San Francisco Veterans Affairs Medical Center Release: Study Observes Link Between Cognitive Impairment And Mental Health Problems In Returning Combat Veterans
SAN FRANCISCO – May 10, 2016 – A new study conducted by researchers at the San Francisco VA Medical Center (SFVAMC) observes that self-reported cognitive impairment (problems with atten¬tion, concentration, memory, etc.) in Veterans is more likely to occur with depression and posttraumatic stress disorder (PTSD) than with combat-related traumatic brain injury (TBI).
The study, titled “Association between Mild Traumatic Brain Injury and Mental Health Problems and Self-Reported Cognitive Dysfunction in Iraq and Afghanistan Veterans,” analyzes data from 66,089 VA-enrolled Iraq and Afghanistan Veterans who screened positive on initial TBI screening upon returning from combat between 2007 and 2012. TBI screening is typically administered by VA primary care to all combat Veterans returning to a VA healthcare facility for the first time after completing a deployment. Veterans who self-report signs of TBI, such as problems with memory and concentration after a head injury, are then referred for more extensive TBI evaluation.
Of the Veterans surveyed in the study, 72% reported moderate to very severe cognitive impairment that interfered with their daily lives. 42% of Veterans in that group were not found to have sustained combat-related TBI. However, 70% of the Veterans with self-reported cognitive impairment received a PTSD diagnosis, and 46% of them received a depression diagnosis. Surveyed Veterans with a PTSD diagnosis were found to be at an elevated risk for cognitive impairment, while Veterans with only a TBI diagnosis and no accompanying mental health complaints were much less likely to report cognitive impairment. The study suggests mental health treatment for conditions like PTSD and depression may result in improvements for Veterans with cognitive impairment.
“So many of these young Veterans are taking advantage of their GI Bill benefits and going to school when they return from combat,” says the study’s lead author Karen Seal, MD, MPH, Director of the Integrated Pain Team and Integrated Care Clinic for Iraq and Afghanistan Veterans, at the San Francisco VA Medical Center, and a professor at the University of California, San Francisco. “The cognitive impairment they are experiencing is preventing them from keeping up with their classes and can be incredibly frustrating.”
“This study reveals some limitations of our TBI screening program. On the one hand, screening brings to light problems that otherwise might have gone undetected, but on the other hand, screening may convey that cognitive problems are due to brain injury, whereas these problems may be best addressed with mental health treatment,” says Dr. Seal.
“When Veterans receive their initial TBI screening, providers need to give good counseling about the possible causes of cognitive impairment,” says Dr. Seal. “We may be missing opportunities for effective treatment. Too often, Veterans learn that they do not have TBI and ultimately do not seek the mental health treatment that could help them manage their cognitive symptoms.”
Dr. Seal hopes that this study can help refine the TBI screening process for returning combat Veterans. “The TBI screen should be an educational opportunity for Veterans. We need to help them drill down and find the real source of their cognitive problems in order to connect them to the right treatment options.”
This study was published in Volume 53, Number 2 of Journal of Rehabilitation Research & Development (JRRD). You can read the study at: 1.usa.gov/21uzXzs
Co-authors of the study are: Daniel Bertenthal, MPH (SFVAMC); Kristin Samuelson, PhD (SFVAMC, California School of Professional Psychology); Shira Maguen, PhD (SFVAMC, UCSF); Sant Kumar, BA (SFVAMC); Jennifer J. Vasterling, PhD (VA Boston Health Care System, Boston University School of Medicine).
SFVAMC has one of the largest medical research programs in the national VA system, with more than 200 research scientists, all of whom are faculty members at University of California, San Francisco.
The study, titled “Association between Mild Traumatic Brain Injury and Mental Health Problems and Self-Reported Cognitive Dysfunction in Iraq and Afghanistan Veterans,” analyzes data from 66,089 VA-enrolled Iraq and Afghanistan Veterans who screened positive on initial TBI screening upon returning from combat between 2007 and 2012. TBI screening is typically administered by VA primary care to all combat Veterans returning to a VA healthcare facility for the first time after completing a deployment. Veterans who self-report signs of TBI, such as problems with memory and concentration after a head injury, are then referred for more extensive TBI evaluation.
Of the Veterans surveyed in the study, 72% reported moderate to very severe cognitive impairment that interfered with their daily lives. 42% of Veterans in that group were not found to have sustained combat-related TBI. However, 70% of the Veterans with self-reported cognitive impairment received a PTSD diagnosis, and 46% of them received a depression diagnosis. Surveyed Veterans with a PTSD diagnosis were found to be at an elevated risk for cognitive impairment, while Veterans with only a TBI diagnosis and no accompanying mental health complaints were much less likely to report cognitive impairment. The study suggests mental health treatment for conditions like PTSD and depression may result in improvements for Veterans with cognitive impairment.
“So many of these young Veterans are taking advantage of their GI Bill benefits and going to school when they return from combat,” says the study’s lead author Karen Seal, MD, MPH, Director of the Integrated Pain Team and Integrated Care Clinic for Iraq and Afghanistan Veterans, at the San Francisco VA Medical Center, and a professor at the University of California, San Francisco. “The cognitive impairment they are experiencing is preventing them from keeping up with their classes and can be incredibly frustrating.”
“This study reveals some limitations of our TBI screening program. On the one hand, screening brings to light problems that otherwise might have gone undetected, but on the other hand, screening may convey that cognitive problems are due to brain injury, whereas these problems may be best addressed with mental health treatment,” says Dr. Seal.
“When Veterans receive their initial TBI screening, providers need to give good counseling about the possible causes of cognitive impairment,” says Dr. Seal. “We may be missing opportunities for effective treatment. Too often, Veterans learn that they do not have TBI and ultimately do not seek the mental health treatment that could help them manage their cognitive symptoms.”
Dr. Seal hopes that this study can help refine the TBI screening process for returning combat Veterans. “The TBI screen should be an educational opportunity for Veterans. We need to help them drill down and find the real source of their cognitive problems in order to connect them to the right treatment options.”
This study was published in Volume 53, Number 2 of Journal of Rehabilitation Research & Development (JRRD). You can read the study at: 1.usa.gov/21uzXzs
Co-authors of the study are: Daniel Bertenthal, MPH (SFVAMC); Kristin Samuelson, PhD (SFVAMC, California School of Professional Psychology); Shira Maguen, PhD (SFVAMC, UCSF); Sant Kumar, BA (SFVAMC); Jennifer J. Vasterling, PhD (VA Boston Health Care System, Boston University School of Medicine).
SFVAMC has one of the largest medical research programs in the national VA system, with more than 200 research scientists, all of whom are faculty members at University of California, San Francisco.