TBI Symptoms, Severity Differ for Women Veterans But Cause Remains A Mystery

by U.S. Medicine

April 12, 2011

WASHINGTON, DC—As more data is emerging on the short and long-term effects of traumatic brain injury (TBI), researchers are discovering that the injury affects women differently than it does men. Most notably, there seems to be a differential pattern of post-concussive symptoms among female compared to male OEF/OIF veterans with deployment–related TBI.

This new information may lead to differences in how post-concussive symptoms are diagnosed in women, and in how they are treated.

More Severe Symptoms

Current estimates are that 12% to 20% of OEF/OIF veterans have TBI—usually blast-related—with most of those cases being mild (mTBI). A significant number of those (65%) experience comorbid PTSD. To date, 13% of U.S. personnel serving in theater are women and, despite having a limited combat role, 10.5% of women OEF/OIF veterans receiving care at VA have screened positive for TBI post-deployment. Sports medicine research has shown that women react differently to TBI than men, explained Katherine Iverson, PhD, clinical psychologist in the Boston VA Healthcare System. “Persistent post-concussive symptoms may be worse for women than men. [We] wanted to see if this remained true for veterans,” said Iverson who was speaking at the annual VA Health Services R&D conference.While differences in how the genders react to combat trauma has been recognized for some time, there has been little study on TBI specifically. Iverson and her colleagues examined gender differences in post-concussive symptoms severity. They looked at each of the four types of cognitive symptoms—affective, somatosensory, cognitive, and vestibular.

“Women reported significantly more severe symptoms in all four domains,” Iverson said. “But we also looked at symptom severity stratified by PTSD status.”

Men with PTSD reported significantly more affective symptoms than those without. Women who had no additional injury at the time of their blast experience reported nearly equivalent symptom severity, regardless of PTSD status.

However, women reported significantly more affective symptoms than their male counterparts across the board, whether they experienced blast only or had additional injuries (“blast-plus”). There was also evidence of a complex interaction between gender, PTSD, and the etiology of the injury when it came to vestibular and somatosensory symptoms.

Causes Unknown

The implications of the data are that women deployed to OEF/OIF experience concussions of all etiologies in meaningful numbers and have returned with more severe post-concussive symptoms than their male counterparts, Iverson said. And the effects of blast trauma are more pronounced in women than men.

The root cause remains a mystery, however. “We can describe gender differences, but we cannot comment on the causes,” Iverson said. “There may be gender-related biases in reporting of symptoms by veterans, or in the diagnosing of TBI by evaluators.”

What the data does prove is that more attention needs to be paid to the post-concussive symptoms of women, and that education is needed for health care providers, veterans, and the general public, Iverson said.

“Although women make up a smaller percentage of men that have mild TBI, the post-concussive symptoms that they experience are more severe. It’s important that we get women connected to services, not only for physical problems, but for their cognitive problems, such as difficulty sleeping and pain problems.”

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