Trauma exposure across the lifespan is associated with persistent mild TBI symptoms in US military Veterans

Abstract: OBJECTIVE: Mild traumatic brain injury (mTBI) is common in military veterans, with most symptoms fully resolving within weeks but some persisting for months or years after injury. Chronic symptoms are often attributed to aftereffects of the physiological injury, but veterans are also exposed to higher rates of psychological trauma which take place before, during, and after their military service careers. The present study sought to investigate the relationship between psychological trauma across the lifespan and persistence of mTBI symptoms and postinjury quality of life in US military veterans. SETTING AND PARTICIPANTS: A total of 463 veterans with a history of mTBI (88.1% male, age 18-92 years [mean age 45.7 years]) were recruited from a VA outpatient TBI clinic. DESIGN AND MAIN MEASURES: In this observational study, participants completed the Neurobehavioral Symptom Inventory (NSI) and Quality of Life after Brain Injury Questionnaire (QOLIBRI) as primary outcome measures. The history of mTBI was extracted from existing VA records, and veterans provided accounts of their cumulative lifetime trauma exposure, including trauma measures from their childhood, deployment, and postdeployment periods. RESULTS: After controlling for demographic and mTBI characteristics, each trauma measure was significantly positively associated with NSI symptom severity (all partial η2 > .033, all P < .004) and significantly negatively associated with QOLIBRI life satisfaction (all partial η2 > .035, all P < .002). There were no significant associations between outcomes and mTBI characteristics after correcting for multiple comparisons. The associations between psychological trauma and mTBI outcomes were observed across most NSI and QOLIBRI symptom domains, including those more often attributed to physiological explanations (eg, NSI somatic, NSI vestibular, and QOLIBRI physical problem scales). CONCLUSION: These findings support the inclusion of comprehensive lifetime trauma assessment in chronic mTBI rehabilitation conceptualizations and underscore the potentially prominent role that psychological stressors play in the persistence of mTBI sequelae.