Examining the Relation Between Combat-Related Concussion, a Novel 5-Factor Model of Posttraumatic Stress Symptoms, and Health-Related Quality of Life in Iraq and Afghanistan Veterans

Objective: This study examined demographic, military, and clinical characteristics associated with combat-related concussion and persistent postconcussive symptoms; and how combat-related concussion and persistent postconcussive symptoms and a novel 5-factor model of posttraumatic stress disorder (PTSD) symptoms are related to physical and mental health-related quality of life in veterans who served in Iraq and Afghanistan. Method: 233 veterans recruited from the Veterans Affairs Hawaii Program Registry who served in Iraq and Afghanistan completed a survey in 2010 that assessed combat-related concussion and persistent postconcussive symptoms, PTSD (DSM-IV criteria), alcohol use problems, and physical and mental health-related quality of life. The primary measure was physical and mental health-related quality of life as assessed by the 12-item Short-Form Health Survey, version 2. Results: Veterans who screened positive for combat-related concussion and persistent postconcussive symptoms were more likely than those who did not to report direct combat exposure (x(2) = 15.46, P < .001), living in a rural area (x(2) = 6.86, P < .01), and screening positive for PTSD (x(2) = 37.67, P < .001) and alcohol use problems (x(2) = 11.62, P < .01); 57.3% of veterans who screened positive for combat-related concussion and persistent postconcussive symptoms screened positive for PTSD. In bivariate analyses, combat-related concussion and persistent postconcussive symptoms were associated with lower scores on measures of physical and mental health-related quality of life (r=-0.27 to -0.45, P < .001). In multivariate analyses, combat-related concussion and persistent postconcussive symptoms were no longer related to these outcomes, with PTSD-related dysphoric arousal symptoms as the strongest predictor of physical health-related quality of life (beta=-0.55, P < .001) and PTSD-related emotional numbing symptoms (beta=-0.56, P < .001) as the strongest predictor of mental health-related quality of life. Conclusions: Results of this study suggest that a 5-factor model of PTSD symptoms may provide greater specificity in understanding the relation between combat-related concussion and persistent postconcussive symptoms, PTSD symptoms, and health-related physical and mental quality of life in Iraq/Afghanistan veterans. Psychiatric clinicians should consider this heterogeneity of PTSD symptoms when assessing and treating symptomatic veterans. J Clin Psychiatry 2012;73(8):1110-1118 (c) Copyright 2012 Physicians Postgraduate Press, Inc.