A recent study funded by the Department of Defense addressing obstacles for assessment and diagnosis of various mental health conditions found that current practices are hindered by biases and complications, but remain the most effective tool to study and assess brain injuries.
The current best practice for identifying physical and mental health concerns related to deployment, such as mild traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD), involves screening immediately after returning from deployment and again in the months to follow.
Both the DoD and the VA utilize the Post-Deployment Health Assessment, administered to service members within 30 days of returning from combat, and the Post-Deployment Health Reassessment, administered three to six months later. The recent study sought to determine whether or not this process is the most effective way to identify health concerns in service members, and what possible biases and complications occur in administering the two assessments.
Researchers found several biases that potentially interfere with accurate reporting. Service members were found to underreport symptoms and health problems immediately following their return home, which negatively impacts the clinical assessment process. This was attributed to several factors: soldiers who believe that symptoms will disappear once they return home; fear that admitting disturbances will lengthen the period of time before they can return home to their families; and fear of stigmatization.
Additional biases complicate the ability for health care workers to accurately assess and diagnose potential mental and physical injuries in service members. First, a patient may confuse a TBI-related alteration of consciousness with a psychological alteration of consciousness, which are separate injuries each with their own complications. Second, because much of the diagnosis process relies on a patient’s memory to accurately report events, the time between injury and assessment can often lead to memory lapse and consequent misdiagnosis.
Similarly, it is often difficult to diagnose the single traumatic event that caused a TBI when the service member may have been involved in multiple blast events. Because symptoms for both mild TBI and PTSD may have either delayed on-set and/or long-term presence, separating symptoms from the root cause of disease accounts for additional biases.
On the other hand, past research has shown that early intervention positively affects outcomes. In addition, the effects of psychiatric comorbidities have been shown to increase over time. Therefore, current processes have value both in “identifying symptoms that require immediate attention and documenting life events which may contribute to an individual’s overburden of adversity.”
The study determined that while many factors complicate current screening and assessment methods, they are an effective way to identify and treat mental and physical health concerns among service members.
Article citation:
Brenner LA, Vanderploeg RD, Terrio H. Assessment and diagnosis of mild traumatic brain injury, posttraumatic stress disorder, and other polytrauma conditions: Burden of adversity hypothesis. Rehabil Psychol. 2009 Aug;54(3):239-46. (Denver VA Medical Center, Defense and Veterans Brain Injury Center, Tampa VA Medical Center, and Evans Army Community Hospital, Fort Carson, CO)