Wartime Brain Injuries: Five Years Later

Wartime traumatic brain injury symptoms in service members appeared to worsen over time

When military service members receive traumatic brain injuries (TBI) in combat, their symptoms immediately after the injury may only be the beginning.

Symptoms of concussive-blast TBIs in US service members appeared to worsen over a five-year period, according to a new study.

A TBI is an injury to the brain from an external force. The authors of this new study said the long-term effects of these injuries among service members had not been thoroughly researched.

This study looked at 94 active-duty service members between November of 2008 and July of 2013 who were in Afghanistan or had been evacuated to a medical facility in Germany. Some of these service members had a TBI, and some didn’t.

Lead study author Dr. Christine L. Mac Donald, PhD, of the University of Washington School of Medicine in Seattle, and colleagues found that the service members who had TBIs were more likely to report worse symptoms five years after the injury occurred than they had at a one-year assessment.

These researchers looked at measures like overall disability, neurobehavioral symptoms, psychiatric symptoms, sleep problems and satisfaction with life. Although these problems were more likely to worsen over time in service members who had received a TBI, there was no detectable difference in cognitive performance between these service members and those who hadn’t had a TBI.

Seventy-two percent of the service members with TBIs had a worse outcome on a measure of overall disability between the one- and five-year evaluations, Dr. Mac Donald and team found. That’s in contrast to only 11 percent of the service members who didn’t have concussive-blast TBIs. That finding led these researchers to note that study participants with TBIs “experienced evolution, not resolution, of symptoms” over time.

Between the first evaluation at one year and the second evaluation at five years, 80 percent of the participants with TBIs and 41 percent of those without TBIs said they sought treatment with a mental health professional. Around 20 percent of those in both groups reported that the mental health treatment helped them.

Still, the study authors said they were hopeful their research could help ease the “extensive public health burden” of TBIs among service members.

“We believe that by being informed from longitudinal studies such as this one, the medical community can be proactive in combatting the potentially negative and extremely costly effect of these wartime injuries,” they wrote in the conclusion of their study.

An editorial published alongside this study, written by Drs. Kristen Dams-O’Connor, PhD, and Jack W. Tsao, MD, DPhil, noted that an estimated 20 percent of service members in Iraq and Afghanistan had at least one TBI. They called for more research and new treatment strategies to address this problem.

“Only by concentrating efforts and supporting research in this high-priority area can the nation best serve those service members and veterans who have sacrificed for our country,” they wrote.

Dr. Mac Donald and team noted that the small size of their study could have limited its findings.

The study and editorial were published in JAMA Neurology.

Grants from the Department of Defense and National Institutes of Health funded this research. The study authors disclosed no potential conflicts of interest.

JAMA Neurology, “Early Clinical Predictors of 5-Year Outcome After Concussive Blast Traumatic Brain Injury”
JAMA Neurology, “Functional Decline 5 Years After Blast Traumatic Brain Injury”
JAMA Network Journals, “Gauging 5-Year Outcomes After Concussive Blast Traumatic Brain Injury”
Written by: Alex Lindley | Medically reviewed by: Dr. Robert Carlson, M.D.