, Mich.; the National Institute of Mental Health, Bethesda, Md.; the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Md.; and the Department of Psychology, Harvard College, Cambridge, Mass.
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Notes

Address correspondence to Dr. Stein ([email protected]).

Funding Information

National Institute of Mental Health10.13039/100000025: U01MH087981
Army STARRS was sponsored by the Department of the Army and funded under cooperative agreement number U01MH087981 with the U.S. Department of Health and Human Services, National Institutes of Health, National Institute of Mental Health (NIH/NIMH).

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