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J Head Trauma Rehabil. 2015 Jul-Aug;30(4):E21-8. doi: 10.1097/HTR.0000000000000065.

The Relationship Between Postconcussive Symptoms and Quality of Life in Veterans With Mild to Moderate Traumatic Brain Injury.

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  • 1VA San Diego Healthcare System (VASDHS), San Diego, California (Drs Schiehser, Twamley, Jak, Hanson, Delano-Wood, and Filoteo, and Ms Matevosyan); Departments of Psychiatry (Drs Schiehser, Twamley, Jak, Hanson, Delano-Wood, Filoteo and Orff) and Family and Preventive Medicine (Dr Liu), School of Medicine, University of California San Diego, La Jolla, California; Center of Excellence for Stress and Mental Health, VASDHS, San Diego, California (Drs Twamley, Jak, Hanson, Delano-Wood and Orff); and VA Puget Sound Health Care System, Seattle, Washington (Dr Sorg).



To assess the relationship between postconcussive symptoms and quality of life (QOL) in Veterans with mild to moderate traumatic brain injury (TBI).


Sixty-one Operation Enduring Freedom/Operation Iraqi Freedom/Persian Gulf War Veterans with a history of mild or moderate TBI, more than 6 months postinjury, and 21 demographically matched Veteran controls were administered self-report measures of QOL (World Health Organization Quality of Life-BREF) and postconcussive symptom severity (Neurobehavioral Symptom Inventory).


Perceived QOL was significantly worse in Veterans with mild-moderate TBI than in controls. In the TBI group, QOL was predominantly associated with affective symptoms, and moderate to strong correlations with fatigue and depression were evident across all QOL areas. Multivariate analyses revealed depression and fatigue to be the best predictors of Psychological, Social, and Environmental QOL, whereas sleep difficulty best predicted Physical QOL in mild-moderate TBI.


Veterans with post-acute mild-moderate TBI evidence worse QOL than demographically matched Veteran controls. Affective symptoms, and specifically those of fatigue, depression, and sleep difficulty, appear to be the most relevant postconcussive symptoms predicting QOL in this population. These findings underscore the importance of examining specific symptoms as they relate to post-acute TBI QOL and provide guidance for treatment and intervention studies.

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