VISN 19 MIRECC Specialties: OEF/OIF/OND Veterans

Research, Education and Clinical Care Related to
OEF/OIF/OND Veterans

Research Projects

Consistency of ANAM Performance in Those with Service Related Mild TBI

Research Team: Lisa A. Brenner PhD, Gina M. Signoracci PhD, Jeri E. Forster PhD, Kim Gorgens PhD

The purpose of this project is to explore the degree to which performance consistency on neuropsychological measures varies in a sample of Operation Iraqi Freedom (OIF)/Operation Enduring Freedom (OEF) Veterans with a history of mild traumatic brain injury (mTBI) with persistent self-reported symptoms.

Keywords: Assessment, OEF/OIF/OND, Traumatic Brain Injury (TBI)

Increasing Statewide Capacity to Provide Mental Health Care to Eligible Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF) Veterans with TBI and Co-Occurring Behavioral Health Issues

Research Team: Lisa A. Brenner PhD, Jennifer Olson-Madden PhD, Bridget B. Matarazzo PsyD, Gina M. Signoracci PhD

The purpose of this study is to explore and potentially increase the capacity of the non-VA community mental health system within the state of Colorado to provide a comprehensive and coordinated service delivery system for Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF) Veterans and their families. The specific population of interest is OEF/OIF Veterans with a history of traumatic brain injury (TBI) and co-occurring behavioral health issues.

Keywords: OEF/OIF/OND, Traumatic Brain Injury (TBI)

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Providing Mental Health Services to Operation Iraqi Freedom (OIF)/Operation Enduring Freedom (OEF) Veterans: Provider Perspectives

Research Team: Gina M Signoracci PhD, Lisa A. Brenner PhD, Jennifer Olson-Madden, PhD, Nazanin H. Bahraini PhD

The purpose of this study is to gather information from VISN 19 ECHCS Denver VA professionals regarding their perspectives of necessary resources to provide mental health service to Operation Iraqi Freedom (OIF)/ Operation Enduring Freedom (OEF) Veterans.

Keywords: OEF/OIF/OND

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Recent Presentations Related to OEF/OIF/OND Veterans

Suicide Risk Assessment in OEF/OIF/OND Veterans

10 February 2012

Bridget B. Matarazzo PsyD

VISN 6 MIRECC Educational Series

Keywords: Assessment, OEF/OIF/OND Veterans, Suicide Prevention

PDF

Suicide Risk Assessment and Safety Planning in Military Personnel

12/5/11

Bridget B. Matarazzo PsyD

Keywords: Assessment, OEF/OIF/OND Veterans, Suicide Prevention

PDF

Military Suicide Research Consortium

9/13/11

Peter M. Gutierrez PhD 

University of Utah National Center for Veterans Studies and American Psychological Association jointly sponsored Military and Veteran Suicide Prevention Clinical Best Practices Consensus Meeting in Washington, DC

Keywords: Evidence-Based Treatments, OEF/OIF/OND Veterans, Suicide Prevention

PowerPoint | PDF 

Post Deployment Reintegration

9/13/11

Pamela J. Staves RN MS NP

Women’s Health Nursing Care Conference, Denver, CO

Keywords: Gender-Specific Care, OEF/OIF/OND Veterans

PowerPoint | PDF 

Introduction to VISN 19 MIRECC & MSRC

7/7/11

Pamela J. Staves RN MS NP

Fort Collins/Greely Vet Clinics

Keywords: OEF/OIF/OND Veterans

PowerPoint | PDF 

Risk of TBI, PTSD & Suicide in OEF/OIF Veterans

11/1/10

Hal S. Wortzel, MD

29th Annual Conference of the Brain Injury Association of Ohio: “Building Community: Recognition, Response, Resilience”, Columbus, OH

Keywords: OEF/OIF/OND Veterans, Post Traumatic Stress Disorder (PTSD), Suicide Prevention, TBI

PowerPoint | PDF

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Recent Publications (since 2009)

Betthauser LM, Bahraini N, Krengel MH, Brenner LA. Self-Report Measures to Identify Post Traumatic Stress Disorder and/or Mild Traumatic Brain Injury and Associated Symptoms in Military Veterans of Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF). Neuropsychol Rev. 2012 Feb 19.

Individuals serving in Iraq and Afghanistan sustain injuries associated with physical and psychological trauma. Among such injuries, mild traumatic brain injury (mTBI) and post traumatic stress disorder (PTSD) are common. Self-report measures are frequently used to identify mTBI and/or PTSD and symptoms associated with these conditions. In addition to providing information regarding mTBI and PTSD, the goal of this literature review was to identify and present information on the psychometric properties of measures used to obtain information regarding these common conditions among Veterans who have returned from Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF). A comprehensive review of studies in which self-report measures were used to evaluate mTBI, PTSD, and associated symptoms among OEF/OIF Veterans is presented. Findings suggest that additional work is needed to identify psychometrically sound and clinically useful self-report measures that assess mTBI and PTSD and associated symptoms among OEF/OIF Veterans.

Keywords: OEF/OIF/OND, PTSD, Traumatic Brain Injury (TBI)

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Brenner, L. A., Ivins, B. J., Schwab, K., Warden, D., Nelson, L. A., Jaffee, M., et al. (2009). Traumatic brain injury, post traumatic stress disorder, and post concussive symptom reporting among troops returning from Iraq. Journal of Head Trauma Rehabilitation, 25(5), 307-312.

OBJECTIVES: Analyze the contribution of mild traumatic brain injury (mTBI) and/or posttraumatic stress disorder (PTSD) to the endorsement of postconcussive (PC) symptoms during Post Deployment Health Assessment. Determine whether a combination of mTBI and PTSD was more strongly associated with symptoms than either condition alone. METHODS: Cross-sectional study design where both the exposure, mTBI and/or PTSD, and the outcomes of interest, PC symptoms, were ascertained after return from deployment. Subjects were injured soldiers (n = 1247) from one Fort Carson Brigade Combat Team (n = 3973). MAIN OUTCOME MEASURES: Positive history of PC symptoms. RESULTS: PTSD and mTBI together were more strongly associated with having PC symptoms (adjusted prevalence ratio 6.27; 95% CI: 4.13-9.43) than either mTBI alone (adjusted prevalence ratio = 4.03; 95% CI: 2.67-6.07) or PTSD alone (adjusted prevalence ratio = 2.74; 95% CI: 1.58-4.74) after adjusting for age, gender, education, rank, and Military Occupational Specialty. CONCLUSIONS: In soldiers with histories of physical injury, mTBI and PTSD were independently associated with PC symptom reporting. Those with both conditions were at greater risk for PC symptoms than those with either PTSD, mTBI, or neither. Findings support the importance of continued screening for both conditions with the aim of early identification and intervention.

Keywords: Suicide, PTSD, Traumatic Brain Injury (TBI), OEF/OIF/OND

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Terrio, H. P., Nelson, L. A., Betthauser, L. M., Harwood, J. E., & Brenner, L.A. (2011). Postdeployment traumatic brain injury screening questions: Sensitivity, specificity, and predictive values in returning soldiers. Rehabilitation Psychology, 56(1), 26-31.

OBJECTIVE: To evaluate the sensitivity, specificity, and predictive values of Post-Deployment Health Assessment traumatic brain injury (TBI) screening questions employed by the Department of Defense (DOD). Participants: Complete data was obtained from 3,072 soldiers upon return from a 15-month deployment to Iraq. METHOD: Comparisons were made between responses to the DOD four-item screener and a brief structured clinical interview for likely deployment-related TBI history. The interview process was facilitated using responses to the Warrior Administered Retrospective Casualty Assessment Tool (WARCAT). RESULTS: The sensitivity and specificity of the DOD screening tool (positive response to all four items) in comparison to the clinician-confirmed diagnosis was 60% and 96%, respectively. The sensitivity increased to 80%, with a slight decrease in specificity to 93%, for positive TBI screening when affirmative responses to questions 1 and 2 only were included. CONCLUSIONS: Affirmative responses to questions 1 and 2 of the DOD TBI screening tool demonstrated higher sensitivity for clinician-diagnosed deployment-related TBI. These two items perform better than positive responses to all four questions; the criteria presently being used for documentation and referral of a deployment-related TBI. These findings support further exploration of TBI screening and assessment procedures.

Keywords: Traumatic Brain Injury (TBI), OEF/OIF/OND

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Terrio, H., Brenner, L.A., Ivins, B. J., Cho, J. M., Helmick, K., Schwab, K., et al. (2009). Response to Charles W. Hoge, MD letters to the editors pertaining to the article “Traumatic brain injury screening: preliminary finding in a US Army brigade combat team.” Journal of head Trauma Rehabilitation.

Abstract not available

Keywords: Traumatic Brain Injury (TBI), OEF/OIF/OND

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Terrio, H., Brenner, L.A., Ivins, B. J., Cho, J. M., Helmick, K., Schwab, K., et al. (2009). Traumatic brain injury screening: preliminary findings in a U.S. Army Brigade Combat Team. Journal of Head Trauma Rehabilitation, 24(1), 14-23.

OBJECTIVES: The objective of this article is to report the proportion of soldiers in a Brigade Combat Team (BCT) with at least 1 clinician-confirmed deployment-acquired traumatic brain injury (TBI) and to describe the nature of sequelae associated with such injuries. PARTICIPANTS: Members of an Army unit (n = 3973) that served in Iraq were screened for history of TBI. Those reporting an injury (n = 1292) were further evaluated regarding sequelae. Of the injuries suffered, 907 were TBIs and 385 were other types of injury. The majority of TBIs sustained were mild. METHODS: Postdeployment, responses to the Warrior Administered Retrospective Casualty Assessment Tool (WARCAT) facilitated clinical interviews regarding injury history and associated somatic (ie, headache, dizziness, balance) and neuropsychiatric symptoms (ie, irritability, memory). Traumatic brain injury diagnosis was based on the American Congress of Rehabilitation Medicine mild TBI criteria, which requires an injury event followed by an alteration in consciousness. RESULTS: A total of 22.8% of soldiers in a BCT returning from Iraq had clinician-confirmed TBI. Those with TBI were significantly more likely to recall somatic and/or neuropsychiatric symptoms immediately postinjury and endorse symptoms at follow-up than were soldiers without a history of deployment-related TBI. A total of 33.4% of soldiers with TBI reported 3 or more symptoms immediately postinjury compared with 7.5% at postdeployment. For soldiers injured without TBI, rates of 3 or more symptoms postinjury and postdeployment were 2.9% and 2.3%, respectively. In those with TBI, headache and dizziness were most frequently reported postinjury, with irritability and memory problems persisting and presenting over time. CONCLUSION: Following deployment to Iraq, a clinician-confirmed TBI history was identified in 22.8% of soldiers from a BCT. Those with TBI were significantly more likely to report postinjury and postdeployment somatic and/or neuropsychiatric symptoms than those without this injury history. Overall, symptom endorsement decreased over time.

Keywords: Traumatic Brain Injury (TBI), OEF/OIF/OND

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