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Positive attitude, social support may promote TBI/PTSD resilience

Navy Lt. Cmdr. John Derenne, a psychiatrist at Naval Hospital Jacksonville, discusses mental health and resiliency at the hospital’s Behavioral Health Clinic. Derenne, a native of Orange, California, says, “Mental health challenges should not be hidden or ignored; seeking help early is a sign of strength. Just like physical fitness, good mental health is integral to your well-being and mission readiness.” (U.S. Navy photo by Jacob Sippel) Navy Lt. Cmdr. John Derenne, a psychiatrist at Naval Hospital Jacksonville, discusses mental health and resiliency at the hospital’s Behavioral Health Clinic. Derenne, a native of Orange, California, says, “Mental health challenges should not be hidden or ignored; seeking help early is a sign of strength. Just like physical fitness, good mental health is integral to your well-being and mission readiness.” (U.S. Navy photo by Jacob Sippel)

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Untangling the relationship between traumatic brain injury and posttraumatic stress disorder is a complex challenge, one that researchers at the Defense and Veterans Brain Injury Center, the Defense Health Agency’s traumatic brain injury center of excellence, are tackling. They are discovering important insights that may help to reduce symptom severity and increase resilience.

DVBIC researchers found that psychological experiences prior to an injury may play a role in recovery in patients diagnosed with both mild TBI, also known as concussion, and posttraumatic stress disorder. Screening for the effects of past trauma may help health care providers identify and treat individuals at greater risk of developing persistent post-concussion symptoms or PTSD.

“The difficulties an individual experiences may relate to stressors and other symptoms that had occurred even before experiencing a TBI,” explained Dr. Lisa Lu, a clinical neuropsychologist and research scientist at DVBIC.

Combat situations sometimes lead service members to experience both a mild TBI and psychological distress. In order to understand more about how the two conditions relate to each other in specific individuals, researchers asked questions of cause and effect: 

  • Does experiencing a mild TBI make a person more likely to experience PTSD?
  • Does the presence of PTSD symptoms mean that an individual has also experienced a mild TBI?
  • Do life experiences prior to military service affect the likelihood that an individual will or will not experience PTSD, mild TBI, or both?

Data collected since 2005 may help answer these questions. Pioneered by DVBIC neuropsychologist Dr. Jan Kennedy, the San Antonio Prospective Traumatic Brain Injury Clinical Tracking Repository helps TBI researchers collect information on the mental health background of TBI patients. Empirical findings contained in the repository have led to multiple studies on TBI, PTSD, and their relationship.

“You have to be in touch with the needs of the service members and ask the relevant research questions that address those needs,” Kennedy said.

In a 2018 study, researchers identified 165 service members with mild TBI, some of whom also had a diagnosis of PTSD. They considered variables such as “positive attitude” -- what the researchers termed “resilience” -- and past trauma. Researchers concluded that resilience was associated with whether an individual reported symptoms from mild TBI or PTSD. Those with lower resilience scores were more likely to report symptoms associated with mild TBI and/or PTSD.

Social support is also important. In another study, Kennedy, Lu, and their colleagues at the DVBIC location at San Antonio Military Medical Center surveyed 326 service members with mild TBI during primary care visits. They found that the presence of regular social relationships – for example, consistent weekly interactions with friends and family – appeared to protect resilience after the TBI.      

These findings suggest that knowledge of prior experiences and attitudes may be just as important for providers as the therapeutic interventions they prescribe for TBI and PTSD.

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