Effectiveness and harms of mental health treatments in service members and veterans with deployment-related mild traumatic brain injury

Princess E. Ackland, Nancy Greer, Nina A Sayer, Michele R. Spoont, Brent C Taylor, Roderick MacDonald, Lauren McKenzie, Christina Rosebush, Timothy J Wilt

Research output: Contribution to journalReview article

1 Citation (Scopus)

Abstract

Background: Co-morbidity of psychiatric conditions with traumatic brain injury (TBI) is common among service members and Veterans from recent deployments. Practice guidelines for mild TBI (mTBI) recommend management of co-occurring psychiatric conditions with existing treatments, but it is unclear whether the effectiveness of treatments for psychiatric conditions is impacted by mTBI. We conducted a systematic literature review to examine the effectiveness and harms of pharmacological and non-pharmacological treatments for posttraumatic stress disorder, depressive disorders, substance use disorders, suicidal ideation or attempts, and anxiety disorders in the presence of co-morbid deployment-related mTBI. Methods: We searched bibliographic databases for peer-reviewed, English language studies published from 2000 to October 2017. Two reviewers independently completed abstract triage and full text review. Results: We identified 7 studies (5 pre-post and 2 secondary analysis). Six assessed psychotherapy and one reported on hyperbaric oxygen therapy (HBO 2 ). Studies comparing outcomes by TBI history found that a history of TBI does not affect treatment outcomes. Harms were reported only for HBO 2 and were mild. No study examined the effectiveness of treatments for substance use disorders or suicidal ideation, or the effectiveness of pharmacological interventions for the psychiatric conditions of interest in service members and Veterans with mTBI. Limitations: Studies lacked usual care or wait-list control groups and no randomized trials were found, making the strength of evidence insufficient. Conclusions: Evidence is insufficient to fully assess the impact of TBI on the effectiveness of treatments for psychiatric conditions. Higher quality evidence with definitive guidance for providers treating this population is needed.

Original languageEnglish (US)
Pages (from-to)493-501
Number of pages9
JournalJournal of Affective Disorders
Volume252
DOIs
StatePublished - Jun 1 2019

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Brain Concussion
Veterans
Psychiatry
Mental Health
Suicidal Ideation
Substance-Related Disorders
Pharmacology
Bibliographic Databases
Therapeutics
Hyperbaric Oxygenation
Triage
Depressive Disorder
Post-Traumatic Stress Disorders
Anxiety Disorders
Practice Guidelines
Psychotherapy
Language
Outcome Assessment (Health Care)
Morbidity
Control Groups

Keywords

  • Mental health treatment
  • Service members
  • Traumatic brain injury
  • Veterans

Cite this

Effectiveness and harms of mental health treatments in service members and veterans with deployment-related mild traumatic brain injury. / Ackland, Princess E.; Greer, Nancy; Sayer, Nina A; Spoont, Michele R.; Taylor, Brent C; MacDonald, Roderick; McKenzie, Lauren; Rosebush, Christina; Wilt, Timothy J.

In: Journal of Affective Disorders, Vol. 252, 01.06.2019, p. 493-501.

Research output: Contribution to journalReview article

Ackland, Princess E. ; Greer, Nancy ; Sayer, Nina A ; Spoont, Michele R. ; Taylor, Brent C ; MacDonald, Roderick ; McKenzie, Lauren ; Rosebush, Christina ; Wilt, Timothy J. / Effectiveness and harms of mental health treatments in service members and veterans with deployment-related mild traumatic brain injury. In: Journal of Affective Disorders. 2019 ; Vol. 252. pp. 493-501.
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abstract = "Background: Co-morbidity of psychiatric conditions with traumatic brain injury (TBI) is common among service members and Veterans from recent deployments. Practice guidelines for mild TBI (mTBI) recommend management of co-occurring psychiatric conditions with existing treatments, but it is unclear whether the effectiveness of treatments for psychiatric conditions is impacted by mTBI. We conducted a systematic literature review to examine the effectiveness and harms of pharmacological and non-pharmacological treatments for posttraumatic stress disorder, depressive disorders, substance use disorders, suicidal ideation or attempts, and anxiety disorders in the presence of co-morbid deployment-related mTBI. Methods: We searched bibliographic databases for peer-reviewed, English language studies published from 2000 to October 2017. Two reviewers independently completed abstract triage and full text review. Results: We identified 7 studies (5 pre-post and 2 secondary analysis). Six assessed psychotherapy and one reported on hyperbaric oxygen therapy (HBO 2 ). Studies comparing outcomes by TBI history found that a history of TBI does not affect treatment outcomes. Harms were reported only for HBO 2 and were mild. No study examined the effectiveness of treatments for substance use disorders or suicidal ideation, or the effectiveness of pharmacological interventions for the psychiatric conditions of interest in service members and Veterans with mTBI. Limitations: Studies lacked usual care or wait-list control groups and no randomized trials were found, making the strength of evidence insufficient. Conclusions: Evidence is insufficient to fully assess the impact of TBI on the effectiveness of treatments for psychiatric conditions. Higher quality evidence with definitive guidance for providers treating this population is needed.",
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AU - Ackland, Princess E.

AU - Greer, Nancy

AU - Sayer, Nina A

AU - Spoont, Michele R.

AU - Taylor, Brent C

AU - MacDonald, Roderick

AU - McKenzie, Lauren

AU - Rosebush, Christina

AU - Wilt, Timothy J

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N2 - Background: Co-morbidity of psychiatric conditions with traumatic brain injury (TBI) is common among service members and Veterans from recent deployments. Practice guidelines for mild TBI (mTBI) recommend management of co-occurring psychiatric conditions with existing treatments, but it is unclear whether the effectiveness of treatments for psychiatric conditions is impacted by mTBI. We conducted a systematic literature review to examine the effectiveness and harms of pharmacological and non-pharmacological treatments for posttraumatic stress disorder, depressive disorders, substance use disorders, suicidal ideation or attempts, and anxiety disorders in the presence of co-morbid deployment-related mTBI. Methods: We searched bibliographic databases for peer-reviewed, English language studies published from 2000 to October 2017. Two reviewers independently completed abstract triage and full text review. Results: We identified 7 studies (5 pre-post and 2 secondary analysis). Six assessed psychotherapy and one reported on hyperbaric oxygen therapy (HBO 2 ). Studies comparing outcomes by TBI history found that a history of TBI does not affect treatment outcomes. Harms were reported only for HBO 2 and were mild. No study examined the effectiveness of treatments for substance use disorders or suicidal ideation, or the effectiveness of pharmacological interventions for the psychiatric conditions of interest in service members and Veterans with mTBI. Limitations: Studies lacked usual care or wait-list control groups and no randomized trials were found, making the strength of evidence insufficient. Conclusions: Evidence is insufficient to fully assess the impact of TBI on the effectiveness of treatments for psychiatric conditions. Higher quality evidence with definitive guidance for providers treating this population is needed.

AB - Background: Co-morbidity of psychiatric conditions with traumatic brain injury (TBI) is common among service members and Veterans from recent deployments. Practice guidelines for mild TBI (mTBI) recommend management of co-occurring psychiatric conditions with existing treatments, but it is unclear whether the effectiveness of treatments for psychiatric conditions is impacted by mTBI. We conducted a systematic literature review to examine the effectiveness and harms of pharmacological and non-pharmacological treatments for posttraumatic stress disorder, depressive disorders, substance use disorders, suicidal ideation or attempts, and anxiety disorders in the presence of co-morbid deployment-related mTBI. Methods: We searched bibliographic databases for peer-reviewed, English language studies published from 2000 to October 2017. Two reviewers independently completed abstract triage and full text review. Results: We identified 7 studies (5 pre-post and 2 secondary analysis). Six assessed psychotherapy and one reported on hyperbaric oxygen therapy (HBO 2 ). Studies comparing outcomes by TBI history found that a history of TBI does not affect treatment outcomes. Harms were reported only for HBO 2 and were mild. No study examined the effectiveness of treatments for substance use disorders or suicidal ideation, or the effectiveness of pharmacological interventions for the psychiatric conditions of interest in service members and Veterans with mTBI. Limitations: Studies lacked usual care or wait-list control groups and no randomized trials were found, making the strength of evidence insufficient. Conclusions: Evidence is insufficient to fully assess the impact of TBI on the effectiveness of treatments for psychiatric conditions. Higher quality evidence with definitive guidance for providers treating this population is needed.

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