Long-Term Clinical Outcomes Associated With the Veterans Health Administration's Traumatic Brain Injury and Mental Health Screens.

OBJECTIVE

Examine if the mandated Veterans Affairs traumatic brain injury (TBI) screen is associated with long-term postconcussive symptoms as compared to how the mandated mental health (MH) screen is associated with long-term MH symptoms.

SETTING

Veterans Health Administration.

PARTICIPANTS

Patients (N = 1628) who were previously screened for TBI with current postconcussive symptoms and MH conditions completed a survey assessing current postconcussive symptoms, depression, posttraumatic stress disorder, alcohol use, and physical and emotional well-being. Participants were mostly male (83%), less than 40 years old (38%), and identified as White (64%). Forty-five percent screened positive for MH conditions; 11% screened positive for TBI.

DESIGN

Cohort survey study of random sample of post-9/11 veterans combined with retrospective database analysis. Bayesian Network Analysis was used to compare how the TBI and MH screens related to long-term postconcussive and MH symptoms. The pathway on the Bayesian Network graph leading to postconcussive symptoms was thoroughly examined with a regression.

MAIN MEASURES: Neurobehavioral Symptom Inventory to measure postconcussive symptoms.

RESULTS

A Bayesian network arch demonstrated TBI screening was related to use of TBI services within 6 months after the screening but not related to long-term postconcussive or MH symptoms. In comparison, the MH screen led to post-screen MH services, postconcussive symptoms, and most of the other secondary outcomes, including posttraumatic stress disorder and depression. The regression model showed that a positive MH screen, more MH service use, negative life events, and moderate depression were associated with greater postconcussive symptoms years after screening.

CONCLUSION

While both TBI and MH screening were associated with increased service use, only the MH screen was associated with long-term postconcussive symptoms. Findings raise questions about whether the TBI screening program adds value over and above the MH screening program.