PHILADELPHIA—Between 60% and 70% of veterans of the wars in Iraq and Afghanistan who screened positive for traumatic brain injury (TBI) have symptoms of pseudobulbar affect (PBA), according to data presented at the 66th Annual Meeting of the American Academy of Neurology. Compared with those without PBA symptoms, veterans with PBA symptoms have higher rates of depression and post-traumatic stress disorder (PTSD) and use antidepressants, opioids, sedatives, and antiepileptic drugs more often.
Jennifer R. Fonda, a researcher at the Translational Research Center for Traumatic Brain Injury and Stress Disorders in the Veterans Affairs (VA) Boston Healthcare System, and colleagues conducted a cross-sectional study during which they searched VA clinical and demographic databases for veterans of Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn who screened positive for TBI and who were receiving care from a VA facility in New England. The researchers excluded veterans with a diagnosis of bipolar disorder, schizophrenia, or other psychotic disorders except psychosis not otherwise specified due to trauma-related hallucinations.
Jennifer R. Fonda
Half of Veterans With Possible TBI Had Pain
Ms. Fonda’s group mailed the Center for Neurologic Study-Lability Scale (CNS-LS) questionnaire and a single question about involuntary episodes of laughing or crying to all eligible study participants. These questions were used to assess the presence of PBA symptoms. The researchers assessed health-related quality of life with the EuroQOL-5 Dimensions (EQ-5D).
Of the 4,283 veterans who were mailed the questionnaire, 758 (19.2%) responded. Respondents were older and more likely to be Caucasian, married, and college graduates than were nonrespondents. Respondents also were more likely to be diagnosed with depression and to have a prescription for antidepressants or antiepileptic drugs.
Among veterans who screened positive for TBI, 47% had PTSD, 50% had pain, 26% had major depression, 17% had headaches or migraine, and 17% had anxiety disorders. In addition, 37% of the study sample took antidepressants, 16% took sedatives or hypnotics, and 14.2% took opioids.
Prescription Costs Were Higher for Veterans With PBA Symptoms
In all, 69.6% of VA respondents who screened positive for TBI had a CNS-LS score of 13 or higher, which indicates the presence of PBA symptoms. Approximately 60% of respondents answered “yes” to the single PBA symptom screening question about involuntary episodes of laughing or crying. Among 591 respondents with complete data for CNS-LS score and the single screening question, 66% were positive for PBA symptoms on both measures and 19.5% were negative for PBA symptoms on both measures. More than 80% of participants who responded “yes” to the single screening question also reported some crying-related PBA symptoms. Mean scores for involuntary crying-related questions on CNS-LS were higher than for involuntary laughing-related questions.
Respondents with PBA symptoms reported lower health-related quality of life in all five functional domains of the EQ-5D than did individuals without PBA symptoms. More than 94% of veterans with a CNS-LS score of 13 or greater reported some problems with pain, discomfort, anxiety, or depression. More than 73% of veterans with a CNS-LS score of 13 or greater reported at least moderate problems with pain, discomfort, anxiety, or depression. About 49% of veterans with a CNS-LS score of 13 or greater reported at least moderate problems with usual activities.
Veterans with PBA had increased mean outpatient costs, compared with veterans without PBA. The increased costs resulted from increased specialty care, primary care, and rehabilitation. Inpatient costs were similar or modestly higher for veterans with PBA symptoms, compared with veterans without these symptoms. Prescription costs were more than doubled and outpatient costs were 20% higher for veterans with PBA symptoms, compared with veterans without these symptoms.
—Erik Greb