Association between combat stress and post-concussive symptom reporting in OEF/OIF service members with mild traumatic brain injuries

Brain Inj. 2011;25(1):1-7. doi: 10.3109/02699052.2010.531692. Epub 2010 Nov 30.


Objective: The relationship between combat stress and post-concussive symptoms in service members with mild traumatic brain injuries (mTBI) is poorly understood. It was hypothesized that the co-occurrence of combat stress would have a significant effect on the severity of post-concussive complaints, specifically on emotional and cognitive symptoms.

Methods: Four hundred and seventy-two combat-deployed service members with mTBI completed self-report inventories of post-traumatic stress and post-concussive symptoms. Two groups were formed based on post-traumatic stress symptoms (High Combat Stress and Low Combat Stress).

Results: A 3-8-fold increase in post-concussive symptoms was observed when comparing the High and Low Combat Stress Groups. Elevations in post-concussive symptom reporting were not limited to emotional and/or cognitive symptoms, but rather were inclusive of all measured post-concussive symptoms.

Conclusions: The findings of the present study suggest that non-brain injury-related factors, such as high-levels of combat stress, may impact post-concussive symptom reporting in this population, further confounding the accuracy of the post-concussion syndrome (PCS) diagnosis. Considerable caution should be exercised in making the diagnosis of PCS in concussed service members with co-occurring combat-stress disorders.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Blast Injuries / complications*
  • Blast Injuries / epidemiology
  • Blast Injuries / psychology
  • Cognition Disorders / epidemiology
  • Cognition Disorders / etiology*
  • Cognition Disorders / psychology
  • Cohort Studies
  • Emotions
  • Female
  • Humans
  • Male
  • Military Personnel* / statistics & numerical data
  • Post-Concussion Syndrome / epidemiology
  • Post-Concussion Syndrome / etiology*
  • Post-Concussion Syndrome / psychology
  • Risk Factors
  • Stress Disorders, Post-Traumatic / complications*
  • Stress Disorders, Post-Traumatic / epidemiology
  • Stress Disorders, Post-Traumatic / psychology
  • Surveys and Questionnaires