The Relationship Between Concussion and Combat History and Mental Health and Suicide Ideation Among United States Military Veterans-A Pilot Study.

Background/

Objectives

Suicides among U.S. military veterans are alarmingly high, driven by factors such as mental health issues, combat exposure, and history of mild traumatic brain injury (mTBI)/concussion. This study aims to examine the relationship between concussion history, combat experience, and their effects on mental health issues and suicide ideation among military veterans. Additionally, this study investigates the impact of post-traumatic stress disorder (PTSD) on these variables.

Methods

A total of 78 veterans (62 males, 16 females) participated in this study. Participants completed a demographic survey and the Global Well-being Index (GWI) to assess concussion history and residual symptoms. A licensed social worker interviewed the veterans using the 9-Item Patient Health Questionnaire (PHQ-9) for depression, the Generalized Anxiety Disorder survey (7 Items) (GAD-7) for anxiety, and the Columbia-Suicide Severity Rating Scale (C-SSRS) for suicide ideation. A 2 × 2 cross-tabulation analysis examined the relationships between concussion history, combat experience, and outcomes of anxiety, depression, and suicide ideation. PTSD was also assessed as both a predictor and an outcome. Statistical analyses yielded odds ratios (OR) with 95% confidence intervals (CI), Chi-square, and Cramer's V (V) correlations along with associated p-values.

Results

The combination of concussion history and combat experience strongly predicted either anxiety, depression, or suicide ideation (OR = 7.97, 95% CI: 1.70, 37.44; V = 0.334, (p = 0.003)), more than either factor alone. Combat experience was the strongest predictor of PTSD (OR = 11.12, 95% CI: 3.30, 37.47; V = 0.485, p ≤ 0.001), both individually and when combined with concussion history. PTSD strongly influenced mental health issues and suicide ideation (OR = 8.16, 95% CI: 1.74, 38.25; V = 0.339, p = 0.003). Stratification by PTSD status (positive or negative) affected the relationships between independent and dependent variables. Small cell counts resulted in a wide 95% CI for some ORs, though some statistically significant Fisher's Exact Test results were observed. Credibility analysis using the critical prior interval (CPI) metric confirmed the intrinsic credibility of the results.

Conclusions

This study provides insights into the relationships between concussion history, combat experience, and their impacts on mental health issues and suicide ideation among military veterans.