Post-concussive symptom endorsement and symptom attribution following remote mild traumatic brain injury in combat-exposed Veterans: An exploratory study

• Published in: Journal of psychiatric research 2020-11, Vol.130, p.224-230
• Main Authors: Merritt, Victoria C., Jurick, Sarah M., Sakamoto, McKenna S., Crocker, Laura D., Sullan, Molly J., Hoffman, Samantha N., Davey, Delaney K., Jak, Amy J.
• Format: Article
• Language: English
• Subjects: Afghan Campaign 2001; Brain Concussion - complications; Brain Concussion - epidemiology; Combat exposure; Cross-Sectional Studies; Humans; Iatrogenic effects; Iraq War, 2003-2011; Mild traumatic brain injury; Military Veterans; Post-Concussion Syndrome - diagnosis; Post-Concussion Syndrome - epidemiology; Post-Concussion Syndrome - etiology; Post-concussive symptoms; Stress Disorders, Post-Traumatic - epidemiology; Stress Disorders, Post-Traumatic - etiology; Symptom attribution; Veterans
• ISSN: 0022-3956; 1879-1379
• DOI: 10.1016/j.jpsychires.2020.08.006

The purpose of this study was to examine rates of and relationships between “post-concussive” symptom endorsement and symptom attribution in Veterans with a history of mild traumatic brain injury (mTBI). This cross-sectional, exploratory study included 48 combat-exposed Iraq/Afghanistan Veterans with remote history of mTBI. All Veterans completed clinical interviews and self-report questionnaires assessing sociodemographic factors, injury and combat-related variables, psychiatric distress, self-efficacy, and coping style. To assess symptom endorsement and symptom attribution, a modified version of the Neurobehavioral Symptom Inventory was administered. Results showed that the most commonly endorsed “post-concussive” symptoms were several non-specific symptoms, while the symptoms most frequently attributed to mTBI included forgetfulness, poor concentration, and headaches. Furthermore, although there were some overlapping correlates of both symptom endorsement and symptom attribution, unique variables were associated with each domain. Specifically, symptom endorsement was uniquely associated with measures of psychiatric distress, while symptom attribution was uniquely associated with having a history of loss of consciousness and a greater degree of combat exposure. Taken together, results suggest that endorsement of symptoms may be significantly impacted by the presence of mental health comorbidities, but that perceptions or beliefs as to why symptoms are occurring are related more to mTBI and combat-related characteristics. Findings offer potential avenues for therapeutic intervention, emphasize the importance of psychoeducation, and highlight the need to consider using alternate terminology for these symptoms that promotes recovery and minimizes misattribution of symptoms.