Long-Term Clinical Outcomes Associated With the Veterans Health Administration's Traumatic Brain Injury and Mental Health Screens.

Abstract

Objective: Examine if the mandated Veterans Affairs traumatic brain injury (TBI) screen is associated with long-term postconcussive symptoms as compared to how the mandated mental health (MH) screen is associated with long-term MH symptoms.

Setting: Veterans Health Administration.

Participants: Patients (N = 1628) who were previously screened for TBI with current postconcussive symptoms and MH conditions completed a survey assessing current postconcussive symptoms, depression, posttraumatic stress disorder, alcohol use, and physical and emotional well-being. Participants were mostly male (83%), less than 40 years old (38%), and identified as White (64%). Forty-five percent screened positive for MH conditions; 11% screened positive for TBI.

Design: Cohort survey study of random sample of post-9/11 veterans combined with retrospective database analysis. Bayesian Network Analysis was used to compare how the TBI and MH screens related to long-term postconcussive and MH symptoms. The pathway on the Bayesian Network graph leading to postconcussive symptoms was thoroughly examined with a regression.

Main measures: Neurobehavioral Symptom Inventory to measure postconcussive symptoms.

Results: A Bayesian network arch demonstrated TBI screening was related to use of TBI services within 6 months after the screening but not related to long-term postconcussive or MH symptoms. In comparison, the MH screen led to post-screen MH services, postconcussive symptoms, and most of the other secondary outcomes, including posttraumatic stress disorder and depression. The regression model showed that a positive MH screen, more MH service use, negative life events, and moderate depression were associated with greater postconcussive symptoms years after screening.

Conclusion: While both TBI and MH screening were associated with increased service use, only the MH screen was associated with long-term postconcussive symptoms. Findings raise questions about whether the TBI screening program adds value over and above the MH screening program.