Concussions are typically thought of as a “short-term” injury. After a week or two, it is assumed a person will heal and be back to work and normal life. But, for the military service members who sustain concussions in combat, a brain injury is just the start of several symptoms that grow and last for years after their initial injury. According to a new study published in JAMA Neurology, this is especially true if the service member has psychiatric problems.
As the researchers from the University of Washington School of Medicine in Seattle note, approximately one in five U.S. service members deployed in the wars in Iraq and Afghanistan sustained a brain injury. The majority of these were diagnosed as mild uncomplicated brain injuries or concussions.
According to the findings, the soldiers who suffered concussions were more likely to have post-traumatic stress disorder (PTSD), severe depression, anxiety, and sleep difficulties.
This is based on research which followed and compared the health outcomes over five years for 50 active-duty service members with combat experience who sustained combat concussions and 44 who had no record of brain injuries.
The report also showed that the symptoms typically grew worse for one to five years after the injury, indicating typical short-term treatment plans may not be right for all concussion patients.
“There is evolution not resolution of symptoms that occur years after these exposures,” lead study author Christine Mac Donald told Reuters by email. “We in the medical research community should not only be working hard to develop therapies that can be administered acutely after injury but also, and this is a bit of a paradigm shift, focus on developing therapies and treatment strategies targeted to the chronic phase of injury as well.”
“In short, there is nothing ‘mild’ about these injuries,” she added.
All concussed service members followed in the study had been evacuated from Afghanistan to a medical center in Germany for treatment between 2008 and 2013. They were compared against other service members who had received treatment for noncombat health issues such as gastrointestinal tract issues or dermatitis.
Nearly three-quarters (36 of 50) of the concussion patients showed declining scores on an evaluation of overall disability within one to five years of their injury. Additionally, they reported worse satisfaction with life, disability, and more severe neurobehavioral and psychiatric symptoms compared to those without brain injuries.
Despite this, both groups performed similarly on cognitive function tests after five years.
The team found several specific factors which could contribute to worse outcomes after five years of a brain injury, such as pre-injury intelligence, motor strength, verbal fluency, and neurobehavioral symptoms like headache, insomnia, fatigue, and depression.
The researchers say it is impossible to draw definitive conclusions from the relatively small study, but they believe psychiatric symptoms may potentially be driving the long-term symptoms.
While it is important to be mindful of the risk of long-term symptoms after a concussion, an accompanying editorial highlights the fact that the majority of service members with concussions make a full recovery.
“Focusing on mild traumatic brain injuries, in the period immediately following concussion or mild traumatic brain injury, we know that injured service members typically make an excellent recovery and are able to return to full duty,” noted Dr. Jack Tsao, coauthor of an accompanying editorial and researcher at the University of Tennessee Health Science Center and the Memphis Veterans Affairs Medical Center.
“The focus of treatment immediately following injury is rest and education about what to expect during recovery, similar to what is recommended for a sports- or accident-related concussion,” Tsao added. “If symptoms persist and become diagnosed as persistent post-concussive syndrome or if new mental health conditions emerge and are diagnosed, additional treatment targeted towards the symptoms is warranted.”