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Murine Model of Controlled Cortical Impact for the Induction of Traumatic Brain Injury
Published on: August 16, 2019
Long-Term Clinical Outcomes Associated With the Veterans Health Administration's Traumatic Brain Injury and Mental
Shannon R Miles1, Peter A Toyinbo, Heather G Belanger
1Author Affiliations: Mental Health and Behavioral Sciences (Dr Miles), Research and Development Service (Dr Toyinbo, Mr Venkatachalam, and Dr Luther), James A Haley Veterans' Hospital, Tampa, Florida; Department of Psychiatry & Behavioral Neurosciences, Morsani College of Medicine (Drs Miles and Belanger), College of Public Health (Drs Toyinbo and Luther), Department of Psychology (Dr Belanger), University of South Florida, Tampa, Florida; Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System (Dr Sayer), Minneapolis, Minnesota; and Departments of Medicine and Psychiatry (Dr Sayer), University of Minnesota, Minnesota.
Objective:
Examine if the mandated Veterans Affairs traumatic brain injury (TBI) screen is associated with long-term postconcussive symptoms as compared to how the mandated mental health (MH) screen is associated with long-term MH symptoms.
Setting:
Veterans Health Administration.
Participants:
Patients (N = 1628) who were previously screened for TBI with current postconcussive symptoms and MH conditions completed a survey assessing current postconcussive symptoms, depression, posttraumatic stress disorder, alcohol use, and physical and emotional well-being. Participants were mostly male (83%), less than 40 years old (38%), and identified as White (64%). Forty-five percent screened positive for MH conditions; 11% screened positive for TBI.
Design:
Cohort survey study of random sample of post-9/11 veterans combined with retrospective database analysis. Bayesian Network Analysis was used to compare how the TBI and MH screens related to long-term postconcussive and MH symptoms. The pathway on the Bayesian Network graph leading to postconcussive symptoms was thoroughly examined with a regression.
Main Measures:
Neurobehavioral Symptom Inventory to measure postconcussive symptoms.
Results:
A Bayesian network arch demonstrated TBI screening was related to use of TBI services within 6 months after the screening but not related to long-term postconcussive or MH symptoms. In comparison, the MH screen led to post-screen MH services, postconcussive symptoms, and most of the other secondary outcomes, including posttraumatic stress disorder and depression. The regression model showed that a positive MH screen, more MH service use, negative life events, and moderate depression were associated with greater postconcussive symptoms years after screening.
Conclusion:
While both TBI and MH screening were associated with increased service use, only the MH screen was associated with long-term postconcussive symptoms. Findings raise questions about whether the TBI screening program adds value over and above the MH screening program.
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