Prospective Longitudinal Evaluation of the Effect of Deployment-Acquired Traumatic Brain Injury on Posttraumatic Stress and Related Disorders: Results From the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS)

Stein, Murray B.; Kessler, Ronald C.; Heeringa, Steven G.; Jain, Sonia; Campbell-Sills, Laura; Colpe, Lisa J.; Fullerton, Carol S.; Nock, Matthew K.; Sampson, Nancy A.; Schoenbaum, Michael; Sun, Xiaoying; Thomas, Michael L.; Ursano, Robert J.; On behalf of the Army STARRS collaborators

doi:10.1176/appi.ajp.2015.14121572

Cited by 162Traumatic Brain Injury ResearchPosttraumatic Stress Disorder ResearchOccupational Health and Performance

Prospective Longitudinal Evaluation of the Effect of Deployment-Acquired Traumatic Brain Injury on Posttraumatic Stress and Related Disorders: Results From the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS)

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Stein, Murray B., Kessler, Ronald C., Heeringa, Steven G., Jain, Sonia, Campbell-Sills, Laura, Colpe, Lisa J., Fullerton, Carol S., Nock, Matthew K. +6 more·2015·American Journal of Psychiatry

DOI 10.1176/appi.ajp.2015.14121572PMC PMC5125442

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Abstract

OBJECTIVE: Traumatic brain injury (TBI) is increasingly recognized as a risk factor for deleterious mental health and functional outcomes. The purpose of this study was to examine the strength and specificity of the association between deployment-acquired TBI and subsequent posttraumatic stress and related disorders among U.S. Army personnel. METHOD: A prospective, longitudinal survey of soldiers in three Brigade Combat Teams was conducted 1-2 months prior to an average 10-month deployment to Afghanistan (T0), upon redeployment to the United States (T1), approximately 3 months later (T2), and approximately 9 months later (T3). Outcomes of interest were 30-day prevalence postdeployment of posttraumatic stress disorder (PTSD), major depressive episode, generalized anxiety disorder, and suicidality, as well as presence and severity of postdeployment PTSD symptoms. RESULTS: Complete information was available for 4,645 soldiers. Approximately one in five soldiers reported exposure to mild (18.0%) or more-than-mild (1.2%) TBI(s) during the index deployment. Even after adjusting for other risk factors (e.g., predeployment mental health status, severity of deployment stress, prior TBI history), deployment-acquired TBI was associated with elevated adjusted odds of PTSD and generalized anxiety disorder at T2 and T3 and of major depressive episode at T2. Suicidality risk at T2 appeared similarly elevated, but this association did not reach statistical significance. CONCLUSIONS: The findings highlight the importance of surveillance efforts to identify soldiers who have sustained TBIs and are therefore at risk for an array of postdeployment adverse mental health outcomes, including but not limited to PTSD. The mechanism(s) accounting for these associations need to be elucidated to inform development of effective preventive and early intervention programs.

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There is a high prevalence of MDE and GAD among service members.
“Additionally, there is a high prevalence of MDE and GAD among service members (Kessler et al. 2014; Rosellini et al. 2015; Stein et al. 2015) which have been associated with substantial morbidity and severe role impairment (Rosellini et al. 2015).”
From Childhood adversity, adult stress, and the risk of major depression or generalized anxiety disorder in US soldiers: a test of the stress sensitization hypothesis (2017) · cites this paper as Stein et al. 2015

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Combat exposure, posttraumatic stress disorder, and head injuries differentially relate to alterations in cortical thickness in military Veterans
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Efficacy of an Interdisciplinary Intensive Outpatient Program in Treating Combat-Related Traumatic Brain Injury and Psychological Health Conditions
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Prospective associations of perceived unit cohesion with postdeployment mental health outcomes
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Behavioral and Health Outcomes Associated With Deployment and Nondeployment Acquisition of Traumatic Brain Injury in Iraq and Afghanistan Veterans
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Association Between 5-Year Clinical Outcome in Patients With Nonmedically Evacuated Mild Blast Traumatic Brain Injury and Clinical Measures Collected Within 7 Days Postinjury in Combat
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Mental Health Outcomes Among Military Service Members After Severe Injury in Combat and TBI
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A prospective study to determine the clinical utility of pharmacogenetic testing of veterans with treatment-resistant depression
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Modern Approaches to Pediatric Brain Injury Therapy
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Fear learning alterations after traumatic brain injury and their role in development of posttraumatic stress symptoms
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Comprehensive analysis of the predictors of neurobehavioral symptom reporting in veterans
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Neurocognitive and Information Processing Biases in Posttraumatic Stress Disorder
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Bumetanide Prevents Brain Trauma-Induced Depressive-Like Behavior
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The influence of deployment stress and life stress on Post-Traumatic Stress Disorder (PTSD) diagnosis among military personnel
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Prospective study of polygenic risk, protective factors, and incident depression following combat deployment in US Army soldiers
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An Update on the Complexity and Importance of Accurately Diagnosing Post-Traumatic Stress Disorder and Comorbid Traumatic Brain Injury
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Emotion Dysregulation in Comorbid Posttraumatic Stress Disorder and Substance Use Disorders: A Narrative Review
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Neuroimaging Biomarkers of New-Onset Psychiatric Disorders Following Traumatic Brain Injury
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Impact of PTSD on post-concussive symptoms, neuropsychological functioning, and pain in post-9/11 veterans with mild traumatic brain injury
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Increased Small-World Network Topology Following Deployment-Acquired Traumatic Brain Injury Associated with the Development of Post-Traumatic Stress Disorder
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Development and Validation of a Machine Learning Prediction Model of Posttraumatic Stress Disorder After Military Deployment
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Lifetime Prevalence and Comorbidity of Mental Disorders in the Two-wave 2002–2018 Canadian Armed Forces Members and Veterans Mental Health Follow-up Survey (CAFVMHS): Prévalence et Comorbidité de Durée de vie Des Troubles Mentaux Dans l’Enquête de Suivi Sur la Santé Mentale Auprès des Membres des Forces Armées Canadiennes et Des ex-Militaires (ESSMFACM) en Deux Cycles de 2002 à 2018
Sareen, J., Bolton, J. M., Mota, N. P., Afifi, T. O., Enns, M. W., Taillieu, T., Stewart-Tufescu, A., El-Gabalawy, R. M., Marrie, R. A., Richardson, J. D., et al. (2021) · The Canadian Journal of Psychiatry · doi:10.1177/07067437211000636 · Cited by 28 · see citing works
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Traumatic brain injury in a community-based cohort of homeless and vulnerably housed individuals
Schmitt, T., Thornton, A. E., Rawtaer, I., Barr, A. M., Gicas, K. M., Lang, D. J., Vertinsky, A. T., Rauscher, A., Procyshyn, R. M., Buchanan, T., et al. (2017) · Journal of Neurotrauma · doi:10.1089/neu.2017.5076 · Cited by 27 · see citing works
3D printing collagen/heparin sulfate scaffolds boost neural network reconstruction and motor function recovery after traumatic brain injury in canine
Jiang, J., Liu, X., Chen, H., Dai, C., Niu, X., Dai, L., Chen, X., & Zhang, S. (2020) · Biomaterials Science · doi:10.1039/d0bm01116a · Cited by 27 · see citing works
Association of day-of-injury plasma glial fibrillary acidic protein concentration and six-month posttraumatic stress disorder in patients with mild traumatic brain injury
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Risk Factors for Mild Traumatic Brain Injury and Subsequent Post-Traumatic Stress Disorder and Mental Health Disorders among United States Army Soldiers
Scofield, D. E., Proctor, S. P., Kardouni, J. R., Hill, O. T., & McKinnon, C. J. (2017) · Journal of Neurotrauma · doi:10.1089/neu.2017.5101 · Cited by 27 · see citing works
3D printing of injury-preconditioned secretome/collagen/heparan sulfate scaffolds for neurological recovery after traumatic brain injury in rats
Liu, X., Chang, Z., Chen, C., Liang, J., Shi, J., Xiu, F., Shao, Q., Meng, W.-W., Wang, J., & Li, X. (2022) · Stem Cell Research & Therapy · doi:10.1186/s13287-022-03208-0 · Cited by 26 · see citing works
Psychoeducation as Precision Health in Military-Related Mild Traumatic Brain Injury
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Reduced prefrontal MEG alpha-band power in mild traumatic brain injury with associated posttraumatic stress disorder symptoms
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PTSD, but not history of mTBI, is associated with altered myelin in combat-exposed Iraq and Afghanistan Veterans
Jak, A. J., Jurick, S. M., Hoffman, S., Evangelista, N. D., DeFord, N. E., Keller, A. V., Merritt, V. C., Sanderson‐Cimino, M. E., Sorg, S. F., Delano‐Wood, L., et al. (2020) · The Clinical Neuropsychologist · doi:10.1080/13854046.2020.1730975 · Cited by 25 · see citing works
Smaller Regional Brain Volumes Predict Posttraumatic Stress Disorder at 3 Months After Mild Traumatic Brain Injury
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Emerging Approaches to Neurocircuits in PTSD and TBI: Imaging the Interplay of Neural and Emotional Trauma
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Resilience Among Caregivers of Injured Service Members: Finding the Strengths in Caregiving
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The Impact of Exercise and Virtual Reality Executive Function Training on Cognition Among Heavy Drinking Veterans With Traumatic Brain Injury: A Pilot Feasibility Study
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Suicidal Ideation After Mild Traumatic Brain Injury: A Consecutive Canadian Sample
Bethune, A., Costa, L. D. S., van Niftrik, C. H. B., & Feinstein, A. (2016) · Archives of Suicide Research · doi:10.1080/13811118.2016.1199990 · Cited by 22 · see citing works
Concerns Over Divergent Approaches in the Diagnostics of Posttraumatic Stress Disorder
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Polygenic risk for mental disorders as predictors of posttraumatic stress disorder after mild traumatic brain injury
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Alterations in the Topology of Functional Connectomes Are Associated with Post-Traumatic Stress Disorder and Blast-Related Mild Traumatic Brain Injury in Combat Veterans
Rowland, J. A., Stapleton-Kotloski, J. R., Martindale, S. L., Rogers, E., Ord, A. S., Godwin, D. W., & Taber, K. H. (2021) · Journal of Neurotrauma · doi:10.1089/neu.2020.7450 · Cited by 18 · see citing works
Post-traumatic stress disorder is associated with altered modulation of prefrontal alpha band oscillations during working memory
Popescu, M., Popescu, E.-A., DeGraba, T. J., Fernandez-Fidalgo, D. J., Riedy, G. P., & Hughes, J. (2019) · Clinical Neurophysiology · doi:10.1016/j.clinph.2019.06.227 · Cited by 19 · see citing works
The Buffering Effect of Relationships on Combat Exposure, Military Performance, and Mental Health of U.S. Military Soldiers: A Vantage Point for CFTs
Reed‐Fitzke, K., & Lucier‐Greer, M. (2019) · Journal of Marital and Family Therapy · doi:10.1111/jmft.12402 · Cited by 19 · see citing works
Comparison of Clinical Outcomes 1 and 5 Years Post-Injury Following Combat Concussion
Donald, C. L. M., Barber, J. K., Patterson, J., Johnson, A. M., Parsey, C. M., Scott, B. R., Fann, J. R., & Temkin, N. R. (2020) · Neurology · doi:10.1212/wnl.0000000000011089 · Cited by 18 · see citing works
Assessment of Neuropsychological Function in Veterans With Blast-Related Mild Traumatic Brain Injury and Subconcussive Blast Exposure
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Association between Altered Cortisol Profiles and Neurobehavioral Impairment after Mild Traumatic Brain Injury in College Students
Villegas, E., Hartsock, M. J., Aben, B. L. L. G., Lenahan, K. N., Hernández, T. D., & Spencer, R. L. (2022) · Journal of Neurotrauma · doi:10.1089/neu.2021.0495 · Cited by 18 · see citing works
Symptoms of major depressive disorder and post-traumatic stress disorder in veterans with mild traumatic brain injury: A network analysis
Shi, S., Almklov, E., Afari, N., & Pittman, J. O. E. (2023) · PLoS ONE · doi:10.1371/journal.pone.0283101 · Cited by 18 · see citing works
Postconcussion symptom reporting is not associated with diffusion tensor imaging findings in the subacute to chronic phase of recovery in military service members following mild traumatic brain injury
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Neuroimaging Correlates of Post-Traumatic Stress Disorder in Traumatic Brain Injury: A Systematic Review of the Literature
Esagoff, A. I., Stevens, D. A., Kosyakova, N., Woodard, K. F., Jung, D., Richey, L. N., Daneshvari, N. O., Luna, L., Bray, M. J. C., Bryant, B. R., et al. (2022) · Journal of Neurotrauma · doi:10.1089/neu.2021.0453 · Cited by 17 · see citing works
Attention Deficit Hyperactivity Disorder and Risk of Posttraumatic Stress and Related Disorders: A Prospective Longitudinal Evaluation in U.S. Army Soldiers
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The Functional Connectome and Long-Term Symptom Presentation Associated With Mild Traumatic Brain Injury and Blast Exposure in Combat Veterans
Rowland, J. A., Stapleton-Kotloski, J. R., Godwin, D. W., Hamilton, C. A., & Martindale, S. L. (2024) · Journal of Neurotrauma · doi:10.1089/neu.2023.0315 · Cited by 16 · see citing works
Hyperarousal symptoms and decreased right hemispheric frontolimbic white matter integrity predict poorer sleep quality in combat-exposed veterans
Bottari, S. A., Lamb, D. G., Murphy, A. J., Porges, E. C., Rieke, J. D., Harciarek, M., Datta, S., & Williamson, J. B. (2021) · Brain Injury · doi:10.1080/02699052.2021.1927186 · Cited by 15 · see citing works
Recent advances in theranostic nanomaterials for overcoming traumatic brain injury
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Does Blast Mild Traumatic Brain Injury Have an Impact on PTSD Severity? A Systematic Review and Meta-Analysis
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Altered lateralization of the cingulum in deployment‐related traumatic brain injury: An ENIGMA military‐relevant brain injury study
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Brain Amygdala Volume Increases in Veterans and Active-Duty Military Personnel With Combat-Related Posttraumatic Stress Disorder and Mild Traumatic Brain Injury
Pieper, J., Chang, D. G., Mahasin, S., Robb, A., Angeles‐Quinto, A., Nichols, S., Diwakar, M., Huang, C. W., Swan, J., Lee, R. R., et al. (2019) · Journal of Head Trauma Rehabilitation · doi:10.1097/htr.0000000000000492 · Cited by 13 · see citing works
Altered modulation of beta band oscillations during memory encoding is predictive of lower subsequent recognition performance in post-traumatic stress disorder
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Deployment and Psychological Correlates of Suicide Ideation: A Prospective, Longitudinal Study of Risk and Resilience Among Combat Veterans
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Long-term negative emotional outcomes of warzone TBI
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Low resilience following traumatic brain injury is strongly associated with poor neurobehavioral functioning in U.S. military service members and veterans
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Postconcussive, posttraumatic stress and depressive symptoms in recently deployed U.S. Army soldiers with traumatic brain injury.
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Examining associations between montage painting imagery and symptoms of depression and posttraumatic stress among active-duty military service members.
Kaimal, G., Walker, M. S., Herres, J. L., Berberian, M., & DeGraba, T. J. (2020) · Psychology of Aesthetics Creativity and the Arts · doi:10.1037/aca0000316 · Cited by 11 · see citing works
Peritraumatic Context and Long-Term Outcomes of Concussion
Etten, E. J. V., Knight, A. R., Colaizzi, T. A., Carbaugh, J., Kenna, A. C., Fortier, C. B., & Milberg, W. (2025) · JAMA Network Open · doi:10.1001/jamanetworkopen.2024.55622 · Cited by 10 · see citing works
The Association of Lifetime and Deployment-Acquired Traumatic Brain Injury With Postdeployment Binge and Heavy Drinking
Adams, R. S., Campbell‐Sills, L., Stein, M. B., Sun, X., Larson, M. J., Kessler, R. C., Ursano, R. J., Jain, S., & Corrigan, J. D. (2019) · Journal of Head Trauma Rehabilitation · doi:10.1097/htr.0000000000000508 · Cited by 10 · see citing works
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The Appalachia Mind Health Initiative (AMHI): a pragmatic randomized clinical trial of adjunctive internet-based cognitive behavior therapy for treating major depressive disorder among primary care patients
Bossarte, R. M., Kessler, R. C., Nierenberg, A. A., Chattopadhyay, A., Cuijpers, P. J., Enrique, Á., Foxworth, P. M., Gildea, S. M., Belnap, B. H., Haut, M. W., et al. (2022) · Trials · doi:10.1186/s13063-022-06438-y · Cited by 9 · see citing works
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Posttraumatic stress symptomatology and abnormal neural responding during emotion regulation under cognitive demands: mediating effects of personality
Sun, M., Marquardt, C. A., Disner, S. G., Burton, P. C., Davenport, N. D., Lissek, S., & Sponheim, S. R. (2020) · Personality Neuroscience · doi:10.1017/pen.2020.10 · Cited by 9 · see citing works
Contextual Effects of Traumatic Brain Injury on the Connectome: Differential Effects of Deployment- and Non–Deployment-Acquired Injuries
Rowland, J. A., Stapleton-Kotloski, J. R., Rogers, E., Taber, K. H., Godwin, D. W., & Martindale, S. L. (2022) · Journal of Head Trauma Rehabilitation · doi:10.1097/htr.0000000000000803 · Cited by 9 · see citing works
Disturbances in fear extinction learning after mild traumatic brain injury in mice are accompanied by alterations in dendritic plasticity in the medial prefrontal cortex and basolateral nucleus of the amygdala
Babb, J. A., Zuberer, A., Heinrichs, S. C., Rumbika, K. K., Alfiler, L., Lakis, G. A., Leite‐Morris, K. A., & Kaplan, G. B. (2023) · Brain Research Bulletin · doi:10.1016/j.brainresbull.2023.04.001 · Cited by 8 · see citing works
The Psychological Impact of Exposure to Battle on Medics: A Cross-Sectional Study of Ex-Soldiers Who Sought Help From the IDF Combat Reaction Unit
Shelef, L., Bechor, U., Ohayon, O., Tatsa-Laur, L., & Antonovsky, A. (2023) · Military Medicine · doi:10.1093/milmed/usad368 · Cited by 8 · see citing works
The 2016 AANS Presidential Address: Leading the way
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Is the Military’s Century-Old Frontline Psychiatry Policy Harmful to Veterans and Their Families? Part Three of a Systematic Review
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Retrospective Case Series of Traumatic Brain Injury and Post-Traumatic Stress Disorder Treated with Hyperbaric Oxygen Therapy
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Cytokine Profiles Differentiate Symptomatic from Asymptomatic PTSD in Service Members and Veterans with Chronic Traumatic Brain Injury
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Medical-encounter mental health diagnoses, non-fatal injury and polypharmacy indicators of risk for accident death in the US Army enlisted soldiers, 2004–2009
Lewandowski-Romps, L. M., Schroeder, H. M., Berglund, P. A., Colpe, L. J., Cox, K., Hauret, K. G., Hay, J. D., Jones, B. H., Little, R. J. A., Mitchell, C. M., et al. (2017) · Preventive Medicine · doi:10.1016/j.ypmed.2017.11.016 · Cited by 7 · see citing works
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Voluntary Exercise to Reduce Anxiety Behaviour in Traumatic Brain Injury Shown to Alleviate Inflammatory Brain Response in Mice
Hu, X.-X., Ou, Y., Li, J.-S., Sun, M., Ge, Q., Pan, Y., Cai, Z., Tan, R.-L., Wang, W., An, J., et al. (2023) · International Journal of Molecular Sciences · doi:10.3390/ijms24076365 · Cited by 9 · see citing works
Symptoms of Posttraumatic Stress Rather Than Mild Traumatic Brain Injury Best Account for Altered Emotional Responses in Military Veterans
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Traumatic Brain Injury and Accelerated Epigenetic Aging Among Post-9/11 Veterans
Bourassa, K. J., Martindale, S. L., Garrett, M. E., Ashley‐Koch, A. E., Beckham, J. C., Kimbrel, N. A., & Rowland, J. A. (2025) · Journal of Head Trauma Rehabilitation · doi:10.1097/htr.0000000000001096 · Cited by 6 · see citing works

Association Between Traumatic Brain Injury and Risk of Posttraumatic Stress Disorder in Active-Duty Marines
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Authors: Stein, M. B., Kessler, R. C., Heeringa, S. G., Jain, S., Campbell-Sills, L., Colpe, L. J., Fullerton, C. S., Nock, M. K., Sampson, N. A., Schoenbaum, M., Sun, X., Thomas, M. L., Ursano, R. J., & collaborators, O. B. O. T. A. S.
Affiliations: University of Michigan (US)
From the Department of Psychiatry, University of California San Diego, La Jolla, Calif.; the Department of Family Medicine and Public Health, University of California San Diego, La Jolla, Calif.; the VA San Diego Healthcare System, San Diego; the Department of Health Care Policy, Harvard Medical School, Boston; the University of Michigan, Institute for Social Research, Ann Arbor, Mich.; the National Institute of Mental Health, Bethesda, Md.; the Center for the Study of Traumatic Stress, Department of...
ORCID: Stein, Murray B.
Kessler, Ronald C.
Heeringa, Steven G.
Jain, Sonia
Colpe, Lisa J.
Nock, Matthew K.
Sampson, Nancy A.
Schoenbaum, Michael
Thomas, Michael L.
Ursano, Robert J.
Venue: American Journal of Psychiatry
Publisher: American Psychiatric Association Publishing
Published: 2015-11-01
Volume: 172
Issue: 11
Pages: 1101-1111
ISSN: 0002-953X (ISSN-L)
1535-7228
DOI: 10.1176/appi.ajp.2015.14121572
PMC: PMC5125442
OpenAlex: W2098752569
Cited by: 161
References: 40
Citations by year: 2026: 10 · 2025: 15 · 2024: 6 · 2023: 13 · 2022: 16 · 2021: 16 · 2020: 11 · 2019: 21 · 2018: 23 · 2017: 15 · 2016: 9 · 2015: 2 · 2014: 1
FWCI: 12.82
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Locations: American Journal of Psychiatry (publishedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
Funders: U.S. Department of Defense
U.S. Department of Health and Human Services
Pfizer
F. Hoffmann-La Roche
School of Medicine, Boston University
University of Pittsburgh
King's College London
Uniformed Services University of the Health Sciences
University of California, San Diego
National Institute of Mental Health (U01MH087981)
Topics: Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
Health Sciences › Health Professions › Occupational Therapy › Occupational Health and Performance
Keywords: post-traumatic stress disorder, major depressive episode, generalized anxiety disorder, suicidality, military personnel, Army STARRS, redeployment, Afghanistan deployment, mental health risk factors
MeSH terms: Adult, Anxiety Disorders, Brain Concussion, Brain Injuries, Depressive Disorder, Major, Major Depressive Disorder, Female, Humans, Longitudinal Studies, Male, Military Personnel, Prospective Studies, Sex Factors, Stress Disorders, Post-Traumatic, Suicide, Attempted, United States, Cohort Studies, Trauma Severity Indices, Prevalence, Logistic Models, Young Adult, Afghan Campaign 2001-, Suicidal Ideation, Occupational Injuries

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Prospective Longitudinal Evaluation of the Effect of Deployment-Acquired Traumatic Brain Injury on Posttraumatic Stress and Related Disorders: Results From the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS)

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