Examining Active Theater and Clinical Outcomes as Indicators of mild TBI in Post-Deployed Veterans vs. Civilians at No-Risk for mild TBI: A Longitudinal Evaluation

Purpose: Of the ~300,000 veterans who experience mild TBI, 40% have ‘residual’ neuropsychological symptoms lasting 3-months or longer – a timeframe considerably longer than the gold standard for diagnosing mild TBI in the post-deployed condition. Failure to recognize residual symptoms as a consequence of mild TBI in veterans is common as these symptoms are often misattributed to posttraumatic stress disorder (PTSD). Determining risks for mild TBI retrospectively is understudied. Here, we examined active theater and clinical indices as retrospective risk indicators for mild TBI in post-deployed veterans compared to civilians. Hypotheses: Veterans at-risk for mild TBI will have poorer depression, anxiety, and quality of life outcomes than civilians with no risk. Risks for mild TBI in veterans will be influenced by military experiences and clinical indices. Methods: Longitudinal data from 182 veterans and 74 civilian clients (n=256) receiving cognitive behavioral therapy (CBT) at Recovery Resource Council from 2013-2015 were analyzed. Descriptive statistics, frequency distributions, ANOVA and regression modeling, were used to test the hypotheses using a 95% confidence level and an alpha level of 0.05 to determine statistical significance. Results: Depression, anxiety, and quality of life scores measured before, after 6- and 12- sessions of CBT were significantly worse in veterans compared to civilians. Active theater and clinical indices predicted risks for mild TBI. 74 civilians and 52 veterans had no-risk for mild TBI (n=126) and 130 veterans were at-risk for mild TBI. Veterans at-risk for mild TBI had significantly higher depression and anxiety scores and lower quality of life scores than the no-risk group measured before, after 6- and 12-sessions of CBT. Risks for mild TBI predicted PTSD severity, depression, anxiety, and quality of life scores at all three time points. Conclusion: Active theater and clinical indices identified veterans at-risk for mild TBI. Even with 12-sessions of CBT, veterans at-risk for mild TBI had poorer depression, anxiety, and quality of life scores than those with no-risk. These outcomes indicate that mild TBI presents with long-lasting psychological symptoms beyond a 3-months timeframe that do not fully resolve with CBT. Veterans returning from active theater should receive a thorough neuropsychological evaluation to differentiate mild TBI from PTSD in order to receive proper treatment.