Effects of a modular telehealth intervention on comorbid conditions in service members with mild traumatic brain injury

Objective Many active duty service members with mild traumatic brain injury (mTBI) report comorbidities such as depression, anxiety, PTSD, insomnia, and pain. We analyzed data from a prior randomized controlled trial (RCT) to examine the effects of evidence-based treatment modules, delivered by telephone, on the number and symptom burden of five common comorbidities. Setting and participants 356 service members from two military medical centers who had sustained deployment-related mTBI in the preceding 2 years. Design Secondary analysis of RCT comparing 6 months of telephone-delivered problem-solving treatment (PST) with comorbidity-specific modules to education only (EO). Main measures Comorbidity burden measured by Patient Health Questionnaire-9, Brief Symptom Inventory-Anxiety, PTSD Checklist, Pittsburgh Sleep Quality Inventory, Rivermead Postconcussion Symptoms Questionnaire (headache item) assessed at baseline and 6 and 12 months. Results 47% of service members endorsed ≥ 3 comorbidities at baseline. At 6 months, the PST group had significantly fewer comorbidities, greater improvement in depression, anxiety, PTSD, and sleep, but not headache, and higher response/remission rates for depression and sleep, compared to EO. There were no significant group differences at 12 months. Conclusion Telephone-delivered PST with comorbidity-specific modules reduces burden of comorbidities after deployment-related mTBI. Research is needed on how to maintain improvements over time.