Association of childhood mild traumatic brain injury with mental and behavioral health outcomes later in life among U.S. Veterans: A LIMBIC-CENC study

Mild traumatic brain injury (mTBI) is a common injury across all age groups and populations, with a high prevalence among military service members and Veterans. The purpose of this cross-sectional study was to use a large, prospective cohort of Veterans to examine the association between childhood mTBI and multimodal mental and behavioral health outcomes, and among those with childhood mTBI, evaluate sociodemographic characteristics associated with worse outcomes. Data came from the Long-term Impact of Military-relevant Brain Injury Consortium-Chronic Effects of Neurotrauma Consortium (LIMBIC-CENC) prospective longitudinal study. This cohort included 1,286 Veterans, 61.3% of whom sustained a childhood mTBI. After adjustment for demographic, behavioral, and military history factors, Veterans with childhood mTBI had higher PTSD symptom scores (Mean Ratio[MR] = 1.36, 95%CI: 1.22–1.51), higher anger scores (MR = 1.08, 95%CI: 1.05–1.10), higher depression scores (MR = 1.31, 95% CI: 1.17–1.46), higher anxiety scores (mean difference [MD]= 4.3, 95% CI: 2.9-5.6), emotional-behavioral dyscontrol scores (MD = 3.2, 95% CI: 2.2–4.3), worse sleep quality (MD = 1.6, 95% CI: 1.1-2.2), worse neurobehavioral symptoms (MD = 6.8, 95% CI: 5.2-8.5), lower satisfaction with life (MD = -1.2, 95% CI: -2.1 to -0.27), and lower resilience scores (MR = 0.96, 95% CI: 0.94–0.99). There were no significant differences after adjustment for alcohol or drug use scores. Among individuals with a history of childhood mTBI, several mental and behavioral health outcomes were worse among those who sustained multiple mTBIs and better among those who were physically active and had higher education. These findings suggest markers of increased riskpresent before military enlistment that may warrant targeted prevention, screening, and treatment strategies. Increased awareness among healthcare providers may help identify Veterans with childhood mTBI history who would benefit from evidence-based treatment and support.