Researchers study Iraq veterans' traumatic brain injuries

Traumatic brain injury (TBI) has been identified as the "signature injury" of the wars in Iraq and Afghanistan.

TBI is known to cause deficits in memory, attention and decision-making and often occurs in conjunction with post-traumatic stress disorder (PTSD), depression, anxiety disorders, and substance abuse.

An estimated 150,000 U.S. veterans have been diagnosed with TBI, based on statistics gathered by the Veterans Administration's (VA) Quality Enhancement Research Initiative, known as QUERI.

While the numbers are relatively easy to assemble, the long-term cognitive and affective consequences of TBI and the effect on veterans' quality of life are not well understood, according to the VA, and evidence-based guidelines for diagnosis and treatment are limited. To be prepared to meet the needs of these veterans over time, the VA's Health Services Research & Development Unit is funding a $1.4 million, four-year prospective cohort study of Iraq and Afghanistan-era veterans, headed by University at Buffalo researchers at the Buffalo VA Medical Center. The results will be used nationwide.

VA medical centers in Albany, Syracuse, Bath and Canandaigua/Rochester also will participate in the study. Kerry T. Donnelly, Ph.D., UB adjunct assistant professor in the Department of Counseling, School and Educational Psychology and clinical assistant professor in the Department of Psychiatry, is principal investigator.

The Department of Counseling, School and Educational Psychology is in the UB Graduate School of Education, while the Department of Psychiatry is part of the UB School of Medicine and Biomedical Sciences.

"This project began here at the Buffalo VA in June 2008," said Donnelly. "While the Departments of Defense and Veterans Affairs have worked well in concert to address the needs of service members with major injuries, such as limb loss or severe TBI, veterans who might have more subtle cognitive and psychological problems are less likely to be identified in the field or upon returning home.

"Symptoms associated with mild TBI often can be overlooked in deference to more obviously visible injuries," she continued. "Nonetheless, war-related TBI is a serious and potentially costly health concern within the VA, and the interplay of TBI and cognitive and affective symptoms in Iraq War veterans over time has not been adequately explored.

"Further, symptoms similar to those associated with TBI may develop from combat experience alone. We're interested in studying returning veterans both with and without TBI, looking at a broader trauma complex.

"Our goal is to provide evidence-based understanding of cognitive and affective correlates of TBI and combat exposure in these veterans, the relationship of symptoms to the use of health care and quality of life, and the evolution of the phenomena over time," Donnelly said.

The study will construct clinical profiles of 500 veterans returning from the wars in Iraq and Afghanistan. Profiles will cover cognitive functioning, psychological symptoms, substance use, TBI status and combat and demographic characteristics, and will examine health care use among those with different diagnoses, quality of life and community participation.

Veterans will be studied at four time points, six months apart. The investigators also are conducting the first large-scale examination of the reliability and validity of the VA TBI screening tool, a brief survey used nationwide to identify veterans who might have sustained TBI in battle.

James Donnelly, Ph.D., UB clinical associate professor of counseling, school and educational psychology, is coinvestigator on the study.

The University at Buffalo is a premier research-intensive public university, a flagship institution in the State University of New York system and its largest and most comprehensive campus. UB's more than 28,000 students pursue their academic interests through more than 300 undergraduate, graduate and professional degree programs. Founded in 1846, the University at Buffalo is a member of the Association of American Universities.