Traumatic Brain Injury in US Veterans: Prevalence and Associations With Physical, Mental, and Cognitive Health

Objective: To examine the prevalence of traumatic brain injury (TBI) in the US veteran population, and physical, mental, and cognitive health conditions associated with TBI. Design: Retrospective cohort study. Setting: A nationally representative sample of US military veterans surveyed in 2019-2020. Participants: Veterans with probable TBI (n=943; M=58.8 years, SD=16.4; 75.9% non-Hispanic White) and without probable TBI (n=3,033; M=63.3 years, SD=15.3; 78.6% non-Hispanic White) were categorized based on a 2-item modified Veterans Health Administration TBI screen or self-reported health professional diagnoses of concussion/TBI. Interventions: Not applicable. Main Outcome Measure(s): Self-reported health professional-diagnosed physical and cognitive health conditions, disability with basic and instrumental activities of daily living (ADLs), positive screens for posttraumatic stress disorder (PTSD), major depressive disorder, anxiety disorder, alcohol use disorder, or drug use disorder, and current suicidal ideation or prior suicide attempts. Results: Among the full sample, 24.5% (95% confidence interval: 22.7, 26.3) had probable TBI. In adjusted analyses, probable TBI was independently associated with greater odds of rheumatoid arthritis (odds ratio [OR]=2.06), chronic pain (OR=1.87), kidney disease (OR=1.81), pulmonary disease (OR=1.74), arthritis (OR=1.65), migraine (OR=1.59), sleep disorders (OR=1.57), and osteoporosis or osteopenia (OR=1.51). Veterans with probable TBI also had higher odds of mild cognitive impairment (OR=4.53) and disability with ADLs (OR=2.18) and instrumental ADLs (OR=1.98), although ADL disability was explained by other physical health conditions. Probable TBI was associated with higher odds of probable current anxiety disorder (OR=2.82), major depressive disorder (OR=2.17), suicidal ideation (OR=1.78), PTSD (OR=1.72), drug use disorder (OR=1.54), and alcohol use disorder (OR=1.47). Conclusions: Nearly 1-in-4 US veterans screen positive for probable TBI, which was associated with several physical and mental health conditions that adversely affect health and functioning. Results underscore the importance of multidisciplinary interventions that concurrently target the unique physical, mental, cognitive, and functional health needs of this population.