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).
This prospective, longitudinal survey study of U.S. Army soldiers deployed to Afghanistan found that TBI acquired during deployment was significantly associated with PTSD at 3 and 9 months after returning home. Risk of generalized anxiety disorder and major depressive episode were also associated with TBI.
- Prospective, longitudinal survey.
- N=4,645 U.S. Army soldiers in three Brigade Combat Teams, deployed to Afghanistan in 2012, who completed one baseline and three follow-up self-administered questionnaires, as follows:
- T0: within 6 weeks of deployment to Afghanistan.
- T1: within 1 month of return from deployment.
- T2: 3 months after return.
- T3: 9 months after return.
- The T0 baseline questionnaire covered socio-demographic characteristics, lifetime and past 30-day mental disorders, as well as potential risk and resilience factors. The T1 follow-up covered deployment experiences. The T2 and T3 follow-ups covered experiences in the intervening time periods.
- The 4,645 soldiers who completed all four assessments represented 47% of the 9,949 total soldiers present for duty in the three Brigade Combat Teams.
- Participants were 95% male, 72% white, 72% under 30 years old, 45% on first deployment. 34% of participants reported having one or more TBI prior to deployment.
- Estimated prevalence of lifetime history of mental disorders, assessed at baseline:
- 12% for PTSD
- 11% for suicidality
- 9% for major depressive episode
- 8% for generalized anxiety disorder
- Primary outcome: PTSD, as measured by a 6-item screening checklist at baseline, and more comprehensive 17-item PTSD Checklist at T2 and T3.
- 18.0% of soldiers reported exposure to mild TBI during deployment, while 1.2% reported exposure to more than mild TBI.
- At 3-month follow up (T2), past-30-day prevalence was:
- 7.8% for DSM-IV PTSD
- 6.8% for major depressive episode
- 4.8% for generalized anxiety
- 2.9% for suicidality
- After adjusting for demographic factors, history of TBI or PTSD, baseline PTSD symptoms, and deployment stress severity, sustaining a TBI during deployment was associated with increased odds of post-deployment PTSD at 3 months. Odds ratio=1.81 (95% CI=1.32-2.46, P<0.0005)
- When stratifying according to TBI severity, odds of PTSD at 3 months increased in a dose-response relationship with TBI severity. Odds ratios:
- 1.66 for very mild TBI
- 1.76 for mild TBI
- 3.90 for more than mild TBI
- At 9-month follow up (T3), past-30-day prevalence was:
- 11.7% for DSM-IV PTSD
- 6.7% for major depressive episode
- 6.2% for generalized anxiety
- 5.7% for suicidality
- At 9-month follow up (T3), odds ratios for PTSD stratified by TBI severity:
- 1.21 for very mild TBI (not significant, P=0.13)
- 1.78 for mild TBI
- 4.49 for more than mild TBI
- Risk of suicidality associated with TBI did not reach statistical significance.
Stein MB, Kessler RC, Heeringa SG, et al. 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). Am J Psychiatry. September 2015:appiajp201514121572. doi:10.1176/appi.ajp.2015.14121572.