{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T18:08:06Z","timestamp":1778263686864,"version":"3.51.4"},"reference-count":35,"publisher":"Oxford University Press (OUP)","issue":"Supplement_1","license":[{"start":{"date-parts":[[2021,1,1]],"date-time":"2021-01-01T00:00:00Z","timestamp":1609459200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,1,25]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>More than 280,000 Active Duty Service Members (ADSMs) sustained a mild traumatic brain injury (mTBI) between 2000 and 2019 (Q3). Previous studies of veterans have shown higher utilization of outpatient health clinics by veterans diagnosed with mTBI. Additionally, veterans with mTBI and comorbid behavioral health (BH) conditions such as post-traumatic stress disorder, depression, and substance use disorders have significantly higher health care utilization than veterans diagnosed with mTBI alone. However, few studies of the relationship between mTBI, health care utilization, and BH conditions in the active duty military population currently exist. We examined the proportion of ADSMs with a BH diagnosis before and after a first documented mTBI and quantified outpatient utilization of the Military Health System in the year before and following injury.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and Methods<\/jats:title>\n                  <jats:p>Retrospective analysis of 4,901,840 outpatient encounters for 39,559 ADSMs with a first documented diagnosis of mTBI recorded in the Department of Defense electronic health record, subsets of who had a BH diagnosis. We examined median outpatient utilization 1 year before and 1 year after mTBI using Wilcoxon signed rank test, and the results are reported with an effect size r. Outpatient utilization is compared by BH subgroups.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Approximately 60% of ADSMs experience a first mTBI with no associated BH condition, but 17% of men and women are newly diagnosed with a BH condition in the year following mTBI. ADSMs with a history of a BH condition before mTBI increased their median outpatient utilization from 23 to 35 visits for men and from 32 to 42 visits for women. In previously healthy ADSMs with a new BH condition following mTBI, men more than tripled median utilization from 7 to 24 outpatient visits, and women doubled utilization from 15 to 32 outpatient visits.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Behavioral health comorbidities affect approximately one-third of ADSMs following a first mTBI, and approximately 17% of previously healthy active duty men and women will be diagnosed with a new BH condition in the year following a first mTBI. Post-mTBI outpatient health care utilization is highly dependent on the presence or absence of BH condition and is markedly higher is ADSMs with a BH diagnosis in the year after a first documented mTBI.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/milmed\/usaa320","type":"journal-article","created":{"date-parts":[[2021,1,26]],"date-time":"2021-01-26T01:51:54Z","timestamp":1611625914000},"page":"567-571","source":"Crossref","is-referenced-by-count":5,"title":["Burden of Behavioral Health Comorbidities on Outpatient Health Care Utilization by Active Duty Service Members With a First Documented mTBI"],"prefix":"10.1093","volume":"186","author":[{"given":"Lalon M","family":"Kasuske","sequence":"first","affiliation":[{"name":"Daniel K. Inouye Graduate School of Nursing, Uniformed Services University, Bethesda, MD 20814, USA"},{"name":"National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Hoover","sequence":"additional","affiliation":[{"name":"National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tim","family":"Wu","sequence":"additional","affiliation":[{"name":"National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Louis M","family":"French","sequence":"additional","affiliation":[{"name":"National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA"},{"name":"Defense and Veterans Brain Injury Center, Silver Spring, MD 20910, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jesus J","family":"Caban","sequence":"additional","affiliation":[{"name":"National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2021,1,25]]},"reference":[{"key":"2021012914154782500_R1","article-title":"DoD Worldwide TBI Numbers 2000\u20132019 (Q3)","volume-title":"Updated 8 November 2019","author":"Defense and Veterans Brain Injury Center","year":"2019"},{"key":"2021012914154782500_R2","article-title":"VA\/DoD Clinical Practice Guidelines for the Management of Concussion-Mild Traumatic Brain Injury","author":"Department of Veteran Affairs and Department of Defense","year":"2016"},{"issue":"5","key":"2021012914154782500_R3","doi-asserted-by":"crossref","first-page":"950","DOI":"10.3171\/JNS\/2008\/108\/5\/0950","article-title":"Traumatic brain injury during Operation Iraqi Freedom: findings from the United States Navy\u2013Marine Corps Combat Trauma Registry","volume":"108","author":"Galarneau","year":"2008","journal-title":"J Neurosurg"},{"issue":"23","key":"2021012914154782500_R4","doi-asserted-by":"crossref","first-page":"2125","DOI":"10.1089\/neu.2015.4320","article-title":"Prognostic indicators of persistent post-concussive symptoms after deployment-related mild traumatic brain injury: a prospective longitudinal study in U.S. Army soldiers","volume":"33","author":"Stein","year":"2016","journal-title":"J Neurotrauma"},{"issue":"16","key":"2021012914154782500_R5","doi-asserted-by":"publisher","first-page":"1571","DOI":"10.1212\/WNL.0000000000003839","article-title":"Epidemiology and prognosis of mild traumatic brain injury in returning soldiers: a cohort study","volume":"88","author":"Schwab","year":"2017","journal-title":"Neurology"},{"issue":"9","key":"2021012914154782500_R6","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/09602011.2019.1604385","article-title":"Long-term neurobehavioural symptom reporting following mild, moderate, severe, and penetrating traumatic brain injury in U.S. military service members","volume":"30","author":"Lange","year":"2020","journal-title":"Neuropsychol Rehabil"},{"issue":"1","key":"2021012914154782500_R7","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3109\/02699052.2010.531692","article-title":"Association between combat stress and post-concussive symptom reporting in OEF\/OIF service members with mild traumatic brain injuries","volume":"25","author":"Cooper","year":"2011","journal-title":"Brain Inj"},{"issue":"10","key":"2021012914154782500_R8","doi-asserted-by":"crossref","first-page":"748","DOI":"10.1097\/NMD.0b013e3181b97a75","article-title":"Posttraumatic stress disorder mediates the relationship between mild traumatic brain injury and health and psychosocial functioning in veterans of Operations Enduring Freedom and Iraqi Freedom","volume":"197","author":"Pietrzak","year":"2009","journal-title":"J Nerv Ment Dis"},{"issue":"1","key":"2021012914154782500_R9","first-page":"79","article-title":"Longitudinal effects of mild traumatic brain injury and posttraumatic stress disorder comorbidity on postdeployment outcomes in National Guard soldiers deployed to Iraq","volume":"68","author":"Polusny","year":"2011","journal-title":"JAMA"},{"issue":"4","key":"2021012914154782500_R10","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1037\/0894-4105.9.4.606","article-title":"Base rates of postconcussive symptoms in health maintenance organization patients and controls","volume":"9","author":"Fox","year":"1995","journal-title":"Neuropsychology"},{"issue":"11","key":"2021012914154782500_R11","doi-asserted-by":"crossref","first-page":"783","DOI":"10.1080\/026990597122990","article-title":"\u2018Postconcussive\u2019 symptoms in persons with chronic pain","volume":"11","author":"Iverson","year":"1997","journal-title":"Brain Injury"},{"issue":"1","key":"2021012914154782500_R12","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1002\/jts.20483","article-title":"Psychiatric diagnoses among Iraq and Afghanistan war veterans screened for deployment-related traumatic brain injury","volume":"23","author":"Carlson","year":"2010","journal-title":"J Trauma Stress"},{"issue":"1","key":"2021012914154782500_R13","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1176\/ajp.2007.164.1.150","article-title":"Association of posttraumatic stress disorder with somatic symptoms, health care visits, and absenteeism among Iraq war veterans","volume":"164","author":"Hoge","year":"2007","journal-title":"Am J Psychiatry"},{"issue":"1","key":"2021012914154782500_R14","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1097\/HTR.0b013e31826c73cc","article-title":"Loss of consciousness, depression, posttraumatic stress disorder, and suicide risk among deployed military personnel with mild traumatic brain injury","volume":"28","author":"Bryan","year":"2013","journal-title":"J Head Trauma Rehabil"},{"key":"2021012914154782500_R15","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1016\/j.jpsychires.2016.10.004","article-title":"Mild traumatic brain injury and suicide risk among a clinical sample of deployed military personnel: evidence for a serial mediation model of anger and depression","volume":"84","author":"Stanley","year":"2017","journal-title":"J Psychiatr Res"},{"issue":"7","key":"2021012914154782500_R16","doi-asserted-by":"crossref","first-page":"1084","DOI":"10.1016\/j.apmr.2009.01.023","article-title":"Mild traumatic brain injury and posttraumatic stress disorder and their associations with health symptoms","volume":"90","author":"Vanderploeg","year":"2009","journal-title":"Arch Phys Med Rehabil"},{"issue":"1","key":"2021012914154782500_R17","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1007\/s11606-009-1117-3","article-title":"Mental health diagnoses and utilization of VA non-mental health medical services among returning Iraq and Afghanistan veterans","volume":"25","author":"Cohen","year":"2010","journal-title":"J Gen Intern Med"},{"issue":"1","key":"2021012914154782500_R18","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1097\/HTR.0b013e318263bb61","article-title":"Predictors of inpatient and outpatient healthcare utilization in veterans with traumatic brain injury","volume":"28","author":"Drag","year":"2013","journal-title":"J Head Trauma Rehabil"},{"issue":"1","key":"2021012914154782500_R19","doi-asserted-by":"crossref","first-page":"E16","DOI":"10.1097\/HTR.0000000000000227","article-title":"Does co-occurring traumatic brain injury affect VHA outpatient health service utilization and associated costs among veterans with posttraumatic stress disorder? An examination based on VHA administrative data","volume":"32","author":"Kehle-Forbes","year":"2017","journal-title":"J Head Trauma Rehabil"},{"issue":"3","key":"2021012914154782500_R20","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1097\/NMD.0000000000000103","article-title":"Health service and medication use among veterans with persistent postconcussive symptoms","volume":"202","author":"King","year":"2014","journal-title":"J Nerv Ment Dis"},{"issue":"4","key":"2021012914154782500_R21","first-page":"311","article-title":"Mild traumatic brain injury: a neuropsychiatric approach to diagnosis, evaluation, and treatment","volume":"1","author":"Arciniegas","year":"2005","journal-title":"Neuropsychiatr Dis Treat"},{"issue":"2","key":"2021012914154782500_R22","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1076\/clin.15.2.162.1895","article-title":"Comparison of premorbid and postinjury MMPI-2 profiles in late postconcussion claimants","volume":"15","author":"Greiffenstein","year":"2001","journal-title":"Clin Neuropsychol"},{"issue":"3","key":"2021012914154782500_R23","doi-asserted-by":"publisher","first-page":"304","DOI":"10.1037\/a0027888","article-title":"Predictors of postconcussive symptoms 3 months after mild traumatic brain injury","volume":"26","author":"Ponsford","year":"2012","journal-title":"Neuropsychology"},{"issue":"5","key":"2021012914154782500_R24","first-page":"19","article-title":"Ambulatory visits, active component, U.S. Armed Forces, 2018","volume":"26","author":"Armed Forces Health Surveillance Branch","year":"2019","journal-title":"MSMR"},{"issue":"12","key":"2021012914154782500_R25","doi-asserted-by":"crossref","first-page":"1206","DOI":"10.1176\/appi.ps.201200051","article-title":"Time to treatment among veterans of conflicts in Iraq and Afghanistan with psychiatric diagnoses","volume":"63","author":"Maguen","year":"2012","journal-title":"Psychiatr Serv"},{"issue":"6","key":"2021012914154782500_R26","doi-asserted-by":"crossref","first-page":"666","DOI":"10.1089\/jwh.2011.3113","article-title":"Gender differences in health service utilization among Iraq and Afghanistan veterans with posttraumatic stress disorder","volume":"21","author":"Maguen","year":"2012","journal-title":"J Womens Health (Larchmt)"},{"issue":"4 Suppl","key":"2021012914154782500_R27","doi-asserted-by":"crossref","first-page":"S210","DOI":"10.1016\/j.whi.2011.04.019","article-title":"Psychiatric diagnoses and neurobehavioral symptom severity among OEF\/OIF VA patients with deployment-related traumatic brain injury: a gender comparison","volume":"21","author":"Iverson","year":"2011","journal-title":"Womens Health Issues"},{"issue":"4","key":"2021012914154782500_R28","doi-asserted-by":"crossref","first-page":"539","DOI":"10.3171\/jns.2000.93.4.0539","article-title":"Do women fare worse: a metaanalysis of gender differences in traumatic brain injury outcome","volume":"93","author":"Farace","year":"2000","journal-title":"J Neurosurg"},{"issue":"1","key":"2021012914154782500_R29","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1002\/jts.21979","article-title":"Deployment-related psychiatric and behavioral conditions and their association with functional disability in OEF\/OIF\/OND veterans","volume":"28","author":"Lippa","year":"2015","journal-title":"J Trauma Stress"},{"issue":"14","key":"2021012914154782500_R30","doi-asserted-by":"crossref","first-page":"2206","DOI":"10.1089\/neu.2016.4434","article-title":"Outcome trends after US military concussive traumatic brain injury","volume":"34","author":"Mac Donald","year":"2017","journal-title":"J Neurotrauma"},{"issue":"4","key":"2021012914154782500_R31","doi-asserted-by":"publisher","first-page":"329","DOI":"10.1093\/arclin\/acu013","article-title":"Factors influencing postconcussion and posttraumatic stress symptom reporting following military-related concurrent polytrauma and traumatic brain injury","volume":"29","author":"Lange","year":"2014","journal-title":"Arch Clin Neuropsychol"},{"issue":"3","key":"2021012914154782500_R32","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1177\/1524838009334448","article-title":"The epidemiology of trauma, PTSD, and other posttrauma disorders","volume":"10","author":"Breslau","year":"2009","journal-title":"Trauma Violence Abuse"},{"issue":"1","key":"2021012914154782500_R33","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1111\/j.1749-6632.2010.05696.x","article-title":"Military traumatic brain injury: an examination of important differences","volume":"1208","author":"French","year":"2010","journal-title":"Ann N Y Acad Sci"},{"issue":"5","key":"2021012914154782500_R34","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1007\/s11920-015-0575-z","article-title":"Prevalence of, risk factors for, and consequences of posttraumatic stress disorder and other mental health problems in military populations deployed to Iraq and Afghanistan","volume":"17","author":"Ramchand","year":"2015","journal-title":"Curr Psychiatry Rep"},{"issue":"12","key":"2021012914154782500_R35","doi-asserted-by":"crossref","first-page":"2450","DOI":"10.2105\/AJPH.2009.166165","article-title":"Gender differences in mental health diagnoses among Iraq and Afghanistan veterans enrolled in Veterans Affairs health care","volume":"100","author":"Maguen","year":"2010","journal-title":"Am J Pub Health"}],"container-title":["Military Medicine"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/milmed\/article-pdf\/186\/Supplement_1\/567\/36145459\/usaa320.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/milmed\/article-pdf\/186\/Supplement_1\/567\/36145459\/usaa320.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,1,29]],"date-time":"2021-01-29T14:18:01Z","timestamp":1611929881000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/milmed\/article\/186\/Supplement_1\/567\/6119483"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1,1]]},"references-count":35,"journal-issue":{"issue":"Supplement_1","published-online":{"date-parts":[[2021,1,25]]},"published-print":{"date-parts":[[2021,1,25]]}},"URL":"https:\/\/doi.org\/10.1093\/milmed\/usaa320","relation":{},"ISSN":["0026-4075","1930-613X"],"issn-type":[{"value":"0026-4075","type":"print"},{"value":"1930-613X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2021,1,1]]},"published":{"date-parts":[[2021,1,1]]}}}