Psychiatric Scars of Wartime Brain Injury May Linger for Years

MONDAY, May 1, 2017 (HealthDay News ) — Brain injuries suffered during wartime exposure to an explosive device often leave psychiatric troubles that can last years, new research shows.

The study also discovered an “evolution” of symptoms, as cognitive (thinking and memory) symptoms ease, but psychological aftereffects linger.

Many soldiers who’ve suffered a traumatic brain injury “experience evolution rather than resolution of symptoms from the one- to five-year outcomes,” said a team led by Christine MacDonald, from the University of Washington School of Medicine in Seattle.

One expert in head injury care said the findings raise important concerns.

“This suggests that soldiers experiencing a traumatic brain injury — especially those at higher risk for psychiatric effects — require much closer monitoring in the years after their injury,” said Dr. Robert Glatter. He directs sports medicine and traumatic brain injury care in the department of emergency medicine at Lenox Hill Hospital in New York City.

In the new study, MacDonald’s team tracked five-year outcomes for 94 active-duty U.S. military service members who’d served in combat roles in Afghanistan. Fifty of the soldiers had experienced a “concussive blast traumatic brain injury,” while the other 44 had not.

The soldiers’ levels of cognitive and psychiatric disability were assessed at one year and five years.

The researchers reported that, in terms of cognitive disability, 36 of the 50 blast-injured soldiers did see an easing of their disability over the five years of the study. By the time of the five-year assessment, levels of thinking/memory were similar between soldiers affected by blast-related head trauma and those who hadn’t had such exposures.

But the same couldn’t be said for psychiatric symptoms. The study found that 80 percent of the blast-affected soldiers said they’d sought care from a licensed mental health professional over the four years between their two evaluations, compared to just 40 percent of soldiers without blast injuries.

Many soldiers, whether they’d been affected by blast injuries or not, found that their psychiatric troubles were tough to treat. Only about one in every five soldiers said that mental health programs had actually helped them, the findings showed.

Overall, MacDonald’s team said that any worsening of symptoms over time “appears to be driven more by psychiatric symptoms than by cognitive deficits.”

According to Glatter, the study suggests “that [soldiers’] period of vulnerability lasts much longer than currently envisioned.”

And he noted that certain risk factors may raise the odds for long-term harm. The study found that “a pre-injury history of migraines, depression and anxiety may place soldiers who face direct combat at greater risk for mental health symptoms including [post-traumatic stress disorder], depression and suicide after a traumatic brain injury,” Glatter said.

“All branches of the military need to face this reality when providing rehabilitation services in the crucial years following a traumatic brain injury, to provide more meaningful and comprehensive long-term care,” he said.

That care needs to be improved, Glatter added.

“Current approaches for addressing mental health effects from traumatic brain injury are inadequate, with low percentages of those with and without [injury] reporting improvement in symptoms,” Glatter noted.

Dr. Ajay Misra is head of neurosciences at NYU Winthrop Hospital in Mineola, N.Y. He agreed that “even mild concussive injuries carry a risk for long-term disability with functional global disability, sleep disturbances, poor life satisfaction and psyche, and behavior problems, [even] without cognitive decline.”

The study was published online May 1 in JAMA Neurology.

More information

Find out more about brain injury from the U.S. Centers for Disease Control and Prevention.

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