EFFORT AND COMMUNITY LEVEL OUTCOME IN VETERANS WITH A HISTORY OF MILD TRAUMATIC BRAIN INJURY

Objective: To determine how demographics, injury variables, neuropsychological and behavioral variables, service connection status, and performance on symptom validity measures are related to community level outcome in veterans with a history of mild traumatic brain injury (TBI).

Participants and Methods: One hundred seventeen consecutive veterans with a history of mild TBI, 45.5 months post deployment completed the MPAI Participation Index, MMPI-II, PCL, ASSIST, HIT-6, CVLT-II, PASAT, Trail Making Test, and six symptom validity measures as part of larger neuropsychological batteries. Between groups ANOVAs, chi square goodness of fit, linear regressions, and multinomial logistic regressions were conducted to test specific hypotheses.

Results: The models significantly predicted general community participation, but not employment level. Symptom validity, PTSD, and headache interference were all related to community level outcome; however, loss of consciousness, age, time since deployment, substance use, PASAT, Trail Making Test performance, and service connection status were unrelated to community level outcome. Symptom validity interacted with CVLT-II performance to predict MPAI Participation Index.

Conclusions: This study highlights the importance of assessing symptom validity in clinical cases of mild TBI and in clinical research studies involving mild TBI patients. It also supports the treatment strategy of addressing current comorbid conditions, such as PTSD and headaches, rather than focusing solely on the remote history of mild TBI.