Impact of PTSD on post-concussive symptoms, neuropsychological functioning, and pain in post-9/11 veterans with mild traumatic brain injury

Psychiatry Res. 2018 Oct:268:460-466. doi: 10.1016/j.psychres.2018.08.019. Epub 2018 Aug 11.


Prior work suggested that post-traumatic stress disorder (PTSD) worsens post-concussive symptoms (PCS), neuropsychological functioning, and pain-related outcomes in post-9/11 veterans. However, the impact of PTSD in the context of mild traumatic brain injury (mTBI) is not entirely clear. We evaluated possible differences among veterans with deployment-related mTBI with and without PTSD, and a comparison group. We hypothesized that veterans with comorbid mTBI and PTSD would report more PCS, perform worse on neuropsychological tasks, and report greater pain intensity and maladaptive pain coping relative to those without PTSD. Ninety (15 female, 75 male) post-9/11 veterans completed measures of psychiatric functioning, PCS, deployment-related mTBI, pain intensity, pain coping, and a brief neuropsychological evaluation. Veterans with comorbid mTBI and PTSD reported significantly higher PCS across domains, and greater pain intensity and maladaptive coping. They also performed more poorly on measures of recall, but not on measures of attention, encoding, or executive functioning. Findings suggest that PTSD results in greater PCS in the context of mTBI, and is associated with greater pain catastrophizing, worse recall, greater pain intensity, and greater illness-focused coping than in mTBI alone. PCS symptoms, recall, and pain coping may be of clinical importance for post-9/11 veterans with the "polytrauma triad."

Keywords: Cognition; PTSD; Pain; Post-concussive symptoms; Traumatic brain injury; Veteran.

Publication types

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

MeSH terms

  • Adult
  • Afghan Campaign 2001-
  • Brain Injuries, Traumatic / psychology*
  • Comorbidity
  • Female
  • Humans
  • Iraq War, 2003-2011
  • Male
  • Middle Aged
  • Neuropsychological Tests
  • Pain / psychology*
  • Post-Concussion Syndrome / psychology*
  • Stress Disorders, Post-Traumatic / psychology*
  • United States
  • Veterans / psychology*