Skip to main content

Military Health System

Concussion Linked to Depression, Anxiety and PTSD, Studies Show

Image of Picture of blast waves during an explosion. Service members can suffer concussions when exposed to blast waves when explosions occur during training or operations (Photo by: U.S. Army, Sgt. M. Austin Parker).

Recommended Content:

Traumatic Brain Injury Center of Excellence

Recent research shows mounting evidence of a link between mild traumatic brain injury and mental health conditions like depression, anxiety, and posttraumatic stress disorder.

For the first time, a study of post-mortem brains of service members who were diagnosed with blast-related concussions found visible evidence of damage to the brain.

Researchers believe the unique scarring that the study found could account for the mental health conditions that are diagnosed more frequently among service members who have suffered mild TBIs or been exposed to blast concussions.

In other words, the "invisible wounds" - as TBI is frequently called - might not be invisible anymore.

"The more we look, the more we're finding other subtleties and other kinds of changes in the brains of individuals who've been exposed to blast," said Dr. Daniel Perl, one of the study's researchers and a neuropathologist specializing in TBI and neurodegeneration at the Uniformed Services University (USU) of the Health Sciences in Bethesda, Maryland.

As a result, "we think there is a biology to this, that the exposure to blast can, in some people, produce damage to the brain, which leads to dysfunction and underlies some aspects of [mental health issues]," Perl said.

The Link

TBI is associated with an increased risk of psychological health conditions, such as anxiety, depression, and even post-traumatic stress, according to experts at the Defense Health Agency's Traumatic Brain Injury Center of Excellence (TBICoE), in Falls Church, Virginia.

A 2019 study of a Department of Veterans Affairs health care database found that "a history of TBI increased the risk for suicide and other psychiatric conditions by more than two-fold."

Veterans with a history of TBI also had a two-to-four times higher prevalence of psychiatric diagnoses compared with those who did not suffer a TBI, with PTSD being the most common, according to the TBICoE team.

The prevalence of depression in the mTBI group was 68.1 percent, the TBICoE team said.

David Riggs, a clinical psychologist and chair of the Department of Medical and Clinical Psychology at USU, explained how the exact reason for the neuropsychiatric symptoms service members experience following a blast-related concussion is not clear.

"We don't know exactly, particularly in the case of mild TBIs or concussions, what might be leading to these problems because it's very hard to identify the specific change in the way that the brain functions after a concussion," he said.

"If you have a penetrating head injury, where the skull is fractured or penetrated, you can actually identify the part of the brain that was injured and perhaps is no longer functioning at all," added Riggs.

"In the case of concussion, it's very hard to identify where the brain was injured."

Riggs explained that there might be a disruption in "the way that the neurons in the brain talk to one another."

What is known, is "that the way that a person processes information is related to mood and trauma symptoms on the psychological or psychiatric side," said Riggs. "So, it may be that there are disruptions at the neurological level that lead to these psychological and psychiatric issues."

"It's also possible that what leads to the depression or the trauma symptoms isn't about the injury, the concussion, or the idea that the brain is working differently, but rather the emotional and life-disrupting aspects of that," he added.

Seeing the 'Invisible Wounds'?

Mild TBI occurs when there's a sudden jolt to the head due to impact or blast, causing it and the brain to jerk abruptly back and forth. This results in the brain bouncing or twisting inside the skull, creating chemical changes that can stretch and harm the brain cells, thus affecting brain function, according to the Centers for Disease Control and Prevention.

While the USU study appears to have identified physical scars from blast damage in service members who are deceased, there are no visible damages to the brain when testing live patients diagnosed with blast-related concussion and other forms of TBI.

Picture of the brain
Concussion, or mild traumatic brain injury, occurs when a service member experiences a bump, blow, or jolt to the head that causes the head and brain to move rapidly back and forth, causing the brain to bounce around or twist in the skull and creating chemical changes in the brain and sometimes stretching and damaging brain cells (Photo by: CDC).

"When you do an MRI on such a patient, you don't see anything consistently," said Perl. "The implication is that something's wrong with the brain, but you just can't see it."

Perl established a neuropathology lab at USU dedicated to researching the acute and long-term effects of TBI and PTSD among military personnel. In the study, they analyzed brain specimens of cases with chronic blast exposure, acute blast exposure, chronic impact TBI, exposure to opiates, and a control group with no known neurological disorders for comparison.

"The one thing that kept coming up in these cases [with blast exposure] was a pattern of scarring in the brain that seemed rather unique and had really not been described previously," he said.

"And the more we worked, the more it appeared to be related to blast exposure."

The type of unique scarring they observed is called interface astroglial scarring. From there, they learned that blast waves emerging from detonations of high explosives such as improvised explosive devices and suicide bombs carry pressure waves "that expand in all different directions, at about the speed of sound, and actually pass through the skull, and through the brain, the most delicate and complex organ in the body," he said.

This led to the assumption that it must produce some damage to the brain.

"Indeed, the places where we found the scarring were places where biophysicists had previously shown that the blast wave gives off its energy," he said. "Putting two and two together, we have indicated that we think that the blast wave is damaging the brain in these locations, and this is the brain's attempt to repair itself from that damage."

"Mental health issues may be superimposed to this," he said, attributing the symptoms of concussion to "a duality of both factors - biologic factors plus functional factors - that are interplaying, interacting."

Similar Symptoms

Concussion can result in a wide variety of symptoms that can also be attributed to other causes, including headaches, irritability, fatigue, balance difficulties, sleep disturbance, dizziness, ringing in the ears, blurred vision, concentration, or memory difficulties, and other problems. But these are believed to be temporary and usually heal on their own over time, as the brain resettles back to regular functioning.

Likewise, people who have had a TBI and people who are depressed can share similar symptoms. These include low activity levels, sleep problems, difficulty controlling emotions, loss of interest in pleasurable activities, decreased energy, changes in appetite, and lack of initiation.

Similarly, Riggs said, while some people with a concussion may also have PTSD, not everyone does. He said some experts believe some people may be more vulnerable to psychological health conditions after a concussion because they were having problems already, or because they may be genetically predisposed to psychological health issues, like depression or anxiety.

Either way, the psychological health conditions that arise from concussions may require longer-term treatment.

Common treatment options include counseling and medications. Most cases of PTSD respond well to treatment, according to TBICoE.

And some complementary or alternative medical approaches such as meditation have shown to be useful, as a second-line treatment for managing PTSD.

Perl's research findings have implications for the way TBI might be diagnosed and treated in the future as well as for spurring broader research on the ways service members can be better protected as they head into situations where they might be exposed to blasts.

"We're beginning to work on if there are means by which we can detect this in living individuals," said Perl. "Our work has stimulated a number of ongoing studies to look for unique ways in which newer imaging and even fluid biomarkers can be used to identify these changes in the living."

Service members experiencing depression, anxiety, and PTSD due to concussion are not alone. The TBICoE website provides ample resources to help service members, veterans, their families, and loved ones cope with mTBI.

If you notice changes in the behavior of a loved one after concussion or fear a loved one may try to hurt themselves, urge them to call their health care provider, the Suicide and Crisis Lifeline at 988, or the Military Crisis Line at 800-273-8255 as soon as possible.

You also may be interested in...

Interview with the SEAC: TBI from a Joint Perspective

Video
7/18/2022
Interview with the SEAC: TBI from a Joint Perspective

In this episode of Picking Your Brain, Traumatic Brain Injury Center of Excellence Branch Chief Capt. Scott Cota and clinical moderator Amanda Gano interview the Senior Enlisted Advisor to the Chairman of the Joint Chiefs of Staff (SEAC), Ramón Colón-López. The discussion covers the health impacts of TBI and blast-related concussion stemming from the demands of combat and training. The SEAC also addresses the importance of maintaining medical readiness through education and military leadership. Listen to more Picking Your Brain episodes at www.health.mil/TBIPodcasts, on DVIDS, or wherever you listen to podcasts.

Recommended Content:

Traumatic Brain Injury Center of Excellence | TBICoE Podcasts | TBI Provider Resources | Patient and Family Resources | TBI Educators | Centers of Excellence | Traumatic Brain Injury Center of Excellence

One Airmans Recovery from TBI

Video
3/28/2022
One Airmans Recovery from TBI

After a motorcycle accident, Master Sergeant Stalnaker started having symptoms of traumatic brain injury, or TBI. He tells his story about his symptoms and his road to recovery from physical and emotional wounds as a result.

Recommended Content:

Traumatic Brain Injury Center of Excellence

A Retired Navy SEAL Discusses his TBI

Video
3/9/2022
A Retired Navy SEAL Discusses his TBI

Retired Navy SEAL Edward Rasmussen discusses his TBI, and urges others to seek treatment if they have symptoms. If you’re experiencing symptoms of TBI, visit health.mil/TBI to learn about the resources available to you.

Recommended Content:

Brain Injury Awareness To Improve Readiness | Traumatic Brain Injury Center of Excellence | Traumatic Brain Injury Center of Excellence

One Airman's Recovery from TBI

Video
3/9/2022
One Airman's Recovery from TBI

After a motorcycle accident, Master Sergeant Stalnaker started having symptoms of traumatic brain injury, or TBI. He tells his story about his symptoms and his road to recovery from physical and emotional wounds as a result. If you’re experiencing symptoms of TBI, visit health.mil/TBI to learn about the resources available to you.

Recommended Content:

Brain Injury Awareness To Improve Readiness | Traumatic Brain Injury Center of Excellence | Traumatic Brain Injury Center of Excellence

TBI Prevention

Video
2/9/2022
TBI Prevention

It is important for everyone to remember that we only have one brain. That means taking the necessary to protect your brain when engaging in sports, driving, or during exercises while on-duty.

Recommended Content:

Traumatic Brain Injury Center of Excellence

PRA Training Video 6: The Return to Duty Screening

Video
7/22/2021
PRA Training Video 6: The Return to Duty Screening

In this lesson, we cover how to perform the Return to Duty, or RTD screening, which now includes both vestibular/physical and neurocognitive examinations. The purpose of the RTD screening is to objectively measure whether a service member is ready for return to full duty. Each video in the Progressive Return to Activity training series is designed to support primary care providers' ability to manage concussion/traumatic brain injury (TBI).

Recommended Content:

Traumatic Brain Injury Center of Excellence | TBI Provider Resources | Provider Education | Traumatic Brain Injury Center of Excellence

PRA Training Video 3: Understanding Relative Rest

Video
7/22/2021
PRA Training Video 3: Understanding Relative Rest

In this lesson we explain the differences between complete rest and relative rest in a staged concussion recovery process, and provide examples of activities that promote relative rest. The revised Progressive Return to Activity (PRA) Clinical Recommendation uses the term 'relative rest' to emphasize the importance of early introduction of physical and cognitive activities that do not provoke symptoms following TBI. Each video in the PRA training series is designed to support primary care providers' ability to manage concussion/traumatic brain injury (TBI).

Recommended Content:

Traumatic Brain Injury Center of Excellence | TBI Provider Resources | Provider Education | Traumatic Brain Injury Center of Excellence

PRA Training Video 8: Clinical Case Scenario

Video
7/22/2021
PRA Training Video 8: Clinical Case Scenario

This is an interactive clinical case scenario to test your understanding in applying the Progressive Return to Activity (PRA). We hope this will help medical providers become more familiar with the PRA process when treating service members with concussion. Each video in the PRA training series is designed to support primary care providers' ability to manage concussion/traumatic brain injury (TBI).

Recommended Content:

Traumatic Brain Injury Center of Excellence | TBI Provider Resources | Provider Education | Traumatic Brain Injury Center of Excellence

PRA Training Video 7: Symptom-Guided Management and Specialty Referral Guidance Tables

Video
7/22/2021
PRA Training Video 7: Symptom-Guided Management and Specialty Referral Guidance Tables

This lesson covers how to use the Progressive Return to Activity, or PRA's Symptom-Guided Management and Specialty Referral Guidance tables. This lesson also details primary care management strategies for service members who are not progressing as expected in the PRA. Each video in the Progressive Return to Activity training series is designed to support primary care providers' ability to manage concussion/traumatic brain injury (TBI).

Recommended Content:

Traumatic Brain Injury Center of Excellence | TBI Provider Resources | Provider Education | Traumatic Brain Injury Center of Excellence

PRA Training Video 1: PRA Overview

Video
7/22/2021
PRA Training Video 1: PRA Overview

In the first of TBICoE's Progressive Return to Activity (PRA) video training series, you will learn about the reasons for using a progressive return to activity process and receive an overview of the 2021 PRA algorithm and its associated tools. By the end of lesson one, providers will better understand the PRA process, and explain that process to service members diagnosed with concussion. Each video in the PRA training series is designed to support primary care providers' ability to manage concussion/traumatic brain injury (TBI).

Recommended Content:

Traumatic Brain Injury Center of Excellence | TBI Provider Resources | Provider Education | Traumatic Brain Injury Center of Excellence

PRA Training Video 2: Six Major Changes

Video
7/22/2021
PRA Training Video 2: Six Major Changes

In this lesson we review the six major changes in the TBICoE's revised 2021 Progressive Return to Activity (PRA) Clinical Recommendation that differ from the original recommendation. The changes reflect the latest TBI research, and will make it easier for providers to manage the recovery process and return service members with concussion to full duty as quickly and safely as possible. Each video in the PRA training series is designed to support primary care providers' ability to manage concussion/traumatic brain injury (TBI).

Recommended Content:

Traumatic Brain Injury Center of Excellence | TBI Provider Resources | Provider Education | Traumatic Brain Injury Center of Excellence

PRA Training Video 5: The Six Stages of the PRA

Video
7/22/2021
PRA Training Video 5: The Six Stages of the PRA

In this lesson, we cover the key activity objectives for each of the six stages of the Progressive Return to Activity (PRA) Clinical Recommendation and provide activity examples for each stage. Each stage is designed to gradually increase the intensity and duration of a service member's physical and cognitive activity as they advance in the PRA process. Each video in the PRA training series is designed to support primary care providers' ability to manage concussion/traumatic brain injury (TBI).

Recommended Content:

Traumatic Brain Injury Center of Excellence | TBI Provider Resources | Provider Education | Traumatic Brain Injury Center of Excellence

PRA Training Video 4: PRA Progression Criteria

Video
7/22/2021
PRA Training Video 4: PRA Progression Criteria

In this lesson, we review the criteria for advancing through the stages of the Progressive Return to Activity (PRA) Clinical Recommendation. Each video in the PRA training series is designed to support primary care providers' ability to manage concussion/traumatic brain injury (TBI).

Recommended Content:

Traumatic Brain Injury Center of Excellence | TBI Provider Resources | Provider Education | Traumatic Brain Injury Center of Excellence

MHS Minute March 2021

Video
4/1/2021
MHS Minute March 2021

March marked Brain Injury Awareness month in the military. We're spotlighting efforts across the MHS to combat Traumatic Brain Injury (TBI), and better understand how TBI impacts our Service members. For more information about the National Intrepid Center of Excellence (NICoE), go to walterreed.tricare.mil/NICoE For more info on the Traumatic Brain Injury Center of Excellence (TBICoE), go to Health.mil/TBICoE

Recommended Content:

Brain Injury Awareness To Improve Readiness | Brain Injury Awareness To Improve Readiness | Traumatic Brain Injury Center of Excellence | The National Intrepid Center of Excellence

Traumatic Brain Injury Awareness

Video
3/8/2021
Traumatic Brain Injury Awareness

A TBI is a blow or jolt to the brain that can be life-altering if the symptoms are not recognized. If you or a loved one experience the symptoms mentioned in this video, speak to a health care professional for more information.

Recommended Content:

Traumatic Brain Injury Center of Excellence | Traumatic Brain Injury Center of Excellence | Brain Injury Awareness To Improve Readiness | Brain Injury Awareness To Improve Readiness | Brain Injury Awareness To Improve Readiness | Brain Injury Awareness To Improve Readiness
<< < 1 2 > >> 
Showing results 1 - 15 Page 1 of 2
Refine your search
Last Updated: September 01, 2022
Follow us on Instagram Follow us on LinkedIn Follow us on Facebook Follow us on Twitter Follow us on YouTube Sign up on GovDelivery