Mental Health Needs for Military Members Suffering from Traumatic Brain Injury

By Ida Babakhanyan, Ph.D.
June 28, 2022

MHS photo by Janet Aker

There are a number of symptoms that overlap with various psychological disorders and mild head injuries, commonly known as concussion.^{1, 2} Mental health issues and mild head injury are also often present simultaneously in the same patient (also called “comorbidities”). ^3-5 The link between mild traumatic brain injury and mental health problems makes it difficult to diagnose and plan their treatments separately. Accordingly, treatment guidelines incorporate psychological interventions as part of the multidisciplinary approach to TBI treatment within the Department of Defense.⁶ This article will discuss TBI and the prevalence of co-morbid psychological conditions, challenges in accessing mental health resources for military members and veterans, and the importance of treating co-occurring psychological conditions as part of rehabilitation care. TBI.

The mild prognosis of TBI is influenced by comorbid psychological conditions such as posttraumatic stress disorder. A range of 15 to 30 percent of service members who complete a traumatic brain injury rehabilitation program show no improvement.^{7, 8} Analysis of treatment outcomes at Intrepid Spirit Center Camp Pendleton shows that patients who present for TBI care with elevated PTSD symptoms, including hyperarousal and avoidance, are less likely to benefit from rehabilitation care TBI.⁹ These challenges not only have an immediate impact; they also affect long-term quality of life. The severity of mental health problems – up to 10 years after mild traumatic brain injury – is one of the strongest indicators of long-term functioning among service members and veterans.^ten Untreated and unresolved mental health needs can lead to a multitude of challenges for military members and their families. It is estimated that 10 to 40% of patients who suffer a mild traumatic brain injury will develop emotional, cognitive and behavioral difficulties that may persist and lead to stress, poor sleep, post-traumatic stress disorder, depression, anxiety, unemployment and reduced quality of life.^{1, 2}

Stigma associated with mental health care is also a factor. Soldiers may be reluctant to seek care directly. Patients often feel that it is more acceptable to seek treatment for their history of concussions than to seek help for psychological distress related to combat, casualties, and war experiences. As a result, service members and veterans with mental health needs do not seek appropriate treatment.¹¹ As the conflicts in Iraq and Afghanistan have ended and service members with two decades of war experience are entering retirement, many of these service members are coming for traumatic brain injury rehabilitation care, where their health needs mental health can also be considered and treated given the limited resources available. somewhere else. Evidence suggests that behavioral health interventions are a necessary part of the treatment of service members and veterans with mild traumatic brain injury and should be considered a primary intervention. ^{12, 13}

When should you consider mental health treatment?

• When head injury symptoms do not improve or worsen after extensive rehabilitation
• When patients have a history of combat deployment AND have:
  • Lost one or more friends or teammates during combat operations
  • Loss or trauma experienced on the battlefield
  • Been involved in kinetic combat deployments (either self-reported or informed by military occupational specialties – or MOS – which place our warfighters in direct combat roles)
  • Indicates moral damage. Moral injury can occur in response to actions or behaviors that go against an individual’s values ​​and moral beliefs (https://www.ptsd.va.gov/professional/treat/cooccurring/moral_injury.asp
• If there is a history of childhood abuse or trauma and the patient expresses a willingness to explore and address these past traumas as well as the potential impacts of the past traumas on the most recent trauma.
• When patients are currently going through major life stressors or transitions, such as divorce, and express interest in additional support or treatment to strengthen coping mechanisms related to these stressors.
• When there are signs of substance abuse – it is often an unhealthy coping mechanism used to alleviate the feeling of psychological distress.

By learning about a service member’s life experiences, we can provide a more comprehensive TBI treatment approach to meet their needs. This may ultimately impact treatment response, improve return to service rates and provide a better prognosis for long-term outcomes.

Dr. Ida Babakhanyan is a licensed clinical psychologist specializing in neuropsychology and TBI research through the Traumatic Brain Injury Center of Excellence.

The references

1. Chen, C., Lin, M., Huda, M., and Tsai, P. (2020). Effects of cognitive behavioral therapy for adults with post-concussion syndrome: systematic review and meta-analysis of randomized controlled trials. Journal of Psychosomatic Research. https://pubmed.ncbi.nlm.nih.gov/32712533/
2. Teo, SH, Fong, KNK, Chen, Z., and Chung, RCK (2020). Cognitive and psychological interventions for the reduction of post-concussive symptoms in patients with mild traumatic brain injury: a systematic review. Brain injury, 34(10), 1305-1321. https://pubmed.ncbi.nlm.nih.gov/32772725/
3. Chin, DL and Zeber, JE, (2019). Mental health outcomes among service members after serious combat injuries and traumatic brain injury. Military medicine. https://pubmed.ncbi.nlm.nih.gov/31889174/
4. Farmer, CM, Krull, H., Concannon, TW, Simmons, M., Pillemer, F., Ruder, T., Parker, A., Purohit, MP, Hiatt, L., Batorsky, BS and Hepner, KA ( 2017). Understanding the treatment of mild traumatic brain injuries in the military healthcare system. Rand Health Q, https://pubmed.ncbi.nlm.nih.gov/28845349/
5. Cooper, DB, Bunner, AE, Kennedy, JE, Balldin, V., Tate, DF, Eapen, BC, & Jaramillo, CA (2015). Treatment of persistent post-concussive symptoms after mild traumatic brain injury: a systematic review of cognitive rehabilitation and behavioral health interventions in military personnel and veterans. Brain imaging and behavior, 9, 403-420. https://pubmed.ncbi.nlm.nih.gov/26330376/
6. DeGraba, T.J., Williams, K., Koffman, R., Bell, J.L., Pettit, W., Kelly, J.P., Pickett, T.C. (2020). Effectiveness of an Intensive Interdisciplinary Outpatient Program in the Treatment of Combat-Related Head Injury and Psychological Health Problems. Frontiers in Neurology. https://pubmed.ncbi.nlm.nih.gov/33536993/
7. Miller, KJ, Kennedy, JE, & Schwab, KA (2017). Long-term outcomes and needs of military personnel after non-combat-related traumatic brain injury. Military medicine. doi:10.7205/MILMED-D-16-00175.
8. Rabinowitz, AR, Li, Prevalence and predictors of poor recovery following mild traumatic brain injury. Journal of Neurotrauma. https://pubmed.ncbi.nlm.nih.gov/28291465/
9. >Ettenhofer, M., Stuessi, K., Babakhanyan, I. and Hungerford, L. (2021). In case of treatment failure: Factors Associated with Negative Outcomes of Military TBI Treatment Programs. Oral presentation at the annual Military Health Systems Research Symposium.
10. Lange, RT, French, LM, Lippa, SM, Bailie, JM and Brickell, TA (2020). Posttraumatic stress disorder is a more powerful predictor of long-term neurobehavioral outcomes than head injury severity. Traumatic Stress Diary. https://pubmed.ncbi.nlm.nih.gov/32379932/ (doi:10.1002/jts.22480)
11. Peck, B.S. & Parcell, E.S. (2021). Let’s Talk Mental Health: Dilemmas U.S. Military Service Members and Their Spouses Experience Post-Deployment. Family Communication Journal. https://www.tandfonline.com/doi/abs/10.1080/15267431.2021.1887195
12. Prince and Bruhns, M.E. (2017). Assessment and treatment of mild head injuries: the role of neuropsychology. Brain Sciences. https://pubmed.ncbi.nlm.nih.gov/28817065/
13. Cooper, DB, Bowles, AO Kennedy, JE, Curtiss, G., French, LM, Tate, DF, Vanderploeg, RD (2017). Cognitive rehabilitation for military personnel with mild traumatic brain injury: a randomized clinical trial. Journal of Head Injury Rehabilitation. https://pubmed.ncbi.nlm.nih.gov/27603763/