A Systematic Review and Meta-analysis on PTSD Following TBI Among Military/Veteran and Civilian Populations

Objectives: To determine whether persons with traumatic brain injury (TBI) are at greater risk of developing posttraumatic stress disorder (PTSD) than other trauma-exposed populations without TBI, and whether this risk is even greater in military/veteran settings than in civilian settings. Design: A systematic review and meta-analysis was conducted in 7 databases. Reference lists from the 33 identified studies and other relevant reviews were also searched. Results: The pooled PTSD proportion reached 27% (95% confidence interval = 21.8-33.1) in groups with TBI, which was 2.68 times greater than the observed 11% (95% confidence interval = 8.0-15.0) in groups without TBI. PTSD after TBI was more frequently observed in military samples than in civilians (37% vs 16%). Military and civilian samples were respectively 4.18 and 1.26 times more inclined to have a diagnosis of PTSD after TBI than when there was no TBI. The proportion of PTSD after TBI was concurrently attributable to the methods of the included studies (objectives focused on PTSD diagnosis, type of comparison group) and to characteristics specific to the military setting (country, sex, blast injuries). Conclusions: TBI diagnosis and military setting represent greater risks for PTSD. The dual diagnosis of TBI and PTSD requires interdisciplinary collaboration, as physical and psychological traumas are closely intertwined.