Traumatic Brain Injury and Associated Mental Health Treatment in Veterans

Accurate estimates of veterans' mental health service utilization is important for providing high-quality health care.

Findings published in PLoS ONE show that veterans returning from Iraq and/or Afghanistan with traumatic brain injury (TBI) had more psychotherapy and medical management visits than veterans without a history of TBI.

Researchers examined Veterans Health Administration (VHA) records of 55,458 veterans returning from Iraq or Afghanistan who received a new mental health diagnosis in fiscal year 2010 (between October 1, 2009 and September 30, 2010) whether or not they had TBI. Only veterans born in 1973 or later were included in the study; all had served on active duty, and only veterans treated as outpatients participated in the study.

The most common mental health diagnosis was posttraumatic stress disorder (PTSD), followed by depressive and anxiety disorders. Veterans with mental health diagnoses and TBI were younger, more often white, more likely to have a service-connected disability rating of 50% or higher, and more likely to have a substance-use disorder than patients without TBI.

Of the whole study population, 20% of patients had a diagnosis of TBI, 57% PTSD, 38% a depressive disorder, and 22% an anxiety disorder. Some patients had more than one condition.

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Approximately 16% of patients with TBI and 10% of patients without TBI had 8 or more psychotherapy visits, a significant difference ( X2 [6, n=225] = 13.93, df=2, P <.001, ψ=.25). A history of TBI was statistically associated with the number of psychotherapy visits.

PTSD was most strongly associated with the number of psychotherapy visits, while depression corresponded most strongly with medication visits. Comorbid mental health diagnoses correlated with an increased number of psychotherapy and medication visits — for example, substance use and personality disorders; chronic conditions requiring ongoing psychotherapy.

The researchers recommended that future studies analyze which mental health services veterans utilize, and the effectiveness of these services for veterans with TBI.


Miles SR, Harik JM, Hundt NE, et al. Delivery of mental health treatment to combat veterans with psychiatric diagnoses and TBI histories [published online September 8, 2017]. PLoS One. doi:10.1371/journal.pone.0184265