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Personality and neuroimaging measures differentiate PTSD from mTBI in veterans

  • Military/Veteran TBI
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Abstract

Mild traumatic brain injury (mTBI) is common among recent veterans and often is associated with chronic post-concussive symptoms (PCS). Elevated PCS may also be a consequence of post-traumatic stress disorder (PTSD) which shares symptoms with PCS. Identification of personality, biological, and psychopathology factors that contribute to the relationship between mTBI and PCS could help isolate the sources of chronic post concussive syndrome in veterans. Clinician rated diagnoses (PTSD, Major Depression, Alcohol Dependence), personality characteristics (Multidimensional Personality Questionnaire [MPQ] subscales), white matter brain imaging measures (Mean Diffusivity, Generalized Fractional Anisotropy), and diagnoses of mTBI were collected from 125 American military veterans of Iraq or Afghanistan. Linear and logistic regression models were tested to determine contributions to PCS and whether there were similar contributors to PTSD and mTBI. PCS score was associated with personality characteristics of high Stress Reaction and Traditionalism and low Control as well as mTBI. A diagnosis of PTSD was associated with low Social Closeness, PCS, Alcohol Dependence, and abnormal white matter mean diffusivity. Diagnosis of mTBI was associated with fewer white matter mean diffusivity abnormalities, PCS, and number of deployments. As commonly observed clinically, both PTSD and mTBI were associated with higher rates of PCS, though the contribution of PTSD appears to be secondary to personality traits, particularly Stress Reaction. Furthermore, the observation of factors that are uniquely associated with Blast mTBI (number of deployments) or with PTSD (Lifetime Alcohol Dependence and low Social Closeness), as well as a factor (region of abnormal MD) that had opposite effects on the likelihood of each diagnosis, indicates that the complex relationships between personality, psychopathology, and nature of mTBI need to be considered when interpreting chronic post-concussive symptoms.

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Acknowledgments

The authors would like to thank Michael Armstrong, Amanda Ferrier-Auerbach, Molly Charlesworth, and Emily Johnson for clinical assessment of participants; Kathleen McGuire, Nathaniel Nelson, Gregory Lamberty, Bridget Doane, and Daniel Goldman for consensus review of TBI and clinical diagnoses; and the veterans who participated in this study.

Financial Disclosures

This study was supported in part by Grants funded by the Congressionally Directed Medical Research Program (number PT074550, contract W81XWH-08-2-0038) and the Department of Veterans Affairs, Veterans Health Administration, Rehabilitation Research and Development Service (1I01RX000622-01A1 to SRS; 1IK2RX000709-01A3 to NDD). Drs. Davenport, Sponheim, and Lim report no biomedical financial interests or potential conflicts of interest.

Informed consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, and the applicable revisions at the time of the investigation. Informed consent was obtained from all patients for being included in the study.

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Authors and Affiliations

  1. Minneapolis Veterans Affairs Health Care System, VA Medical Center (B68-2), 1 Veterans Drive, Minneapolis, MN, 55417, USA

    Nicholas D. Davenport, Kelvin O. Lim & Scott R. Sponheim

  2. Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA

    Nicholas D. Davenport, Kelvin O. Lim & Scott R. Sponheim

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Correspondence to Nicholas D. Davenport.

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Davenport, N.D., Lim, K.O. & Sponheim, S.R. Personality and neuroimaging measures differentiate PTSD from mTBI in veterans. Brain Imaging and Behavior 9, 472–483 (2015). https://doi.org/10.1007/s11682-015-9371-y

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