Total Brain Diagnostics: Advancing Precision Brain and Mental Health at the Department of Veterans Affairs

The Commander John Scott Hannon Veterans Mental Health Care Improvement Act of 2019 directs the US Department of Veterans Affairs Precision Medicine Initiative to identify and validate brain and mental health biomarkers related to the unique exposures and experiences of service members. Efforts are focused on individuals who served in combat to incorporate biopsychosocial factors into medical decision-making. At present, well-planned and reproducible data compilation, curation, and standardization are needed to harmonize data from varied sources.

Harmonized data can facilitate precision care to improve veterans' brain and mental health. Longitudinal cohort studies of service members and veterans with military combat and training exposure histories provide researchers with access to biopsychosocial data shown to impact adverse health risks. Precision medicine efforts that incorporate biopsychosocial variables require the combination of such datasets because of the large sample sizes necessary for adequately powered multivariable analyses. The Total Brain Diagnostics (TBD) research team is harmonizing variables from the Long-Term Impact of Military-Relevant Brain Injury Consortium-Chronic Effects of Neurotrauma Consortium and the Translational Research Center for TBI and Stress Disorders. Together, they contain prospective longitudinal data from > 4000 combat-exposed service members and veterans.

Military service often results in unique exposures associated with brain and mental health disorders and functional impairment. To address clinical needs, the TBD team is creating a unified longitudinal dataset that combines measures from existing longitudinal protocols. Work by the TBD team may lay the foundation for using of prospective longitudinal datasets and linked large datasets to generate generalizable, clinically relevant information to advance precision brain and mental health care among service members and veterans. These efforts may facilitate precision prognostics, diagnostics, and tailored interventions, with potential benefits for the general population as well.