Traumatic brain injury (TBI) is considered the “signature injury” of the wars in Iraq and Afghanistan due to the huge number of soldiers returning home with documented brain injuries. However, new research shows many more veterans returned to civilian life with undiagnosed TBI which has wreaked havoc in their post-deployment lives.
According to the research from Johns Hopkins University, tens of thousands of American combat veterans with undetected brain injuries were “thrown into a canyon” of increasing despair, often including addiction and thoughts of suicide. It typically took years before they were finally pushed by a “wake-up call” moment to seek help.
The study, published by researchers at the Johns Hopkins University Department of International Health in the journal Social Science and Medicine, builds on past studies from the Baltimore university. Past research has found tens of thousands of undiagnosed and untreated brain injuries caused by improvised explosive devices or IEDs.
In 2007, better screening protocols were put into place to better identify soldiers with brain injury and improve long-term outcomes. However, countless veterans with brain injuries slipped through undiagnosed before these new protocols were put into place.
For this study, the Johns Hopkins researchers conducted in-depth interviews with Army combat veterans and their family members to assess the impact of traumatic brain injury on their lives, and evaluate their long-term recovery. According to the researchers, a pattern emerged over the course of the 38 interviews: veterans frequently downplayed their injuries, but became detached from friends and family while experiencing memory loss, cognitive struggles, mood disorders, and issues with addiction, insomnia, and suicide.
For the vast majority, the veterans denied their downward spiral until a “wake-up call” encouraged them to seek help. Once they did, aid could still sometimes be difficult to obtain since most lacked documentation for their injury.
“When veterans came to me before the study, there was so much uncertainty. They told me that they thought that they ‘were alone’ when they came home, but these actually were shared experiences. Their symptoms were very similar, so a picture of their lives post-blast exposure needed to be modeled,” said Rachel P. Chase, who has a doctorate in international health from Johns Hopkins.
The researchers say the veterans with the best outcomes typically had been encouraged by spouses or family to get help earlier or lived near a respected clinic that specializes in brain injury care, or featured a particularly good medical provider “even within a reportedly low-functioning facility.”
The researchers also found that veterans who had been exposed to a subsequent bomb blast following 2010 – when the military again increased its efforts to diagnose and treat every brain injury obtained during war and training – often had better outcomes than those who were only wounded once.
Chase also says changing social codes in the military have improved overall treatment of brain injuries, as commanders are now likely to ensure troops are thoroughly screened for concussions and are more likely to keep them out of the field until they are cleared.
A more detailed review of the study’s findings is due to be published in 2016 in Military Medicine, the flagship journal for health care providers serving the Defense Department, the VA, and the U.S. Public Health Service.
“For health providers, our study gives you a way to talk about the problem with the family, to show them that this isn’t unusual and that there is hope for the veterans,” Chase said.