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Longitudinal Associations among Posttraumatic Stress Disorder Symptoms, Traumatic Brain Injury, and Neurocognitive Functioning in Army Soldiers Deployed to the Iraq War

Published online by Cambridge University Press:  04 December 2017

Jennifer J. Vasterling ,
Mihaela Aslan ,
Lewina O. Lee ,
Susan P. Proctor ,
John Ko ,
Shawna Jacob  and
John Concato
Jennifer J. Vasterling*
Affiliation:
National Center for PTSD and Psychology Service, VA Boston Healthcare System, Boston, Massachusetts Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
Mihaela Aslan
Affiliation:
Clinical Epidemiology Research Center, VA Cooperative Studies Program, West Haven, Connecticut Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
Lewina O. Lee
Affiliation:
Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts Research Service, VA Boston Healthcare System, Boston, Massachusetts
Susan P. Proctor
Affiliation:
Research Service, VA Boston Healthcare System, Boston, Massachusetts US Army Research Institute of Environmental Medicine, Natick, Massachusetts Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts
John Ko
Affiliation:
Clinical Epidemiology Research Center, VA Cooperative Studies Program, West Haven, Connecticut
Shawna Jacob
Affiliation:
Psychology Service, VA Boston Healthcare System, Boston, Massachusetts
John Concato
Affiliation:
Clinical Epidemiology Research Center, VA Cooperative Studies Program, West Haven, Connecticut Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
*
Correspondence and reprint requests to: Jennifer J. Vasterling, Psychology (116B), VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA 02130. E-mail: jennifer.vasterling@va.gov
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Abstract

Objectives: Military deployment is associated with increased risk of adverse emotional and cognitive outcomes. Longitudinal associations involving posttraumatic stress disorder (PTSD), relatively mild traumatic brain injury (TBI), and neurocognitive compromise are poorly understood, especially with regard to long-term outcomes, and rigorous research is necessary to better understand the corresponding relationships. The objective of this study was to examine short-term and long-term (>5 years) longitudinal associations among PTSD, neurocognitive performance, and TBI following military deployment. Methods: In this prospective study, N=315 U.S. Army soldiers were assessed at military installations before (2003–2005) and after (2004–2006) an index deployment to the Iraq War, and again an average of 7.6 years later (2010–2014) as a nationally dispersed cohort of active duty soldiers, reservists, and veterans. Thus, the study design allowed for two measurement intervals over which to examine changes. All assessments included the PTSD Checklist, civilian version, and individually-administered performance-based neurocognitive tests. TBI history was derived from clinical interview. Results: Autoregressive analyses indicated that visual reproduction scores were inversely related to subsequent PTSD symptom severity at subsequent assessments. Conversely, increases in PTSD symptom severity over each measurement interval were associated with poorer verbal and/or visual recall at the end of each interval, and less efficient reaction time at post-deployment. TBI, primarily mild in this sample, was associated with adverse PTSD symptom outcomes at both post-deployment and long-term follow-up. Conclusions: These results suggest longitudinal relationships among PTSD symptoms, TBI, and neurocognitive decrements may contribute to sustained emotional and neurocognitive symptoms over time. (JINS, 2018, 24, 311–323)

Keywords

Cognitive functionPosttraumatic stress disordersMilitary personnelVeteransTraumatic brain injuryWar exposure
Type
Research Articles
Information
Journal of the International Neuropsychological Society , Volume 24 , Issue 4 , April 2018 , pp. 311 - 323
Copyright
Copyright © The International Neuropsychological Society 2017 

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References

REFERENCES

Alosco, M.L., Aslan, M., Du, M., Ko, J., Grande, L., Proctor, S.P., & Vasterling, J.J. (2016). Consistency of recall for deployment-related traumatic brain injury. Journal of Head Trauma Rehabilitation, 31(5), 360–368.CrossRefGoogle ScholarPubMed
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text Revision). Washington, DC: American Psychiatric Association.Google Scholar
Armistead-Jehle, P., Soble, J.R., Cooper, D.B., & Belanger, H.G. (2017). Unique aspects of traumatic brain injury in military and veteran populations. Physical Medicine and Rehabilitation Clinics of North America, 28(2), 323–337.CrossRefGoogle ScholarPubMed
Arnsten, A.F., Raskind, M.A., Taylor, F.B., & Connor, D.F. (2015). The effects of stress exposure on prefrontal cortex: Translating basic research into successful treatments for post-traumatic stress disorder. Neurobiology of Stress, 1, 89–99.CrossRefGoogle ScholarPubMed
Aslan, M., Concato, J., Peduzzi, P.N., Proctor, S.P., Schnurr, P.P., Marx, B.P., & Vasterling, J.J. (2013). Design of “Neuropsychological and mental health outcomes of Operation Iraqi Freedom: A longitudinal cohort study. Journal of Investigative Medicine, 61(3), 569–577.CrossRefGoogle ScholarPubMed
Belanger, H.G., Curtiss, G., Demery, J.A., Lebowitz, B.K., & Vanderploeg, R.D. (2005). Factors moderating neuropsychological outcomes following mild traumatic brain injury: A meta-analysis. Journal of the International Neuropsychological Society, 11(3), 215–227.CrossRefGoogle ScholarPubMed
Belanger, H.G., Kretzmer, T., Yoash-Gantz, R., Pickett, T., & Tupler, L.A. (2009). Cognitive sequelae of blast-related versus other mechanisms of brain trauma. Journal of the International Neuropsychological Society, 15, 1–8.CrossRefGoogle ScholarPubMed
Blake, D.D., Weathers, F.W., Nagy, L.M., Kaloupek, D.G., Gusman, F.D., Charney, D.S., && Keane, T.M. (1995). The development of a clinician-administered PTSD scale. Journal of Traumatic Stress, 8(1), 75–90.Google ScholarPubMed
Brewin, C.R., Gregory, J.D., Lipton, M., & Burgess, N. (2010). Intrusive images in psychological disorders: Characteristics, neural mechanisms, and treatment implications. Psychological Review, 117(1), 210–232.CrossRefGoogle ScholarPubMed
Bryant, R.A., Nickerson, A., Creamer, M., O’Donnell, M., Forbes, D., Galatzer-Levy, I., & Silove, D. (2015). Trajectory of post-traumatic stress following traumatic brain injury: 6-year follow-up. British Journal of Psychiatry, 206(5), 417–423.CrossRefGoogle Scholar
Bryant, R.A., O’Donnell, M.L., Creamer, M., McFarlane, A.C., Clark, C.R., & Silove, D. (2010). The psychiatric sequelae of traumatic injury. American Journal of Psychiatry, 167(3), 312–320.CrossRefGoogle ScholarPubMed
Clark, A.L., Sorg, S.F., Schiehser, D.M., Luc, N., Bondi, M.W., Sanderson, M., & Delano-Wood, L. (2016). Deep white matter hyperintensities affect verbal memory independent of PTSD symptoms in veterans with mild traumatic brain injury. Brain Injury, 30(7), 864–871.CrossRefGoogle ScholarPubMed
Eekhout, I., Reijnen, A., Vermetten, E., & Geuze, E. (2016). Post-traumatic stress symptoms 5 years after military deployment to Afghanistan: An observational cohort study. Lancet Psychiatry, 3(1), 58–64.CrossRefGoogle ScholarPubMed
Gilbertson, M.W., Williston, S.K., Paulus, L.A., Lasko, N.B., Gurvits, T.V., Shenton, M.E., && Orr, S.P. (2007). Configural cue performance in identical twins discordant for posttraumatic stress disorder: Theoretical implications for the role of hippocampal function. Biological Psychiatry, 62(5), 513–520.CrossRefGoogle ScholarPubMed
Hayes, J.P., Miller, D.R., Lafleche, G., Salat, D.H., & Verfaellie, M. (2015). The nature of white matter abnormalities in blast-related mild traumatic brain injury. Neuroimage: Clinical, 8, 148–156.CrossRefGoogle ScholarPubMed
Hoge, C.W., McGurk, D., Thomas, J.L., Cox, A.L., Engel, C.C., & Castro, C.A. (2008). Mild traumatic brain injury in U.S. soldiers returning from Iraq. New England Journal of Medicine, 358(5), 453–463.CrossRefGoogle ScholarPubMed
Holmes, E.A., & Mathews, A. (2005). Mental imagery and emotion: A special relationship? Emotion, 5(4), 489–497.CrossRefGoogle ScholarPubMed
Karr, J.E., Areshenkoff, C.N., & Garcia-Barrera, M.A. (2014). Neuropsychological outcomes of concussion: Meta-analyses on the cognitive sequelae of mild traumatic brain injury. Neuropsychology, 28(3), 321–336.CrossRefGoogle ScholarPubMed
Kelley, A.M., Athy, J.R., Cho, T.H., Erickson, B., King, M., & Cruz, P. (2012). Risk propensity and health risk behaviors in U.S. army soldiers with and without psychological disturbances across the deployment cycle. Journal of Psychiatric Research, 46(5), 582–589.CrossRefGoogle ScholarPubMed
Letz, R., Green, R.C., & Woodard, J.L. (1996). Development of a computer-based battery designed to screen adults for neuropsychological impairment. Neurotoxicology Teratology, 18(4), 365–370.CrossRefGoogle ScholarPubMed
Luethcke, C.A., Bryan, C.J., Morrow, C.E., & Isler, W.C. (2011). Comparison of concussive symptoms, cognitive performance, and psychological symptoms between acute blast-versus nonblast-induced mild traumatic brain injury. Journal of the International Neuropsychological Society, 17(1), 36–45.CrossRefGoogle ScholarPubMed
Mac Donald, C.L., Johnson, A.M., Wierzechowski, L., Kassner, E., Stewart, T., Nelson, E.C., & Brody, D.L. (2014). Prospectively assessed clinical outcomes in concussive blast vs nonblast traumatic brain injury among evacuated US military personnel. JAMA Neurology, 71(8), 994–1002.CrossRefGoogle ScholarPubMed
Mac Donald, C.L., Johnson, A.M., Wierzechowski, L., Kassner, E., Stewart, T., Nelson, E.C., & Brody, D.L. (2017). Outcome trends after US military concussive traumatic brain injury. Journal of Neurotrauma, 34, 2206–2219.CrossRefGoogle ScholarPubMed
Marx, B.P., Brailey, K., Proctor, S.P., Macdonald, H.Z., Graefe, A.C., Amoroso, P., & Vasterling, J.J. (2009). Association of time since deployment, combat intensity, and posttraumatic stress symptoms with neuropsychological outcomes following Iraq War deployment. Archives of General Psychiatry, 66(9), 996–1004.CrossRefGoogle ScholarPubMed
Marx, B.P., Doron-Lamarca, S., Proctor, S.P., & Vasterling, J.J. (2009). The influence of pre-deployment neurocognitive functioning on post-deployment PTSD symptom outcomes among Iraq-deployed Army soldiers. Journal of the International Neuropsychological Society, 15(6), 840–852.CrossRefGoogle ScholarPubMed
Neipert, L., Pastorek, N.J., Troyanskaya, M., Scheibel, R.S., Peterson, N.J., & Levin, H.S. (2014). Effect of clinical characteristics on cognitive performance in service members and veterans with histories of blast-related mild traumatic brain injury. Brain Injury, 28(13-14), 1667–1674.CrossRefGoogle ScholarPubMed
Parslow, R.A., & Jorm, A.F. (2007). Pretrauma and posttrauma neurocognitive functioning and PTSD symptoms in a community sample of young adults. American Journal of Psychiatry, 164(3), 509–515.CrossRefGoogle Scholar
O’Bryant, S.E., Engel, L.R., Kleiner, J.S., Vasterling, J.J., & Black, F.W. (2007). Test of Memory Malingering (TOMM) Trial 1 as a screening measure for insufficient effort. Clinical Neuropsychologist, 21(3), 511–521.CrossRefGoogle ScholarPubMed
Pertab, J.L., James, K.M., & Bigler, E.D. (2009). Limitations of mild traumatic brain injury meta-analyses. Brain Injury, 23(6), 498–508.CrossRefGoogle ScholarPubMed
Pitman, R.K., Rasmusson, A.M., Koenen, K.C., Shin, L.M., Orr, S.P., Gilbertson, M.W., & Liberzon, I. (2012). Biological studies of post-traumatic stress disorder. Nature Reviews. Neuroscience, 13(11), 769–787.CrossRefGoogle ScholarPubMed
Rabinowitz, A.R., & Levin, H.S. (2015). Cognitive sequelae of traumatic brain injury. Psychiatric Clinics of North America, 37(1), 1–11.CrossRefGoogle Scholar
Ramchand, A., Rudavsky, R., Grant, S., Tanielian, T., & Jaycox, L. (2015). Prevalence of, risk factors for, and consequences of, posttraumatic stress disorder and other mental health problems in military populations deployed to Iraq and Afghanistan. Current Psychiatry Reports, 17(5), 37.CrossRefGoogle ScholarPubMed
Reeves, D., Kane, R., Elsmore, T., Winter, K., & Bleiberg, J. (2002). ANAM 2001 user’s manual: Clinical and research modules. San Diego: National Cognitive Recovery Foundation.Google Scholar
Regasa, L.E., Thomas, D.M., Gill, R.S., Marion, D.W., & Ivins, B.J. (2016). Military deployment may increase the risk for traumatic brain injury following deployment. Journal of Head Trauma Rehabilitation, 31(1), E28–E35.CrossRefGoogle ScholarPubMed
Rubin, D.C., Burt, C.D.B., & Fifeld, S.J. (2003). Experimental manipulations of the phenomenology of memory. Memory and Cognition, 31(6), 877–886.CrossRefGoogle ScholarPubMed
Ruggiero, K.J., Del Ben, K., Scotti, J.R., & Rabalais, A.E. (2003). Psychometric properties of the PTSD Checklist-Civilian Version. Journal of Traumatic Stress, 16(5), 495–502.CrossRefGoogle ScholarPubMed
Scott, J.C., Matt, G.E., Wrocklage, K.M., Crnich, C., Jordan, J., Southwick, S.M., & Schweinsburg, B.C. (2015). A quantitative meta-analysis of neurocognitive functioning in posttraumatic stress disorder. Psychology Bulletin, 141(1), 105–140.CrossRefGoogle ScholarPubMed
Smith, T.C., Ryan, M.A.K., Wingard, D.L., Slymen, D.J., Salis, J.F., & Kritz-Silverstein, D. (2008). New onset and persistent symptoms of post-traumatic stress disorder self reported after deployment and combat exposures: Prospective population based US military cohort study. BMJ, 336(7640), 366–371.CrossRefGoogle ScholarPubMed
Stein, M.B., Kessler, R.C., Heeringa, S.G., Jain, S., Campbell-Sills, L., & Cople, L.J., Army STARRS collaborators. (2015). 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). American Journal of Psychiatry, 172(11), 1101–1111.CrossRefGoogle ScholarPubMed
Sundin, J., Herrell, R.K., Hoge, C.W., Fear, N.T., Adler, A.B., Greenberg, N., & Bliese, P.D. (2014). Mental health outcomes in US and UK military personnel returning from Iraq. British Journal of Psychiatry, 204(3), 200–207.CrossRefGoogle ScholarPubMed
Vasterling, J.J., Aslan, M., Proctor, S.P., Ko, J., Marx, B.P., Jakupcak, M., & Concato, J. (2016). Longitudinal examination of posttraumatic stress disorder as a long-term outcome of Iraq War deployment. American Journal of Epidemiology, 184(11), 796–805.CrossRefGoogle ScholarPubMed
Vasterling, J.J., Brailey, K., Proctor, S.P., Kane, R., Heeren, T., & Franz, M. (2012). Neuropsychological outcomes of mild traumatic brain injury, post-traumatic stress disorder and depression in Iraq-deployed US Army soldiers. British Journal of Psychiatry, 201(3), 186–192.CrossRefGoogle ScholarPubMed
Vasterling, J.J., Proctor, S.P., Amoroso, P., Kane, R., Gackstetter, G., Ryan, M.A., & Friedman, M.J. (2006). The Neurocognition Deployment Health Study: A prospective cohort study of Army Soldiers. Military Medicine, 171(3), 253–260.CrossRefGoogle ScholarPubMed
Vasterling, J.J., Proctor, S.P., Amoroso, P., Kane, R., Heeren, T., & White, R.F. (2006). Neuropsychological outcomes of army personnel following deployment to the Iraq War. JAMA, 296(5), 519–529.CrossRefGoogle Scholar
Vasterling, J.J., Verfaellie, M., & Sullivan, K.D. (2009). Mild traumatic brain injury and posttraumatic stress disorder in returning veterans: Perspectives from cognitive neuroscience. Clinical Psychology Review, 29(8), 674–684.CrossRefGoogle ScholarPubMed
Verfaellie, M., Lafleche, G., Spiro, A., & Bousquet, K. (2014). Neuropsychological outcomes in OEF/OIF veterans with self-report of blast exposure: Associations with mental health, but not MTBI. Neuropsychology, 28(3), 337–346.CrossRefGoogle Scholar
Vogt, D.S., Proctor, S.P., King, D.W., King, L.A., & Vasterling, J.J. (2008). Validation of scales from the Deployment Risk and Resilience Inventory (DRRI) in a sample of Operation Iraqi Freedom veterans. Assessment, 15(4), 391–403.CrossRefGoogle Scholar
Weathers, F.W., Keane, T.M., & Davidson, J.R. (2001). Clinician-administered PTSD scale: A review of the first ten years of research. Depression and Anxiety, 13(3), 132–156.CrossRefGoogle Scholar
Wechsler, D.A. (1945). A standardized memory scale for clinical use. Journal of Psychology, 19, 87–95.CrossRefGoogle Scholar
Wechsler, D.A. (1997). Wechsler Memory Scale (3rd ed.). San Antonio: Psychological Corporation.Google Scholar
Wilkins, B.A., Lang, A.J., & Norman, S.B. (2011). Synthesis of the psychometric properties of the PTSD Checklist (PCL) military, civilian, and specific versions. Depression and Anxiety, 28, 596–606.CrossRefGoogle ScholarPubMed
Wingenfeld, K., & Wolf, O.T. (2011). HPA axis alterations in mental disorders: Impact on memory and its relevance for therapeutic interventions. CNS Neuroscience and Therapeutics, 17(6), 714–722.CrossRefGoogle ScholarPubMed
Yurgil, K.A., Barkauskas, D.A., Vasterling, J.J., Nievergelt, C.M., Larson, G.E., & Schork, N.J., Marine Resiliency Study Team. (2014). Association between traumatic brain injury and risk of posttraumatic stress disorder in active-duty Marines. JAMA Psychiatry, 71(2), 149–157.CrossRefGoogle ScholarPubMed
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