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Deployment-Related Traumatic Brain Injury and Co-Occurring Conditions

A Course for Civilian Health Care Providers from

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Coping with multiple problems after a concussion can make the frustrations of daily life seem overwhelming. Capt. J.L. Hancock likens this to overstretching a balloon.

VIDEO: Picture a "Mood Balloon"

Picture a "Mood Balloon"

"In normal, everyday life, that balloon's about half-full. So as you add problems of everyday life, you can contain it, it doesn't blow up…"

Changes in Mood

Changes in mood and emotions often accompany concussion. Problems with memory and concentration can be frustrating. Sleep problems can add to irritability, as can headache and other kinds of pain. Alcohol can also alter mood. All of these combined factors can affect an individual's emotional state so assessing and treating mood should be a top priority.

VIDEO: Helping Patients with Mood Disorders

Helping Patients with Mood Disorders

"It's important for you to get that full history, like you would with any patient presenting with a mood disorder, and understand them…"


One of the most common mood problems that can occur with concussion is depression. It's important to ask if the service member had any signs of depression prior to the mTBI. Prior psychological health issues should be carefully examined to determine if, and how, the intensity and severity of symptoms have changed since the concussion.

Dr. Joel Scholten says it's critical to ask people who seem sad or lethargic if they have had suicidal thoughts.

VIDEO: Thoughts of Suicide Are Not Uncommon After a Brain Injury

Thoughts of Suicide Are Not Uncommon After a Brain Injury

"When we think of depression we also need to think about risk of suicide…"

Current suicidal thoughts need to be treated as an emergency. A report of occasional suicidal thoughts merits prompt referral and follow-up. Here are resources for service members:


Rehabilitation psychologist Karl Hursey discusses some of the causes of depression in returning service members.

VIDEO: The Physiological and Psychological Causes of Depression

The Physiological and Psychological Causes of Depression

"The person is often faced with multiple losses — loss of a career, perhaps loss of family, depending on how things unravel when they come back…"


To be diagnosed with clinical depression, the individual must either have a depressed mood or have lost interest in pleasurable activities. View the complete definition of clinical depression.

In addition, your patient must have at least five of the following symptoms lasting more than two weeks:

  • Sleep disturbance
  • Anhedonia (loss of enjoyment in daily activities)
  • Feelings of guilt, hopelessness, or worthlessness
  • Trouble concentrating
  • Reduced energy
  • Alteration in weight or appetite
  • Psychomotor agitation or retardation
  • Suicidal ideation
  • Somatic complaints

Even if someone does not meet the clinical criteria of depression, it's still important to recognize the signs and symptoms. Treatment should include evidence-based modalities if the depression is at the level of a disorder.

Here are treatment guidelines for depression, including an overview in the context of concussion:

Post-TBI Depression

Learn more about how depression and brain injury are connected.


Heightened anxiety is a common persistent symptom after a concussion. A service member might not be aware of this new level of worry until he or she returns to civilian life. Army Veteran Adam Anicich talks about how problems with remembering added to his anxiety.

VIDEO: Big, Crowded Events Are Difficult After a Brain Injury

Big, Crowded Events Are Difficult After a Brain Injury

"One thing that I just try and do is not be too hard on myself…"


Anxiety is also one of the most common emotional changes in service members who have fought in Iraq and Afganistan, where many have experienced multiple tours of combat.

VIDEO: Concussions in Military Population Often Come with Anxiety

Concussions in Military Population Often Come with Anxiety

"Keep in mind that typically these concussions are the result of a terrorist activity, you have somebody who's also dealing with some anxiety issues…"


Rehabilitation psychologist Karl Hursey discusses two of the reasons for heightened anxiety.

VIDEO: Brain Injuries Can Inhibit People's Coping Mechanisms

Brain Injuries Can Inhibit People's Coping Mechanisms

"An uncontrollable challenge, or even threat, is much worse than one that we're confident that we have a plan for and we're going to be able to manage."


Treatment for anxiety with counseling and/or medication is usually successful, so there's no reason not to get started immediately. Here are some treatment guidelines:

Anxiety & Stress

Following a life-changing event like a brain injury, it’s normal to feel intense stress. But sometimes stress can build up and lead to anxiety.


Another emotional change that commonly accompanies concussion and perhaps the one that needs most urgent intervention is irritability. Neuropsychologists Cynthia Boyd and Alison Cernich offer insight into some of the contributing factors.

VIDEO: Irritability After a TBI: Normal but Potentially Dangerous

Irritability After a TBI: Normal but Potentially Dangerous

"In the constellation of symptoms that I see in returning service members, one of the greatest behavioral symptoms is irritability…"

Sleep problems and headaches can both cause irritability as well as worsen it.

Discuss ways to manage situations that are frustrating and strategize about avoiding circumstances that can trigger outbursts. Anger management skills — including self-calming strategies, relaxation techniques, and communication methods — can be helpful as well. Consider referring the service member to a psychologist or other mental health worker who has experience with these techniques.

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