VISN 19 MIRECC Staff: Lisa Brenner Ph.D. ABPP

Lisa A. Brenner PhD ABPP

Title:

Director, VA VISN 19 Mental Illness Research Education and Clinical Center (MIRECC)
Director VA Advanced Fellowship Program in Mental Illness - Psychology

Contact

303-399-8020 ext. 2571
1055 Clermont Street
Denver, CO 80220 Lisa.Brenner@va.gov

Specialty information:

Specialty/board certification: American Board of Professional Psychology, Diplomate, Rehabilitation Psychology, 2006

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Research Projects

Blister Packaging Medication to Increase Treatment Adherence and Clinical Response: Impact on Suicide

Research Team: Peter M. Gutierrez PhD, Lisa A. Brenner PhD, Hal S. Wortzel MD, Jeffrey Rings PhD, Steve Bartlett RPh, Jeri E. Forster PhD, Becky Leitner BA

Medication overdoses account for substantial numbers of suicide-related behaviors. Non-adherence is a significant issue for those with psychiatric illness.

Keywords: Suicide Prevention

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Burden Belonging and Response to Pain in Veterans

Research Team: Peter M. Gutierrez PhD, Lisa A. Brenner PhD, Theresa D. Hernández PhD, Nazanin H. Bahraini PhD, Bridget B. Matarazzo PsyD, James Pease MSW, Jennifer Olson-Madden PhD

This study is designed to test the psychometric properties of the Interpersonal Needs Questionnaire (INQ-12) and the Acquired Capability for Suicide Scale (ACSS) in a sample of military veterans, something which has not been done. These measures were developed to assess the constructs of Joiner’s interpersonal psychological theory of suicide. Secondary goals of the study are to determine if values mediate the relationship between reasons for living and suicide risk, and whether participants’ suicidal wish can be categorized as either escaping their problems or influencing other people.

Keywords: Suicide Prevention

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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)

Differentiating Between Mild Traumatic Brain Injury And Behavioral Health Conditions: The Role Of The Neurobehavioral Symptom Inventory

Research Team: Nancy Cutter, Lisa A. Brenner PhD, Gina M Signoracci, PhD, Bryan Alvarez, MD, Melissa McHarg BA

The purpose of this retrospective chart review study is to examine differences in post-concussive (PC) symptom endorsement among four groups of Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF) Veterans: those with a history of target, service-related, mild traumatic brain injury (mTBI) and co-occurring posttraumatic stress disorder (PTSD) (Group 1); those with a history of target, service-related, mTBI only (Group 2); those with PTSD only (Group 3); and those with no history of target, service-related, mTBI or PTSD (Group 4).

Keywords: Assessment, PTSD, Traumatic Brain Injury (TBI)

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Effects of mild TBI and PTSD on Executive Functioning in OEF/OIF Veterans

Research Team: Marie Banich PhD, Lisa A. Brenner PhD, Jennifer Olson-Madden PhD, Brendan Depue PhD, Herbert Nagamoto MD, Elissa Roesch BA, Brooke Holliman MA, Melodi Billera MSW LSW

This project will determine whether methods drawn from basic science can robustly detect the effects of traumatic brain injury (TBI) and/or post traumatic stress disorder (PTSD) on executive function. Although TBI often occurs in the context of a traumatic event, very little research has attempted to disentangle the effects of TBI from PTSD, which also compromises executive function.

Keywords: Suicide Prevention, Post Traumatic Stress Disorder (PTSD), Traumatic Brain Injury (TBI)

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Examining the relationship between personal values, interpersonal needs, and suicidal ideation in a Veteran population

Research Team: Nazanin H. Bahraini PhD, Lisa A. Brenner PhD, Patricia Alexander PhD, Jeri E. Forster PhD, Stephen Bensen PhD, Marie Devore MS

Through this research we hope to understand which values (e.g., power, achievement, security) and value dimensions (e.g., importance, success) have the strongest impact on suicidality in this population.

Keywords: Suicide Prevention

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Executive Dysfunction and Suicide in Psychiatric Inpatients and Outpatients

Research Team: Lisa A. Brenner PhD, Beeta Homaifar PhD, Nazanin H. Bahraini PhD, Joe Huggins MSW MSCIS, Jeri E. Forster PhD, Herbert Nagamoto MD, Shea A. Lott MA, Brooke Holliman MA

This study will assess decision making in the context of an interaction between suicide and TBI.

Keywords: Suicide Prevention, Seriously Mentally Ill (SMI), Traumatic Brain Injury (TBI)

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Experiential avoidance in combat Veterans with and without posttraumatic stress disorder (PTSD)

Research Team: Nazanin H. Bahraini PhD, Lisa A. Brenner PhD, Marie Devore MS

This study is designed to test a novel method of measuring avoidance of trauma-related material in combat Veterans with and without PTSD, and to compare this novel behavioral measure of avoidance with other traditional self report measures of avoidance.

Keywords: Suicide Prevention, Post Traumatic Stress Disorder (PTSD)

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Home-Based Mental Health Evaluation (HOME): A Model for Assisting Suicidal Veterans with the Transition from Inpatient to Outpatient Settings

Research Team: Bridget B. Matarazzo PsyD, Michael H. Allen MD, Sean M. Barnes PhD, Herbert Nagamoto MD, Deborah Yurgelun-Todd PhD, Lisa A. Brenner PhD

Project Summary: The intent of the proposed clinical demonstration project, Home-Based Mental Health Evaluation (HOME) is to enhance the VA infrastructure for ensuring that Veterans with recent suicidal crises receive the care they need during the often difficult transition from psychiatric inpatient hospitalization to home. This will be accomplished by meeting Veterans in the home environment to review and revise aftercare plans. The primary goal of the HOME project is to increase engagement with aftercare, and decrease the risk of suicide during this time of transition and elevated suicide risk. The HOME demonstration project will be conducted in Denver and Salt Lake City.

Keywords: Evidence-Based Treatments, Suicide Prevention

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HOPPS - A pilot phase II investigation of hyperbaric oxygen for persistent post-concussive symptoms after mild traumatic brain injury

Denver VA Research Team: Lisa A. Brenner PhD, Nazanin H. Bahraini PhD, Marie Devore MS, Leah Russell MA

This purpose of this study, sponsored by The Office of the Surgeon General, is to describe the magnitude of change between baseline and follow-up outcomes for a battery of neuropsychological tests within groups of participants with mild traumatic brain injury after receiving hyperbaric oxygen.

Keywords: Traumatic Brain Injury (TBI)

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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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Lithium Augmentation for Hyperarousal Symptoms of PTSD: Pilot Study

Research Team: Hal S. Wortzel MD, Pamela Staves RN MS NP, Thomas Beresford MD, Lisa A. Brenner PhD, Peter M. Gutierrez PhD, Jeri E. Forster PhD, Jeffrey Rings PhD, Latoya Conner BA

The proposed investigation is a pilot study intended to establish the safety and tolerability of lithium augmentation of standard psychopharmacological treatment of PTSD for combat veterans seeking treatment at the Denver VA Medical Center.

Keywords: Evidence-Based Treatments, Post Traumatic Stress Disorder (PTSD)

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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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SAFE VET - A Brief Intervention to Reduce Suicide Risk in Military Service Members and Veterans

Research Team: Lisa A. Brenner PhD, Bridget B. Matarazzo PsyD, Patricia Alexander PhD, Kimberly Arne MSW, Parri Hinton BA, Melodi Billera MSW LSW

The purpose of this study is to compare the effectiveness of the SAFE VET (Suicide Assessment and Follow-up Engagement: Veteran Emergency Treatment) intervention versus enhanced usual care on Veterans’ suicide attempts, suicide ideation, outpatient mental health or substance abuse treatment, and suicide-related coping. SAFE VET uses a standardized intervention that is specifically adapted for use in the Emergency Department to mitigate suicide risk.

Keywords: Evidence-Based Treatment, Suicide Prevention

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Suicide & Self-Directed Violence Classification System

Resarch Team: Lisa A. Brenner PhD, Katherine Bellon, Lisa Betthauser, Ryan Breshears, Morton Silverman, Herbert Nagamoto MD

The purpose of this study is to further develop and adapt the VISN 19 MIRECC SDVCS and Clinical Tool to enhance feasibility for implementation in diverse VA treatment settings, and to assess its impact on healthcare system processes pertaining to the assessment and management of suicide risk.

Keywords: Suicide Prevention

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TBI-4 Study

Research Team: Lisa A. Brenner PhD, Beeta Homaifar PhD, Jennifer Olson-Madden PhD, Bridget B. Matarazzo PsyD, Joe Huggins MSW MSCIS, Herbert Nagamoto MD, Jeri E. Forster PhD, Alexandra Schneider BA

Military personnel are returning from current conflicts with traumatic brain injury (TBI). Brief and sensitive screening measures are needed to assess TBI in this population.

Keywords: Evidence-Based Treatments, Traumatic Brain Injury (TBI)

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Traumatic Brain Injury Among Homeless Veterans

Research Team: Lisa A. Brenner PhD, Jennifer Olson-Madden PhD, Marie Devore, Leah Russell MA, Ann Elizabeth Montgomery PhD, Roger Casey PhD, John Schinka PhD

The National Center on Homelessness among Veterans was established, in part, to assist the Department of Veterans Affairs (VA) in programming efforts to provide care for Veterans who are homeless or at-risk for homelessness. An immediate goal of the Center is to enlist research and clinical expertise to increase understanding regarding traumatic brain injury (TBI) among the homeless Veteran population.

Keywords: Evidence-Based Treatments, Homeless Programs, Traumatic Brain Injury (TBI)

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Using Complementary and Alternative Medicine (CAM) to Promote Stress Resilience in Those with Co-Occurring Mild TBI and PTSD

Research Team: Theresa D. Hernández PhD, Lisa A. Brenner PhD

The research team hypothesizes that, similar to other populations, active acupressure treatments will help promote stress resilience, improve cognition and sleep, helping to reduce suicidal ideation and ultimately suicidal behavior. In addition to these potential functional benefits in Veterans, active acupressure is an independent, portable, safe and no-cost (once learned) intervention that is non-pharmacological and therefore has no side effects. The study aims to address a need (reducing military/Veteran suicidality) that has to date gone largely unmet, a need that is also currently a Department of Defense priority.

Keywords: Complementary and Alternative Medicine, Evidence-Based Treatments, Suicide Prevention

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Window to Hope – Evaluating a Psychological Treatment for Hopelessness among Veterans with Traumatic Brain Injury

Research Team: Lisa A. Brenner PhD, Grahame Simpson PhD (Senior Research Fellow/ Research Team Leader, Brain Injury Rehabilitation Unit, Australia), Bridget B. Matarazzo PsyD, Jeri E. Forster PhD, Gina M. Signoracci PhD, Adam Hoffberg MHS

This proposed project will be the first to replicate a groundbreaking psychological treatment for suicide prevention among those with moderate or severe traumatic brain injury, Window to Hope (WtoH), developed by PI Simpson and colleagues in Sydney, Australia. WtoH has been successfully evaluated in a Randomized Controlled Trial (RCT), in which treated Australian civilians (n=17) with severe TBI recorded significant decreases in hopelessness. The current project aims to (i) undertake the cross-cultural adaptation of the WtoH program; (ii) establish the acceptability and feasibility of WtoH within the VAMC context; and (iii) conduct a RCT within the VAMC to replicate the results from the original trial (efficacy). Deliverables are expected to include an intervention suitable for a larger trial and broader dissemination.

Keywords: Complementary and Alternative Medicine, Evidence-Based Treatments, Suicide Prevention, Traumatic Brain Injury (TBI)

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Recent Publications (since 2009)

Bahraini, N. H., Brenner, L. A., Harwood, J. E. F., Homaifar, B. Y., Ladley-O’Brien, S. E., Filley, C. M., et al. (Adler, L. E.). (2009). Utility of the Trauma Symptom Inventory for the assessment of posttraumatic stress symptoms in veterans with a history of psychological trauma and/or brain injury. Military Medicine, Oct;174(10):1005-9.

Correspondence of three core Trauma Symptom Inventory (TSI) posttraumatic stress disorder (PTSD) scales (Intrusive Experiences, Defensive Avoidance, and Anxious Arousal) and the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-IV) PTSD module were examined among 72 veterans with traumatic brain injury (TBI), PTSD, or both conditions. Subjects were classified into PTSD only, TBI only, or co-occurring PTSD and TBI groups based on TBI assessment and SCID-IV PTSD diagnosis. Linear regression was used to model TSI T-Scores as a function of group. Scores on all three scales significantly differed between the TBI and PTSD groups (PTSD only and co-occurring PTSD and TBI) in the expected direction. Study findings indicate that despite the potential overlap of symptoms between PTSD and TBI, the TSI appears to be a useful measure of trauma-related symptoms in veterans who may also have a TBI, particularly mild TBI. Limitations and areas for future research are discussed.

Keywords: PTSD, Traumatic Brain Injury (TBI)

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Bahraini NH, Gutierrez PM, Harwood JEF, Huggins JA, Hedegaard H, Chase M, Brenner LA. (2012). The Colorado Violent Death Reporting System (COVDRS): Validity and Utility of the Veteran Status Variable. Public Health Rep., May/Jun;127(3):304-309.

Objective. Using the Veterans Affairs Beneficiary Identification Record Locator Subsystem (BIRLS) as the criterion database, we evaluated the sensitivity and specificity of the death certificate information in the Colorado Violent Death Reporting System (COVDRS) to determine Veteran status for those who died by suicide. Methods. The study sample consisted of 3,820 individuals aged 18 years and older who died by suicide in Colorado from January 1, 2004, through December 31, 2008. To determine agreement on Veteran status, COVDRS data were submitted to the Veterans Benefits Administration for linkage to the BIRLS using Social Security numbers. Results. Sensitivity and specificity of the Veteran status information on the death certificate were 93.1% (95% confidence interval [CI] 90.7, 95.2) and 91.7% (95% CI 90.5, 92.8), respectively. The overall agreement between the death certificate and the BIRLS on Veteran status was very good (kappa 5 0.76; 95% CI 0.74, 0.79). Conclusions. This study of 3,820 suicide deaths in Colorado demonstrated a high level of agreement between the COVDRS Veteran status variable and the BIRLS. Such findings offer support for using the COVDRS in studying factors associated with suicide in the Veteran population.

Keywords: Suicide

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Brenner LA. Neuropsychological and neuroimaging findings in traumatic brain injury and post-traumatic stress disorder. Dialogues Clin Neurosci. 2011;13(3):311-23. Review.

Advances in imaging technology, coupled with military personnel returning home from Iraq and Afghanistan with traumatic brain injury (TBI) and/or post-traumatic stress disorder (PTSD), have increased interest in the neuropsychology and neurobiology of these two conditions. There has been a particular focus on differential diagnosis. This paper provides an overviev of findings regarding the neuropsychological and neurobiological underpinnings of TBI and for PTSD. A specific focus is on assessment using neuropsychological measures and imaging techniques. Challenges associated with the assessment of individuals with one or both conditions are also discussed. Although use of neuropsychological and neuroimaging test results may assist with diagnosis and treatment planning, further work is needed to identify objective biomarkers for each condition. Such advances would be expected to facilitate differential diagnosis and implementation of best treatment practices.

Keywords: Brain & Biology, PTSD, Traumatic Brain Injury (TBI)

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Brenner L, Bahraini N and Hernández TD (2012). Perspectives on creating clinically relevant blast models for mild traumatic brain injury and post traumatic stress disorder symptoms. Front. Neur. 3:31.

Military personnel are returning from Iraq and Afghanistan and reporting non-specific physical (somatic), behavioral, psychological, and cognitive symptoms. Many of these symptoms are frequently associated with mild traumatic brain injury (mTBI) and/or post traumatic stress disorder (PTSD). Despite significant attention and advances in assessment and intervention for these two conditions, challenges persist. To address this, clinically relevant blast models are essential in the full characterization of this type of injury, as well as in the testing and identification of potential treatment strategies. In this publication, existing diagnostic challenges and current treatment practices for mTBI and/or PTSD will be summarized, along with suggestions regarding how what has been learned from existing models of PTSD and traditional mechanism (e.g., non-blast) TBI can be used to facilitate the development of clinically relevant blast models.

Keywords: PTSD, Traumatic Brain Injury (TBI)

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Brenner LA, Barnes SM. (2012). Facilitating Treatment Engagement During High-Risk Transition Periods: A Potential Suicide Prevention Strategy. American Journal of Public Health, Supplement 1, Vol 102, No. S1

Abstract not available

Keywords: Suicide

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Brenner, L. A., Betthauser, L.M., Homaifar, B. Y., Villarreal, E., Harwood, J. E., Staves, P. J., & Huggins, J. A. (2011). Posttraumatic stress disorder, traumatic brain injury, and suicide attempt history among Veterans receiving mental health services. Suicide & Life Threatening Behavior, 41, 416-423.

History of posttraumatic stress disorder (PTSD) or traumatic brain injury (TBI) has been found to increase risk of suicidal behavior. The association between suicide attempt history among veterans with PTSD and/or TBI was explored. Cases (N = 81) and 2:1 matched controls (N = 160) were randomly selected from a Veterans Affairs Medical Center clinical database. PTSD history was associated with an increased risk for a suicide attempt (OR = 2.8; 95% CI: 1.5, 5.1). This increased risk was present for those with and without a history of TBI. Results support incorporating PTSD history when assessing suicide risk among veterans with and without TBI.

Keywords: Suicide, PTSD, Traumatic Brain Injury (TBI)

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Brenner, L.A., Breshears, R.E., Betthauser, L.M., Bellon, K. K., Holman, E., Harwood, J. E., Silverman, M. M., Huggins, J. & Nagamoto, H. T. (2011). Implementation of a suicide nomenclature within two VA healthcare settings. Journal of Clinical Psychology in Medical Settings.

Implementation of a Suicide Nomenclature within Two VA Healthcare Settings Those who work in the field of Veteran’s care, as well as educators, researchers, and professionals providing direct mental health services agree that learning more about and preventing suicide represents a highly critical goal. Yet, up to now, researchers and mental health professionals lacked a shared language for defining suicidal behavior. This study discusses implementation of the Center for Disease Controls’ Self-Directed Violence Classification System (SDVCS) and an accompanying Clinical Tool (CT) at two VA healthcare facilities (in Denver and Grand Junction, CO). Results of this study show that implementing a more unified language is possible, while at the same time highlights some of the challenges and barriers to adoption of this system. This study provides important information regarding implementation of the SDVCS throughout the VA system.

Keywords: Suicide

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Brenner, L. A., Carlson, N. E., Harrison-Felix, C., Ashman, T., Hammond, F. M., & Hirschberg, R. E. (2009). Self-inflicted traumatic brain injury: Characteristics and outcomes, Brain Injury, 23, 991-998.

OBJECTIVE: To characterize the population of those receiving inpatient rehabilitation who sustained a traumatic brain injury (TBI) secondary to a suicide attempt and identify differences between such individuals and a demographically-matched control group (n = 230) of those whose TBIs were of an unintentional aetiology. METHOD: Analysed cases were identified from the TBI Model Systems National Database. Based on ICD-9-CM external cause-of-injury codes, 79 participants incurred a TBI secondary to a suicide attempt. An approximate 1 : 3 matched case-control (age, gender, race, injury year) design was chosen to make statistical comparisons. RESULTS: Those who sustained a TBI secondary to a suicide attempt had greater pre-existing psychiatric and psychosocial problems (substance use problems (p = 0.01) prior suicide attempt (p < 0.0001), psychiatric hospitalization (p = 0.014) and non-productive activity (p = 0.014)), required more resources during acute and rehabilitative hospitalizations (i.e. charges per day; p = 0.024, p = 0.047) and had greater disability at the time of discharge, even after controlling for injury severity (p = 0.022). CONCLUSION: Individuals who sustained TBIs secondary to a suicide attempt had increased pre-injury psychiatric and psychosocial problems and poorer outcomes at discharge than those who incurred unintentional injuries. For these individuals, acute and rehabilitation charges per day were higher and could not be accounted for by injury severity.

Keywords: Suicide, Traumatic Brain Injury (TBI)

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Brenner, L. A., Ignacio, R. V., & Blow, F. C. (2011). Suicide and traumatic brain injury among individuals seeking Veterans Health Administration services. Journal of Head Trauma Rehabilitation, 26(4), 257-264.

This manuscript examines associations between a history of traumatic brain injury (TBI) diagnosis and death by suicide among individuals receiving care within the Veterans Health Administration (VHA). Among VHA users, those with a diagnosis of TBI were at greater risk for suicide than those without this diagnosis. Further research is indicated to identify evidence-based means of assessment and treatment for those with TBI and suicidal behavior.

Keywords: Suicide, 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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Brenner, L. A., Ladley-O'Brien, S. E., Harwood, J. E. F., Filley, C. M., Kelly, J. P., Homaifar, B. Y., et al. (Adler, L. E.). (2009). An exploratory study of neuroimaging, neurological, and neuropsychological findings in traumatic brain injury and post traumatic stress disorder. Military Medicine, 174(4), 347-352.

Seventy-two veterans with traumatic brain injury (TBI), posttraumatic stress disorder (PTSD), or both participated in assessment procedures to evaluate between group differences. Half the sample was randomly selected for magnetic resonance imaging (MRI). Neurologic examinations were conducted using the Neurologic Rating Scale (NRS). Neuropsychological measures included the Paced Auditory Serial Addition Test (PASAT), Rey Auditory Verbal Learning Test (RAVLT), Conners' Continuous Performance Test II (CPT II), and Halstead Impairment Index (HII) including the Booklet Category Test (BCT). Data were analyzed using linear regression. Participants with moderate/ severe TBI were significantly more likely to have trauma-related imaging findings, and more severe TBI predicted lower scores on the NRS. No significant between-group differences were identified on the HII, PASAT, RAVLT, or CPT II. TBI group performance was significantly better on the BCT. More severe TBI predicted abnormal imaging findings and lower NRS scores. Hypothesized between-group differences on neuropsychological measures were not supported.

Keywords: Brain & Biology, PTSD, Traumatic Brain Injury (TBI)

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Brenner, L. A., Terrio, H., Homaifar, B. Y., Gutierrez, P. M., Staves, P. J., Harwood, J. E. F., et al. (2010). Neuropsychological test performance in soldiers with blast-related mild TBI. Neuropsychology,24(2), 160-175.

This exploratory study was conducted to increase understanding of neuropsychological test performance in those with blast-related mild traumatic brain injury (mTBI). The two variables of interest for their impact on test performance were presence of mTBI symptoms and history of posttraumatic stress disorder (PTSD). Forty-five soldiers postblast mTBI, 27 with enduring mTBI symptoms and 18 without, completed a series of neuropsychological tests. Seventeen of the 45 met criteria for PTSD. The Paced Auditory Serial Addition Test (Frencham, Fox, & Mayberry, 2005; Spreen & Strauss, 1998) was the primary outcome measure. Two-sided, 2-sample t tests were used to compare scores between groups of interest. Presence of mTBI symptoms did not impact test performance. In addition, no significant differences between soldiers with and without PTSD were identified. Standard neuropsychological assessment may not increase understanding about impairment associated with mTBI symptoms. Further research in this area is indicated.

Keywords: PTSD, Traumatic Brain Injury (TBI)

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Brenner, L.A. & Homaifar, B.Y. (2009). Deployment acquired TBI and suicidality: Risk and assessment. In L. Sher (Ed.), War and Suicide. New York: Nova Science Publishers.

Introduction: Existing literature suggests that those with deployment-acquired traumatic brain injury (TBI) may be at increased risk for future suicidal behavior. Pertinent background information and potential best practices for assessing the risk of intentional self-injury in those with deployment-related TBI will be discussed. Conclusion: With the aim of comprehensively assessing risk, clinicians are encouraged to increase understanding regarding possible contributing factors (eg, pre-existing vulnerabilities, TBI sequelae) in the context of military experiences. Using the Interpersonal-Psychological Theory of Suicide Risk and The International Classification of Functioning as organizing frameworks in conjunction with literature regarding post-TBI functioning may facilitate this process.

Keywords: Suicide, Traumatic Brain Injury (TBI)

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Brenner, L.A., Homaifar, B.Y., Adler, L.E., Wolfman, J.H., & Kemp, J. (2009). Suicidality and veterans with a history of traumatic brain injury: Precipitating events, protective factors, and prevention strategies. Rehabilitation Psychology,54(4), 390-397.

OBJECTIVES: To increase understanding regarding precipitating and preventative factors of suicidal behavior and to highlight past experiences and recommendations regarding services aimed at suicide prevention among Veterans with a history of traumatic brain injury (TBI). STUDY DESIGN: Qualitative. PARTICIPANTS: Sample of 13 Veterans with a history of TBI, and a history of clinically significant suicidal ideation or behavior. METHOD: In-person interviews were conducted and data were analyzed using a hermeneutic approach. RESULTS: Shared precipitants noted included loss-of-self post-TBI, cognitive sequelae, and psychiatric and emotional disturbances. Common protective factors noted included social supports, a sense of purpose regarding the future, religion and spirituality, and mental health care. Means of improving care were also identified (e.g., increasing the availability of services and mental health professionals' knowledge regarding TBI, providing more structured treatment). CONCLUSIONS: Findings highlight potential areas of importance in the assessment and treatment of suicidal Veterans with a history of TBI. Recommendations regarding means of improving care are also presented.

Keywords: Suicide, Traumatic Brain Injury (TBI)

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Brenner, L.A., Vanderploeg, R., Terrio, H. (2009). Assessment and Diagnosis of Mild Traumatic Brain Injury, Post Traumatic Stress Disorder, and Other Polytrauma Conditions: Burden of Adversity Hypothesis. Rehabilitation Psychology, Aug 54(3), 239-246.

OBJECTIVE/METHOD: Military personnel returning from Iraq and Afghanistan have been exposed to physical and emotional trauma. Challenges related to assessment and intervention for those with posttraumatic stress disorder (PTSD) and/or history of mild traumatic brain injury (TBI) with sequelae are discussed, with an emphasis on complicating factors if conditions are co-occurring. Existing literature regarding cumulative disadvantage is offered as a means of increasing understanding regarding the complex symptom patterns reported by those with a history of mild TBI with enduring symptoms and PTSD. IMPLICATIONS: The importance of early screening for both conditions is highlighted. In addition, the authors suggest that current best practices include treating symptoms regardless of etiology to decrease military personnel and veteran burden of adversity. (c) 2009 APA

Keywords: Suicide, Traumatic Brain Injury (TBI), PTSD

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Breshears, R. E., Brenner, L. A., Harwood, J. E. F., & Gutierrez, P. M. (2010). Predicting suicidal behavior in Veterans with traumatic brain injury: The utility of the Personality Assessment Inventory. Journal of Personality Assessment, 92,349-355.

In this study, we investigated the Personality Assessment Inventory's (PAI; Morey, 1991, 2007) Suicide Potential Index (SPI) and Suicide Ideation scale (SUI) as predictors of suicidal behavior (SB) in military Veterans with traumatic brain injury (TBI; N = 154). We analyzed electronic medical records were searched for SB in the 2 years post-PAI administration and data via logistic regressions. We obtained statistical support for the SPI and SUI as predictors of SB. Analyses we performed using receiver operating characteristics suggested an optimal SPI cutoff of > or = 15 for this sample. Findings suggest that SPI and SUI scores may assist in assessing suicide risk in those with TBI, particularly when population-based cutoffs are considered.

Keywords: Suicide, Traumatic Brain Injury (TBI)

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Carlson, N. E., Brenner, L. A., Wierman, M. E., Harrison-Felix, C., Morey, C., Gallagher, S., & Ripley, D. (2009) Hypogonadism on admission to acute rehabilitation is correlated with lower functional status at admission and discharge. Brain Injury, 23(4), 336-344.

PRIMARY OBJECTIVE: To investigate the association between hormone levels and functional status during acute TBI rehabilitation. RESEARCH DESIGN: Retrospective cohort study of 43 men with moderate-to-severe TBI admitted to an acute rehabilitation unit during a 1 year period. METHODS AND PROCEDURES: Labs were drawn on admission, including total and free testosterone (T), prolactin, adrenocorticotropin hormone (ACTH), cortisol, thyroid stimulating hormone (TSH), free thyroxine (fT4) and insulin-like growth factor (IGF-1). Functional Independence Measure (FIM) scores were obtained at admission and discharge. MAIN OUTCOME AND RESULTS: Associations between admission hormone levels and the main outcomes, admission and discharge FIM scores, were assessed using linear regression. Lower total and free T-levels at admission were associated with lower total FIM scores at admission (p < 0.038) and discharge (p < 0.046). Higher cortisol levels at admission were significantly associated with lower admission (p = 0.012) and discharge (p = 0.036) scores on the cognitive-FIM. Prolactin, TSH, fT4 and IGF-1 were not correlated with functional status. CONCLUSIONS: In men, lower total and free T-levels at admission to acute rehabilitation correlate with lower admission and discharge FIM scores. These data support the need for studies to investigate the impact of physiological testosterone therapy on outcomes during and post-rehabilitation.

Keywords: Traumatic Brain Injury (TBI)

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Gutierrez, P. M., & Brenner, L. A. (2009) Introduction: Helping military personnel and recent veterans manage stress reactions. Journal of Mental Health Counseling,31, 95-100.

No abstract available.

Keywords: Suicide

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Gutierrez, P. M., & Brenner, L. A. (2011). Helping military personnel/veterans and families manage stress reactions and navigate reintegration. In A. Palmo, W. Weikel & D. Borsos (Eds.), Foundations of mental health counseling, fourth edition (pp. 280-286). Springfield, IL: Charles C. Thomas.

No abstract available.

Keywords: Suicide

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Gutierrez, P.M., Brenner, L.A., Olson-Madden, J.H., Breshears, R., Homaifar, B.Y., Betthauser, L.M., et al. (Staves, P. J., & Adler, L.E.) (2009). Consultation as a means of veteran suicide prevention. Professional Psychology: Research and Practice, Vol 40(6), 586-592.

The development and implementation of a suicide consultation service being run by an interdisciplinary team in a metropolitan Veteran’s Administration (VA) medical center is described. This service is grounded in a collaborative theoretical framework. An overview of the consultation process and theoretical and empirical literature to support the framework used by the service are provided. Some of the interventions commonly recommended to referring clinicians to reduce client suicide risk are reviewed. Although there are many challenges to running a service such as this, the authors conclude that the model presented is flexible enough to be applied in a variety of settings.

Keywords: Suicide, Evidence Based Treatment

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Hart, T., Brenner, L. A., Clark, A. N., Bogner, J. A., Novack, T. A., Chervoneva, I. et al. (2011). Major and minor depression following traumatic brain injury. Archives of Physical Medicine, 92, 1211-1219.

OBJECTIVE: To examine minor as well as major depression at 1 year posttraumatic brain injury (TBI), with particular attention to the contribution of depression severity to levels of societal participation. DESIGN: Observational prospective study with a 2-wave longitudinal component. SETTING: Inpatient rehabilitation centers, with 1-year follow up conducted primarily by telephone. PARTICIPANTS: Persons with TBI (N=1570) enrolled in the TBI Model System database and followed up at 1-year postinjury. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: FIM, Patient Health Questionnaire-9, Participation Assessment with Recombined Tools-Objective, Glasgow Outcome Scale-Extended, and the Satisfaction With Life Scale. RESULTS: Twenty-two percent of the sample reported minor depression, and 26% reported major depression at 1-year post-TBI. Both levels of depression were associated with sex (women), age (younger), preinjury mental health treatment and substance abuse, and cause of injury (intentional). There was a monotonic dose-response relationship between severity of depression and all 1-year outcomes studied, including level of cognitive and physical disability, global outcome, and satisfaction with life. With other predictors controlled, depression severity remained significantly associated with the level of societal participation at 1-year post-TBI. CONCLUSIONS: Minor depression may be as common as major depression after TBI and should be taken seriously for its association to negative outcomes related to participation and quality of life. Findings suggest that, as in other populations, minor and major depression are not separate entities, but exist on a continuum. Further research should determine whether people with TBI traverse between the 2 diagnoses as in other patient groups.

Keywords: Traumatic Brain Injury (TBI), Seriously Mentally Ill (SMI)

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Homaifar, B. Y., Bahraini, N.H., Silverman, M.M., Brenner, L.A.. (2012). Executive Functioning as a Component of Suicide Risk Assessment: Clarifying its Role in Standard Clinical Applications. Journal of Mental Health Counseling, 34(2), 110-120.

Clinically, because executive dysfunction (e.g., impulsivity, insight, thinking process) is often thought of in the context of those with traumatic brain injuries and other neurologic conditions, its formal assessment has historically been seen as the domain of those who assess and treat patients with neurologic disease. However, mental health counselors (MHCs) could benefit from learning how executive functioning relates to suicide risk assessment and coping strategies. Assessment of executive functions can be incorporated in routine clinical practice without the need for formal neuropsychological measures or other time-consuming procedures. In fact, during standard clinical assessment, mental health professionals often informally assess components of executive functioning such as impulsivity, insight, and thinking processes. This article highlights aspects of executive functioning with which MHCs may already be familiar and demonstrates their clinical utility in enhancing assessment and management of suicide-related thoughts and behaviors.

Keywords: Assessment, Suicide Prevention, Traumatic Brain Injury (TBI)

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Homaifar, B. Y., Brenner, L.A., Gutierrez, P.M., Harwood, J. E. F., Thompson, C., Filley, C. M., et al. (Adler, L. E.) (2009). Sensitivity and specificity of the Beck Depression Inventory-II (BDI-II) in individuals with traumatic brain injury (TBI). Archives of Physical Medicine & Rehabilitation, 90(4), 652-656.

OBJECTIVES: Our objective was to examine the Beck Depression Inventory-II (BDI-II) in a traumatic brain injury (TBI) sample using a receiver operating characteristic (ROC) curve to determine how well the BDI-II identifies depression. An ROC curve allows for analysis of the sensitivity and specificity of a diagnostic test using various cutoff points to determine the number of true positives, true negatives, false positives, and false negatives. DESIGN: This was a secondary analysis of data gathered from an observational study. We examined BDI-II scores in a sample of 52 veterans with remote histories of TBI. SETTING: This study was completed at a Veterans Affairs (VA) Medical Center. PARTICIPANTS: Participants were veterans eligible to receive VA health care services. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Outcome measures included the BDI-II and the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-IV). RESULTS: We generated an ROC curve to determine how well the BDI-II identifies depression using the SCID-IV as the criterion standard for diagnosing depression, defined here as a diagnosis of major depressive disorder. Results indicated a cutoff score of at least 19 if one has a mild TBI or at least 35 if one has a moderate or severe TBI. These scores maximize sensitivity (87%) and specificity (79%). CONCLUSIONS: Clinicians working with persons with TBI can use the BDI-II to determine whether depressive symptoms warrant further assessment.

Keywords: Traumatic Brain Injury (TBI), Seriously Mentally Ill (SMI)

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Homaifar, B. Y., Harwood, J. E. F., Wagner, T. H., Brenner, L.A. (2009). A description of outpatient utilization and costs in a group of veterans with traumatic brain injuries. Journal of Rehabilitation Research & Development,46(8), 1003-1010.

In an attempt to increase understanding regarding the nonacute healthcare needs of veterans with traumatic brain injury (TBI), we examined the outpatient utilization and cost patterns of 72 patients with TBI who were at least 4 years postinjury. We selected participants from a clinical database of veterans receiving care at a western Department of Veterans Affairs (VA) medical center. We extracted data from national utilization databases maintained by the VA and examined data from primary care and internal medicine, psychiatry and substance use, rehabilitation, and other services (e.g., ancillary, diagnostic, prosthetic, dental, nursing home, and home care). We extracted data for fiscal years 2002 to 2007. In addition to descriptive statistics, we modeled visits per year as a function of time since injury. The data show that this sample of patients with TBI consistently used a wide array of outpatient services over time with considerable variation in cost. Further study regarding economic aspects of care for patients with TBI is warranted.

Keywords: Traumatic Brain Injury (TBI)

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Jobes, D. A., Comtois, K., Brenner, L.A. & Gutierrez, P.M. (2011). Clinical trial feasibility studies of the collaborative assessment and management of suicidality (CAMS). In R. O'Connor, S. Platt & J. Gordon (Eds.), International handbook of suicide prevention research, policy, and practice. (pp. 383-400). West Sussex, United Kingdom: John Wiley & Sons Ltd.

Abstract not available

Keywords: Suicide

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Kirschner, K. L., Mukherjee, D., Gittler, M., Brenner, L.A., & Kelly, J. P. (2011). Setting limits: The threat of violence in the health care setting. The American Academy of Physical Medicine and Rehabilitation, 3, 68-72.

Abstract not available

Keywords: Suicide

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Knox KL, Stanley B, Currier GW, Brenner LA, Ghahramanlou-Holloway M, Brown GK. An emergency based brief intervention for veterans at risk for suicide (SAFE VET). Am J Public Health. 2012;102(S1):S33 – S37.

Reducing deaths from veteran suicide is a public health priority for veterans who receive their care from the Department of Veterans Affairs (VA) and those who receive services in community settings. Emergency departments frequently function as the primary or sole point of contact with the health care system for suicidal individuals; therefore, they represent an important venue in which to identify and treat veterans who are at risk for suicide. We describe the design, implementation and initial evaluation of a brief behavioral intervention for suicidal veterans seeking care at VA emergency departments. Initial findings of the feasibility and acceptability of the intervention suggest it may be transferable to diverse VA and non-VA settings, including community emergency departments and urgent care centers.

Keywords: Suicide

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Olson-Madden, J., Brenner, L.A., Harwood, J. E., Emrick, C. D., Corrigan, J. D., & Thompson, C. (2010). Traumatic brain injury and psychiatric diagnoses in Veterans seeking outpatient substance abuse treatment. Journal of Head Trauma and Rehabilitation, 25(6), 470-479.

OBJECTIVES: Explore the incidence of traumatic brain injury (TBI) in veterans seeking outpatient substance abuse treatment and the association between TBI and psychiatric diagnoses. MAIN MEASURE: The Ohio State University TBI identification method (OSU TBI-ID) was administered to veterans with positive TBI-4 screens; substance-related and psychiatric diagnoses were extracted from the medical record. PARTICIPANTS: : Over an 18-month period, 247 veterans completed the TBI-4. Of the 136 who screened positive, 70 were administered the OSU TBI-ID. RESULTS: On the basis of the TBI-4, 55% (95% CI: 49%-61%) of veterans screened positive for a history of TBI. The OSU TBI-ID was used to confirm screening results. Those who completed the OSU TBI-ID sustained an average of 3.4 lifetime TBIs. For each additional TBI sustained, after initial injury, there was an estimated 9% increase in the number of psychiatric diagnoses documented (99% CI: 1%-17%). For each additional documented psychiatric diagnosis, there was an estimated increase of 11% in the number of injuries sustained (99% CI: 1%-22%). Also, 54% (38/70) had a positive history of TBI prior to adulthood. CONCLUSION: These results emphasize the need for TBI screening in this vulnerable population, as well as the importance of increasing brain injury awareness among those abusing substances and their care providers. These findings also highlight the need for specialized services for those with TBI and co-occurring substance misuse aimed at decreased future TBIs or negative psychiatric outcomes or both. Further study is needed to clarify best practices.

Keywords: Traumatic Brain Injury (TBI), Substance Use Disorders (SUD)

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Robinson, T. N., Raeburn, C. D., Tran, Z. V., Brenner, L.A., & Moss, M. (2011). Motor subtypes of postoperative delirium in older adults. Archives of Surgery, 146(3), 295-300.

HYPOTHESIS: Increased knowledge about motor subtypes of delirium may aid clinicians in the management of postoperative geriatric patients. DESIGN: Prospective cohort study defining preoperative risk factors, outcomes, and adverse events related to motor subtypes of postoperative delirium. SETTING: Referral medical center. PATIENTS: Persons 50 years and older with planned postoperative intensive care unit (ICU) admission following an elective operation were recruited. MAIN OUTCOME MEASURES: Before surgery, a standardized frailty assessment was performed. After surgery, delirium and its motor subtypes were measured using the validated tools of the Confusion Assessment Method-ICU and the Richmond Agitation-Sedation Scale. Statistical analysis included the univariate t and χ(2) tests and analysis of variance with post hoc analysis. RESULTS: Delirium occurred in 43.0% (74 of 172) of patients, representing 67.6% (50 of 74) hypoactive, 31.1% (23 of 74) mixed, and 1.4% (1 of 74) hyperactive motor subtypes. Compared with those having mixed delirium, patients having hypoactive delirium were older (mean [SD] age, 71 [9] vs 65 [9] years) and more anemic (mean [SD] hematocrit, 36% [8%] vs 41% [6%]) (P = .002 for both). Patients with hypoactive delirium had higher 6-month mortality (32.0% [16 of 50] vs 8.7% [2 of 23], P = .04). Delirium-related adverse events occurred in 24.3% (18 of 74) of patients with delirium; inadvertent tube or line removals occurred more frequently in the mixed group (P = .006), and sacral skin breakdown was more common in the hypoactive group (P = .002). CONCLUSIONS: Motor subtypes of delirium alert clinicians to differing prognosis and adverse event profiles in postoperative geriatric patients. Hypoactive delirium is the most common motor subtype and is associated with worse prognosis (6-month mortality, 1 in 3 patients). Knowledge of differing adverse event profiles can modify clinicians' management of older patients with postoperative delirium.

Keywords: Brain & Biology

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Robinson, T. N., Raeburn, C. D., Zung, V. T., Angles, E. M., Brenner, L.A., & Moss, M. (2009) Post-operative delirium in the elderly – Risk factors and outcomes. Annals of Surgery, 249(1), 173-178.

OBJECTIVE: The purpose of this study was to describe the natural history, identify risk factors, and determine outcomes for the development of postoperative delirium in the elderly. BACKGROUND: Postoperative delirium is a common and deleterious complication in geriatric patients. METHODS: Subjects older than 50 years scheduled for an operation requiring a postoperative intensive care unit admission were recruited. After preoperative informed written consent, enrolled subjects had baseline cognitive and functional assessments. Postoperatively, subjects were assessed daily for delirium using the confusion assessment method-intensive care unit. Patients were also followed for outcomes. RESULTS: During the study period, 144 patients were enrolled before major abdominal (40%), thoracic (53%), or vascular (7%) operations. The overall incidence of delirium was 44% (64/144). The average time to onset of delirium was 2.1 +/- 0.9 days and the mean duration of delirium was 4.0 +/- 5.1 days. Several preoperative variables were associated with an increased risk of delirium including older age (P < 0.001), hypoalbuminemia (P < 0.001), impaired functional status (P < 0.001), pre-existing dementia (P < 0.001), and pre-existing comorbidities (P < 0.001). In a multivariable logistic regression model, pre-existing dementia remains the strongest risk factor for the development of postoperative delirium. Worse outcomes, including increased length of stay (P < 0.001), postdischarge institutionalization (P < 0.001), and 6 month mortality (P = 0.001), occurred in subjects who developed delirium. CONCLUSIONS: In the current study, delirium occurred in 44% of elderly patients after a major operation. Pre-existing cognitive dysfunction was the strongest predictor of the development of postoperative delirium. Outcomes, including an increased rate of 6 month mortality, were worse in patients who developed postoperative delirium.

Keywords: Brain & Biology

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Simpson, G., & Brenner, L.A. (2011). Perspectives on suicide and traumatic brain injury. Journal of Head Trauma and Rehabilitation, 26(4), 241-243.

Abstract not available

Keywords: Suicide, Traumatic Brain Injury (TBI)

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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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Yurgelun-Todd, D.A., Bueler, C. E., McGlade, E., Churchwell, J., Brenner, L.A., & Lopez-Larson, M. (2011). Neuroimaging correlates of traumatic brain injury and suicidal behavior. Journal of Head Trauma Rehabilitation, 26(4), 276-289.

INTRODUCTION: There is an urgent need to define the neurobiological and cognitive underpinnings of suicidal ideation and behavior in veterans with traumatic brain injury (TBI). Separate studies implicate frontal white matter systems in the pathophysiology of TBI, suicidality, and impulsivity. We examined the relationship between the integrity of major frontal white matter (WM) systems on measures of impulsivity and suicidality in veterans with TBI. METHODS: Fifteen male veterans with TBI and 17 matched healthy controls (HC) received clinical ratings, measures of impulsivity and MRI scans on a 3T magnet. Diffusion tensor imaging (DTI) data for the genu and cingulum were analyzed using Freesurfer and FSL. Correlations were performed for fractional anisotropy (FA) (DTI) values and measures of suicidality and impulsivity for veterans with TBI. RESULTS: Significantly decreased in FA values in the left cingulum (P = 0.02), and left (P = 0.02) and total genu (P = 0.01) were observed in the TBI group relative to controls. Measures of impulsivity were significantly greater for the TBI group and total and right cingulum FA positively correlated with current suicidal ideation and measures of impulsivity (P <0.03). CONCLUSION: These data demonstrate a significant reduction in FA in frontal WM tracts in veterans with mild TBI that was associated with both impulsivity and suicidality. These findings may reflect a neurobiological vulnerability to suicidal risk related to white matter microstructure.

Keywords: Brain & Biology, Suicide, Traumatic Brain Injury (TBI)

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Recent Presentations

Traumatic Brain Injury among the Homeless: Current State of the Science and Clinical Implications

16-18 May 2012

Kansas City

2012 National Health Care for the Homeless Conference & Policy Symposium

Lisa Brenner, Ph.D. 

Keywords: Assessment, Homeless Veterans, Traumatic Brain Injury (TBI)

PowerPoint | PDF

Traumatic Brain Injury and Post Traumatic Stress Disorder: Current State of the Science, Diagnostic Challenges, and Best Clinical Practices

10/28/11

Fort Carson, CO

PowerPoint | PDF 

Keywords: TBI, PTSD

Traumatic Brain Injury and Homelessness: The Importance of Assessing Injury History - Research and Practice.

August 23-25, 2011

VA Mental Health Conference, Baltimore, MD

Brenner, L.A., Russell, L., Devore, M., Casey, R., Schinka, J., Montgomery, A.

Keywords: Homelessness, TBI

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Traumatic Brain Injury Among Homeless Veterans. (Poster)

August 4-7, 2011

The American Psychological Association, Washington, DC

Russell, L., Devore, M., Brenner, L.A., Casey, R., Kane, V., Schinka, J., Montgomery, A.

Keywords: Homelessness, TBI

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Research & Grant Info:

Current Research & Grants

A Longitudinal Study of Deployment-Related Mild Traumatic Brain Injury (mTBI): Incidence, Natural History, and Predictors of Recovery in Soldiers Returning from OIF/OEF, CDMRP Intramural TBI Investigator-Initiated Research Award, $1,318,984; 1/1/2008 – 12/31/2012

A Brief Intervention to Reduce Suicide Risk in Military Members and Veterans, U.S. Army Medical Research and Materiel Command (MOMRP), $2,671,337; 10/1/2009 – 9/30/2012

Blister Packaging Medication to Increase Treatment Adherence and Clinical Response: Impact on Suicide-related Morbidity and Mortality, U.S. Army Medical Research and Materiel Command MOMRP, $1,173,408; 9/28/2009 – 9/27/2013

Neurobiology of Suicide Risk in Traumatic Brain Injury and Substance Abuse, VA Merit Review, $922,788; 10/1/2009 – 9/30/2013

Executive Dysfunction and Suicide in Psychiatric Outpatients and Inpatients, VA Merit Review, $688,367; 4/1/2010 – 3/31/2013

Executive Dysfunction and Self-Harm Behavior: An Examination of Veterans with Traumatic Brain Injury, Post Traumatic Stress, or Both, Colorado Traumatic Brain Injury Trust Fund, $342,711; 5/1/2010 – 4/30/2012

A Randomized Clinical Trial of the Collaborative Assessment and Management of Suicidality vs. Enhanced Care as Usual for Suicidal Soldiers, U.S. Army Medical Research and Materiel Command MOMRP, $3,338,221; 12/1/2010 – 11/30/2014

TBI Implementation Partnership Grant Mental Health Initiative: The TBI Program, US Department of Health and Human Services Administration, Health Resources and Services Administration (HRSA), $348,709; 10/01/2010 – 9/30/2015

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Older Publications (Prior to 2009)

Brenner, L. A. (2008). Suicide Risk Assessment after Traumatic Brain Injury: Application of a Novel Theoretical Model. Brain Injury Professional, 5(1).

Brenner, L. A., Homaifar, B. Y., & Schultheis, M. (2008). Driving, aging and traumatic brain injury: Integrating findings from the literature. Rehabilitation Psychology, 53(1), 18-27.

Brenner, L. A., Gutierrez, P. M., Cornette, M. M., Betthauser, L. M., Bahraini, N., & Staves, P.J. (2008). A qualitative study of potential suicide risk factors in returning combat veterans. Journal of Mental Health Counseling, 30(3), 211-225.

Brenner, L. A., Harwood, J. E. F., Homaifar, B. Y., Cawthra, E., Waldman, J., & Adler, L. E. (2008). Psychiatric hospitalization and veterans with traumatic brain injury: A retrospective study. Journal of Head Trauma Rehabilitation, 23(6), 401-406.

Gutierrez, P. M., Brenner, L. A., & Huggins, J. A. (2008). A preliminary investigation of suicidality in psychiatrically hospitalized veterans with traumatic brain injury. Archives of Suicide Research, 12, 336-343.

Brenner, L. A., Dise-Lewis, J., Bartles, S., Selinger, M., Obrien, S. E., & Godleski, M. (2007). The long term impact of pediatric brain injury: A 50-year follow-up case study. Journal of Head Trauma Rehabilitation, 22(1), 56-64.

Thompson, C., Gutierrez, P. M., Brenner, L. A., Homaifar, B. Y., & Harwood, J. E. F. (2007) Veterans with traumatic brain injury: Preliminary norms for the Personality Assessment Inventory [Abstract]. Proceedings of The American Academy of Clinical Neuropsychology, June.

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Older Research & Grants

Traumatic Brain Injury (TBI) Model Systems, Health and Wellness Intervention of Individuals with TBI, National Institute on Disability and Rehabilitation Research, $350,752; 8/1/2007 – 8/31/2011

Amoxetine (Strattera) for the Treatment of Attention Disorders in Individuals with TBI, National Institute on Disability and Rehabilitation Research, $ 307,662; 8/1/2007 – 8/31/2011

Hyperbaric Oxygen for Persistent Post-Concussive Symptoms After Mild Traumatic Brain Injury (HOPPS): A Pilot Feasibility Study, U.S. Army OTSG, $315,000; 10/01/2010 – 9/30/2011

Tele-TBI Cell Phone Initiative SME Support – Suicide Nomenclature and Measure Development, DoD TATRC, $40,288; 9/01/2009 – 10/01/2010

Use of a Traumatic Brain Injury Screen in a Veteran Mental Health Population: Prevalence, Validation and Psychiatric Outcomes, Colorado Traumatic Brain Injury Trust Fund, $322,575, 6/1/2009 – 5/31/2011

Development of an Intervention for Soldiers and Veterans with Co-Occurring TBI and Substance Abuse, DoD DRMMRP Office of Congressionally Directed Medical Research Program, $112,000; 9/1/2009 – 3/31/2011

Implementation and Refinement of the Suicide Classification System, $95,500; 9/1/2009 – 8/31/2010

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