Back to Top Skip to main content Skip to sub-navigation

Concussion Linked to Depression, Anxiety and PTSD, Studies Show

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

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 National Suicide Prevention Lifeline at 800-273-8255 (TALK), or the Military Crisis Line at 800-273-8255 as soon as possible.

You also may be interested in...

HEADS: Protect Your Strongest Weapon

Publication
3/11/2021

This flyer promotes awareness of the key symptoms of concussion/mild TBI.

Recommended Content:

Traumatic Brain Injury Center of Excellence | TBI Educators | Patient and Family Resources | Traumatic Brain Injury

Distinguishing between TBIs, psychological conditions key to treatment

Article
3/10/2021
Military personnel holding a gun

Expert says long-lasting symptoms may be a sign of another issue.

Recommended Content:

Traumatic Brain Injury Center of Excellence | A Head for the Future | Traumatic Brain Injury | Brain Injury Awareness Month | Brain Injury Awareness Toolkit | Brain Injury Awareness Toolkit | Brain Injury Awareness Toolkit | TBI and Total Force Fitness

Traumatic Brain Injury Awareness

Video
3/8/2021
DHA Seal

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 | Brain Injury Awareness Month | Brain Injury Awareness Toolkit | Brain Injury Awareness Toolkit | Brain Injury Awareness Toolkit | Brain Injury Awareness Toolkit

New NICoE director sets an ambitious agenda for the future

Article
3/8/2021
Military personnel wearing face mask while talking to each other

The accomplished new leader of the NICoE and Intrepid Spirit Center network has plans for increased services and a higher profile for the unique care center.

Recommended Content:

Traumatic Brain Injury | Brain Injury Awareness Month | TBI Education and Training Events | Brain Injury Awareness Toolkit | Brain Injury Awareness Toolkit | Centers of Excellence

Updated tools and training improve TBI and concussion recovery

Article
3/3/2021
A group of military personnel wearing face mask working on laptop computers

Up-to-date clinical tools help diagnose and manage TBI on and off the battlefield.

Recommended Content:

Traumatic Brain Injury | Traumatic Brain Injury Center of Excellence | TBICoE Podcasts | Brain Injury Awareness Toolkit | Brain Injury Awareness Toolkit | Brain Injury Awareness Month | Brain Injury Awareness Toolkit | Brain Injury Awareness Toolkit

NICoE Brain Injury Awareness/March 2021Events

Publication
3/2/2021

The National Intrepid Center of Excellence (NICoE) is hosting a number of virtual events throughout March 2021 in observance of Brain Injury Awareness Month.

Recommended Content:

Traumatic Brain Injury | Brain Injury Awareness Month | TBI Education and Training Events

March is Brain Injury Awareness Month; TBICoE’s mission lasts all year

Article
3/2/2021
Military health personnel performing a balance test on a patient

Staying a-head of TBI

Recommended Content:

Traumatic Brain Injury Center of Excellence | Brain Injury Awareness Toolkit | A Head for the Future | Brain Injury Awareness Toolkit | Traumatic Brain Injury | Brain Injury Awareness Month | Brain Injury Awareness Toolkit | Brain Injury Awareness Toolkit | Centers of Excellence

Progressive Return to Activity After Concussion Video

Video
2/25/2021
DHA Seal

The PRA is an evidence-based, easy-to-use approach to help providers return service members with mild TBIs back to duty safely. TBICoE researchers have found that, if medical providers completed a two-hour, in-person training on the use of the PRA, their patients saw an overall reduction in symptoms after one week, one month, and three months, when compared to patients treated by providers who had not received the training.

Recommended Content:

Traumatic Brain Injury Center of Excellence | Provider Resources | TBI Educators | Traumatic Brain Injury | Brain Injury Awareness Month | TBI Resources | TBI Screening

Brain Injury Awareness Month "Be TBI Ready" Infographic

Infographic
2/24/2021
March is Brain Injury Awareness Month. Be TBI Ready. A traumatic brain injury—or TBI—is a blow or jolt to the head that disrupts the normal function of the brain. The severity of the TBI is determined at the time of the injury and may be classified as: mild, moderate, severe, or penetrating.

During Brain Injury Awareness Month, TBICoE and the MHS will promote the theme “Be TBI Ready” — recognizing that health care providers and others in the military community need to be aware of the latest educational trainings, research, fact sheets, and other available resources to prevent, diagnose, and treat TBI.

Recommended Content:

Brain Injury Awareness Month | Traumatic Brain Injury | Traumatic Brain Injury Center of Excellence | TBI Educators | Brain Injury Awareness Toolkit

Returning to Duty After Concussion

Infographic
2/24/2021
What's the best way to recover from a concussion? Returning to duty too soon after a concussion can lead to prolonged symptoms, decreased readiness, poor marksmanship, accidents and falls, and increased risk of more concussions. Progressively increasing activity in a step-wise manner can help you resolve your symptoms and return to duty safely. Ask your primary health care provider about TBICoE's Progressive Return to Activity to help you return to duty as quickly and safely as possible. Visit health.mil/TBICoE.

This TBICoE infographic gives an overview of the risks of returning to duty too soon after a concussion and explains how a progressive increase in activity can help get you back to duty safely. Returning to duty too soon after concussion can lead to prolonged symptoms, poor marksmanship, decreased readiness, accidents and falls, and increased risk of more concussions.

Recommended Content:

Traumatic Brain Injury | Brain Injury Awareness Month | Traumatic Brain Injury Center of Excellence | Patient and Family Resources | TBI Educators | Provider Resources | Brain Injury Awareness Toolkit

Progressive Return to Activity Following Acute Concussion/Mild TBI

Publication
2/23/2021

The 2021 Progressive Return to Activity (PRA) Following Acute Concussion/Mild Traumatic Brain Injury Clinical Recommendation is an evidence-based return to activity protocol for primary care managers and concussion/traumatic brain injury (TBI) clinic providers. The PRA is a six-step approach that begins after the provider performs the Military Acute Concussion Evaluation 2 (MACE 2) and diagnoses the patient with a concussion/TBI. The PRA stages start with relative rest and allow service members to gradually increase activities until they receive clearance for return to full duty or activity. In each stage, it offers general and military specific activities and options to help providers manage their patients’ primary symptom clusters. The PRA also offers recommendations on specialty referrals and handouts are available for providers to give patients and leadership.

Recommended Content:

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

March 2021 Toolkit

Publication
2/22/2021

March is nationally recognized as Brain Injury Awareness Month, with the goal of increasing traumatic brain injury (TBI) awareness and improve health care providers’ ability to identify, care for, and treat all those who are affected by TBI. A TBI is a blow or jolt to the head that disrupts the normal function of the brain. According to the Defense Health Agency Traumatic Brain Injury Center of Excellence, 430,720 service members have been diagnosed with a first-time TBI since 2000. The toolkit also contains information on patient Safety Awareness Week, National Nutrition Month and many other graphics and messages you can use for holidays and observances during March.

Recommended Content:

Brain Injury Awareness Toolkit | Total Force Fitness | Traumatic Brain Injury | Brain Injury Awareness Month

Sleep After Concussion

Infographic
2/18/2021
Sleep After Concussion. Service members with TBI report 3 times more sleep problems. TBIs can happen anywhere, only 16.9 percent of TBIs happen while deployed. Visit health.mil/TBIFactSheets to learn more about sleep problems and how to improve them

"Sleep After Concussion" is intended for patients and caregivers of those who have sustained a TBI. The infographic reviews general information of sleep-related concerns and points towards additional educational resources.

Recommended Content:

Traumatic Brain Injury Center of Excellence | Patient and Family Resources | TBI Educators | Traumatic Brain Injury | Sleep | Brain Injury Awareness Toolkit

Sleep and TBI

Video
2/8/2021
DHA Seal

Sleep disturbances are common for service members and veterans following a mild TBI, also known as concussion.

Recommended Content:

Traumatic Brain Injury Center of Excellence | TBI Educators | Patient and Family Resources | Provider Resources | Traumatic Brain Injury | Brain Injury Awareness Toolkit | Brain Injury Awareness Toolkit | Total Force Fitness

2020 DoD Worldwide Numbers for TBI

Publication
1/28/2021

TBICoE is the Defense Department's office of responsibility for tracking traumatic brain injury data in the U.S. military. Here you'll find data on the number of active-duty service members—anywhere U.S. forces are located—with a first-time TBI diagnosis in calendar year 2020. The data is also broken down by each branch of the armed services.

Recommended Content:

DOD TBI Worldwide Numbers | Traumatic Brain Injury Center of Excellence | Traumatic Brain Injury
<< < 1 2 3 4 5  ... > >> 
Showing results 46 - 60 Page 4 of 15

DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101

Some documents are presented in Portable Document Format (PDF). A PDF reader is required for viewing. Download a PDF Reader or learn more about PDFs.