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Advanced Neurology TBI and depression by veteran status

Veterans are a unique subpopulation with cumulative definitive conclusion regarding the presence and severity
exposure to multiple stressors including blast injury, long of depression among study participants. Second, all the
overseas deployment, and other psychological stressors, data included in the analysis are self-reported and cross-
that coupled with TBI may exacerbate depression sectional, making them susceptible to information or recall
among veterans. Veterans Affairs initiatives such as bias. For example, participants were asked about whether
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telepsychiatry and trauma informed therapy could lessen they had suffered significant brain injury or concussion in
the psychological impacts post-TBI and reduce depression their lifetime. Injuries sustained in early life might not be
incidence among veterans. 32,33 reported properly, and the definition of “significant brain
Policy makers and health care providers should injury” might be open to interpretation. Finally, brain
consider implementing longitudinal surveillance due to injuries were reported on a lifetime basis but excludes recent
the unpredictable and often late-onset nature of depressive TBI incidents, along with source and severity of the injury.
symptoms post-TBI. Patients should be monitored over a Further research is warranted to investigate how these TBI
long period of time, and health records should be stored characteristics may influence mental health. Nonetheless,
electronically. 32,33 There should be a policy where the measurement of lifetime TBI history strengthens our
Department of Defense, Department of Veterans Affairs, findings by lending temporality to our analysis of the
and public health agencies relating to veteran health association between TBI and depression. In addition, the
should operate on a common platform where they can cross-sectional nature of the study design does not allow
share data across providers to ensure continuity of care and us to establish causality between TBI and depression, even
identification of each high-risk individual. 34,35 though TBI is often associated with increased prevalence

At the federal level, the government should allocate of mental health issues and health resource utilization. 40
sufficient funds for treatment and prevention of TBI Despite these limitations, we analyzed a large nationally
associated depression. At present, there is a shortage of representative U.S. sample and applied a rigorous analysis
staff and services geared toward minimizing post-TBI adjusting for many possible covariates that may confound
sequelae among affected individuals. Non-governmental the association between TBI and depression.
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organizations dealing with mental health issues should also 5. Conclusion
come forward and include post-TBI depression prevention
in their organizational framework. While treatment and Our study sheds light on the association between TBI and
management of post-TBI depression warrants significant depression in the general population, as well as veterans.
resources, efforts should also be directed toward The findings of our study reveal that veterans with head
formulation and implementation of preventive strategies. injuries are more susceptible to depression compared to
Approaches such as an evidence-based resilience training, the general population. This establishes veterans as priority
a post-deployment debriefing program, and a peer support groups for future intervention programs aimed at reducing
network could be adopted to reduce post TBI morbidity the burden of depression among the U.S. population.
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in addition to traditional psychotherapies such as CBT.
Furthermore, a large scale destigmatization program should Acknowledgments
be conducted among both military individuals and civilians None.
regarding mental health treatment, as stigmatization is
hitherto a significant barrier to accessing care. Finally, Funding
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people of color as well as individuals from socioeconomically
disadvantaged backgrounds traditionally face significant None.
hurdles while accessing mental health care. Ensuring equal Conflict of interest
opportunity and equity of access for all the people would be
a key determinant while seeking successful outcomes at the The authors declare that they have no competing interests.
population level. 39
There are several limitations to our study. First, the Author contributions
two-item questionnaire used to screen for depression Conceptualization: All authors
is not a clinical depression diagnosis among study Formal analysis: Md Maruf Ahmed Molla
participants. This is originally part of a larger PHQ-8 Investigation: Md Maruf Ahmed Molla
questionnaire that also commonly screens for depression. Methodology: All authors
While the two-item questionnaire was tested for sensitivity Writing–original draft: Md Maruf Ahmed Molla
and specificity, further evaluation is required to reach a Writing–review & editing: All authors

Volume 4 Issue 3 (2025) 75 doi: 10.36922/AN025050008