Influence of cognitive functioning on the effectiveness of treatment of veterans with post-traumatic stress disorder and mild traumatic brain injury

Abstract

A history of traumatic brain injury in veterans is associated with higher use of mental health services, regardless of psychiatric diagnoses, which makes it important to develop a comprehensive approach to treatment and evaluate its effectiveness. The study aimed to investigate the impact of cognitive functioning among 329 veterans with comorbid post-traumatic stress disorder and mild traumatic brain injury on the effectiveness of combination therapy. The following tests were used to assess cognitive functioning: the Ray-Osterritz test, the Symbolic Communication Test, the Stroop test, and the Verbal Fluency Test. Functioning was assessed using the World Health Organization Questionnaire for the Assessment of Disability. The effectiveness of the combination therapy was also assessed using the Four-Dimensional Symptom Inventory. The influence of cognitive functioning on the effectiveness of 8-week complex therapy for veterans with this comorbidity was confirmed. The results of the Trail Making Test had statistically significant negative correlations with the cognitive sphere scale (ρ = -0.237; p = 0.0117) and the integral index of the World Health Organization questionnaire for the assessment of disability (ρ= -0.192; p = 0.0424), as well as positive correlations with the scales of self-care (ρ = 0.2038; p = 0.0311) and daily activity (ρ = 0.2048; p = 0.0303). It was found that patients with post-traumatic stress disorder, mild traumatic brain injury and their comorbidity responded differently to therapy, which was determined by the clinical features of their cognitive processes, namely associative performance, control rigidity/flexibility, attention, working memory and executive function. The dynamics of cognitive functioning differed in each group. It was also found that cognitive symptoms were targeted by therapy, as evidenced by their reduction after the intervention. The data obtained will allow for a more efficient and comprehensive organization of specialised psychiatric care for veterans, and cognitive functioning is predictive of the effectiveness and duration of treatment