STARRS Study Finds Link Between TBI and PTSD, Anxiety, Depression After Deployment

Traumatic brain injury (TBI) is associated with a higher risk of posttraumatic stress disorder (PTSD), generalized anxiety, and depression approximately three and nine months after returning from deployment in a combat zone, according to a recent report in AJP in Advance.

Researchers from multiple institutions drew on data from the Pre/Post Deployment Study (PPDS), a prospective, longitudinal component of the Army Study to Assess Risk and Resilience in Service Members (Army STARRS). The PPDS is a multiwave panel survey that collected baseline data from U.S. Army soldiers in three Brigade Combat Teams during the first quarter of 2012, within approximately six weeks of their deployment to Afghanistan. Follow-up data were collected from these same respondents at three times after they returned from deployment: within one month of their return (T1), approximately three months later (T2), and nine months later (T3).

Complete information was available for 4,645 soldiers, approximately 1 in 5 of whom reported exposure to mild or more-than-mild TBI(s) during deployment. The authors found that even after adjusting for risk factors (including predeployment mental health status, severity of deployment stress, and 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.

“Importantly, PTSD was not the only outcome related to TBI,” said study coauthor Robert Ursano, M.D., director of the Center for the Study of Traumatic Stress at the Uniformed Services University of the Health Sciences. “Risk was also increased specifically for generalized anxiety disorder post deployment and for a composite outcome of PTSD, major depressive episode, generalized anxiety disorder, and suicidality. And the more severe the TBI, the greater the risk,” he told Psychiatric News.

“The results suggest that the extent of injury to the brain moderates the likelihood of the development of mental health sequelae and that our focus on post-TBI surveillance needs to be broadened to include not only PTSD but also other anxiety and depressive disorders,” Ursano said.

For related information, see the Psychiatric News article “Army Learning Complex Factors Associated with Soldier Suicide.”

(Image: Robert Ursano, M.D.)