Different Causes
The meta-analysis did find that men and women veterans suffer TBIs from different causes. Men are more likely to have TBIs related to car accidents and explosions. Women are much more likely to experience TBI as a result of interpersonal violence and military sexual trauma. Nearly two-thirds of women who experienced TBIs associated with interpersonal violence met criteria for post-traumatic stress disorder.
Overall, the study “gives us some way to think about the issues that individuals may experience after brain injury. Brain injury rehabilitation is very customized for each individual within the VA. It helps us to think at a system level about screening to monitor or chick in on individuals after TBI. If we know the trends, we can better plan as an entire system of care for these veterans,” Scholten told U.S. Medicine.
The results also support recommendations to regularly screen for TBI and mental health issues. “This study strengthens the recommendation to ask specifically about how an individual is functioning in the community and to encourage the individual to engage in mental healthcare if that need exists,” Scholten said.
Ironically, understanding how common some of the sequelae of mild TBI are among women may help men, who could be experiencing the same things but be more reticent to seek help.
“Sometimes studies that look at the percentage of diagnoses can help normalize engaging with mental health professionals and destigmatize it,” Scholten noted. “If it’s not an unusual issue for someone to experience additional anxiety or depression after brain injury, it becomes standard of care for them to engage with the mental health care team.”
Increasing provider awareness of the association between interpersonal violence and mild TBI can help women get the care they need, too, by encouraging providers to ask follow-up questions about injuries to the head, Cogan said.
Knowing that interpersonal violence might be an issue in a veteran with TBI, “helps providers prepare and approach individuals in an open, nonbiased, more therapeutic approach rather than being surprised that this might have happened,” Scholten added.
In addition to asking women veterans with TBI about military sexual trauma and interpersonal violence, the researchers recommended screening for TBI in female veterans who report a history of interpersonal violence or military sexual trauma.
The length of time over which veterans reported effects of concussions could also impact care. “The studies we reviewed assessed veterans at various points of time. Some were immediate and some years past the original injury,” Cogan observed. The results indicated a need for “consistent monitoring over the long-term for these veterans. As some seek care outside of VA, I would encourage all providers to screen for prior military service and identify any military-related previous injuries that may create problems for these veterans later.”
- Cogan AM, McCaughey VK, Scholten J. Gender Differences in Outcomes after Traumatic Brain Injury among Service Members and Veterans. PM R. 2019 Aug 10. [epub ahead of print.]