The impact of multiple concussions on emotional distress, post-concussive symptoms, and neurocognitive functioning in active duty United States marines independent of combat exposure or emotional distress
Open accessAbstract
Controversy exists as to whether the lingering effects of concussion on emotional, physical, and cognitive symptoms is because of the effects of brain trauma or purely to emotional factors such as post-traumatic stress disorder or depression. This study examines the independent effects of concussion on persistent symptoms. The Defense Automated Neurobehavioral Assessment, a clinical decision support tool, was used to assess neurobehavioral functioning in 646 United States Marines, all of whom were fit for duty. Marines were assessed for concussion history, post-concussive symptoms, emotional distress, neurocognitive functioning, and deployment history. Results showed that a recent concussion or ever having experienced a concussion was associated with an increase in emotional distress, but not with persistent post-concussive symptoms (PPCS) or neurocognitive functioning. Having had multiple lifetime concussions, however, was associated with greater emotional distress, PPCS, and reduced neurocognitive functioning that needs attention and rapid discrimination, but not for memory-based tasks. These results are independent of deployment history, combat exposure, and symptoms of post-traumatic stress disorder and depression. Results supported earlier findings that a previous concussion is not generally associated with post-concussive symptoms independent of covariates. In contrast with other studies that failed to find a unique contribution for concussion to PPCS, however, evidence of recent and multiple concussion was seen across a range of emotional distress, post-concussive symptoms, and neurocognitive functioning in this study population. Results are discussed in terms of implications for assessing concussion on return from combat.
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The third finding, on the effects of recurrent injuries, is broadly consistent with the emerging literature on the adverse consequences of sports and combat-related neurotrauma.
“Our third finding, on the effects of recurrent injuries, is broadly consistent with the emerging literature on the adverse consequences of sports and combat-related neurotrauma [7,9,11–14,46–49].”
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- Authors
- Spira, J. L., Lathan, C. E., Bleiberg, J., & Tsao, J. W.
- Affiliations
- University of Hawaiʻi at Mānoa (US)
- AnthroTronix (United States) (US)
- Walter Reed National Military Medical Center (US)
- Bureau of Medicine and Surgery (US)
- Corresponding author
- Spira, James L.
- Venue
- Journal of Neurotrauma
- Publisher
- SAGE Publications
- Published
- 2014-11
- Volume
- 31
- Issue
- 22
- Pages
- 1823-1834
- ISSN
- 0897-7151 (ISSN-L)
- 1557-9042
- PMC
- PMC4224036
- OpenAlex
- W2072535152
- Cited by
- 79
- References
- 58
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 2 · 2023: 5 · 2022: 2 · 2021: 10 · 2020: 8 · 2019: 13 · 2018: 9 · 2017: 15 · 2016: 6 · 2015: 6
- FWCI
- 6.82
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Journal of Neurotrauma (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- U.S. Department of Defense
- U.S. Department of Veterans Affairs
- U.S. Navy
- National Center for PTSD, U.S. Department of Veterans Affairs
- Bureau of Medicine and Surgery
- Topics
- Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
- Health Sciences › Medicine › Neurology › Long-Term Effects of COVID-19
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Keywords
- multiple concussions, post-concussion symptoms, emotional distress, neurocognitive function, United States Marines, combat exposure, post-traumatic stress disorder, depression, memory, military personnel
- MeSH terms
- Adult, Affective Symptoms, Brain Concussion, Cognition, Female, Humans, Male, Military Personnel, Neuropsychological Tests, United States, Post-Concussion Syndrome, Young Adult
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