Psychiatric comorbidity effects on compensatory cognitive training outcomes for veterans with traumatic brain...

To investigate the influence of posttraumatic stress disorder (PTSD) diagnosis, and PTSD and depression severity, on the postconcussive symptom trajectory over the course of a 1-year study period.

Secondary analysis of a randomized controlled trial comparing veterans who received supported employment combined with compensatory cognitive training to those who received supported employment only. Assessments were conducted at baseline, 3- (postintervention), 6-, and 12-months. Participants were 50 Operation Enduring and Iraqi Freedom (OEF/OIF) veterans with a history of mild to moderate traumatic brain injury (TBI) who were unemployed, seeking work, and who had neuropsychological impairment. Of all participants, 74% met diagnostic criteria for PTSD. All participants received supported employment and half of the sample also received Cognitive Symptom Management and Rehabilitation Therapy (CogSMART), a 12-session, manualized compensatory cognitive training intervention.

Veterans with PTSD and greater depression severity endorsed significantly more severe postconcussive symptomatology at all assessment time points. However, the rate of CogSMART-associated improvement in postconcussive symptoms did not differ as a result of psychiatric symptomatology.

Study results suggest that for veterans with a history of mild to moderate TBI, presence of comorbid PTSD or depressive symptoms should not preclude participation in cognitive rehabilitation interventions.