The Development of Posttraumatic Stress Disorder after Mild Traumatic Brain Injury in Civilian Populations: A Meta-Analysis

Abstract

Background: Posttraumatic stress disorder (PTSD) is an anxiety disorder following exposure to a traumatic event. Recent studies demonstrate that mild traumatic brain injury (mTBI) is strongly associated with PTSD among soldiers returning from Iraq. However, the effect of mTBI on development of PTSD in civilian populations is quite controversial. The study is aimed at identifying whether mTBI contributes to an increased risk of PTSD in civilian populations as it happens in the service members. Methods: A comprehensive search of literature was undertaken in order to identify published studies on PTSD associated with mTBI. mTBI was defined according to the American Congress of Rehabilitation Medicine (ACRM). PTSD was operationalized as the presence of symptoms consistent with those defined by the Diagnostic and Statistical Manual of Mental Disorders. The effect of mTBI on the development of PTSD was assessed with odds ratio (OR) with 95% confidence intervals (CIs). Results: The pooled data consisted of 1222 mTBI patients and 1468 general trauma participants. 14% of mTBI patients reported PTSD, and 9% of general trauma patients developed PTSD. Or of the pooled studies indicates a 61% increase in the prevalence of PTSD, suggesting that mTBI might increase the risk of development of PTSD in civilian settings (or 1.61, 95% CI 1.25-2.06. p=0.0002, I2=0%). The occurrence of PTSD was not significantly different among 3-months, 6-months and 12-months follow up subgroups (p=0.28). A sensitivity analysis shows the results are affected by sequential exclusion of study reported by Bryant et al. (2010). When Bryant et al. data were removed, OR of the other six studies demonstrates that the prevalence of PTSD in mTBI and general trauma groups doesn’t significantly differ (OR 1.30, 95% CI 0.88-1.93. p=0.19, I2=0%). The study from Bryant et al contributed 57% of patients to overall data, which was derived from four levels I trauma centers across three states in Australia. Conclusion: Our data indicate that mTBI patients are more prone to develop PTSD than general trauma patients without mTBI in civilian settings.