{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T11:21:31Z","timestamp":1791544891261,"version":"4.3.4"},"reference-count":41,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2023,8,16]],"date-time":"2023-08-16T00:00:00Z","timestamp":1692144000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Post-traumatic stress disorder (PTSD) is a prevalent psychiatric disorder that often occurs following war trauma. Despite its high prevalence, there is still a lack of comprehensive understanding regarding the mechanisms underlying its progression and treatment resistance. Recent research has shed light on the biological basis of PTSD, with neuroimaging studies revealing altered brain connectivity patterns in affected individuals. In war contexts, traumatic brain injury (TBI) is a common occurrence and is associated with a high prevalence of PTSD. This study aimed to compare the severity of PTSD and depression in patients with and without a history of TBI to shed light on the impact of comorbid TBI on the presentation of PTSD symptoms. To achieve this goal, a cross-sectional study was conducted involving a sample of 60 outpatients who were diagnosed with both PTSD and Depressive Disorder. The inclusion criteria required participants to meet the diagnostic criteria for both disorders using validated tools. The severities of PTSD and depressive symptoms were assessed using scales that have been widely used and validated in previous research. By utilizing these standardized assessment tools, this study aimed to ensure the reliability and validity of the obtained data. The results of this study revealed that patients with comorbid PTSD and TBI exhibited a significantly higher severity of PTSD symptoms compared to those with PTSD only. Specifically, the comorbid group demonstrated higher ratings of symptom intensity across all symptom clusters. These findings are consistent with previous research that has highlighted the impact of comorbid TBI on the intensity and persistence of PTSD symptoms. When controlling for PTSD severity, no significant differences were observed in the severity of depressive symptoms between the two groups. This suggests that the increased depressive symptoms observed in the comorbid group may be primarily driven by the presence of more intense PTSD symptoms rather than TBI per se. The findings highlight the need for an accurate diagnosis of TBI in individuals with PTSD to guide appropriate treatment interventions. Further research is warranted to delve into the underlying mechanisms that contribute to the interaction between TBI and PTSD and to develop targeted interventions for individuals with comorbid PTSD and TBI.<\/jats:p>","DOI":"10.3390\/medicina59081467","type":"journal-article","created":{"date-parts":[[2023,8,16]],"date-time":"2023-08-16T09:57:02Z","timestamp":1692179822000},"page":"1467","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["The Co-Occurrence of Post-Traumatic Stress Disorder and Depression in Individuals with and without Traumatic Brain Injury: A Comprehensive Investigation"],"prefix":"10.3390","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6307-6526","authenticated-orcid":false,"given":"Maja","family":"Simonovic","sequence":"first","affiliation":[{"name":"Faculty of Medicine, University of Nis, Nis 18000, Serbia"},{"name":"Center for Mental Health, University Clinical Center, Nis 18000, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9507-7128","authenticated-orcid":false,"given":"Bojan","family":"Nedovic","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Nis, Nis 18000, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0554-793X","authenticated-orcid":false,"given":"Misa","family":"Radisavljevic","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Nis, Nis 18000, Serbia"},{"name":"Clinic for Neurosurgery, University Clinical Center, Nis 18000, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0124-3501","authenticated-orcid":false,"given":"Nikola","family":"Stojanovic","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Nis, Nis 18000, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,8,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.jpsychires.2016.06.022","article-title":"The association between post-traumatic stress disorder and lifetime DSM-5 psychiatric disorders among veterans: Data from the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III)","volume":"82","author":"Smith","year":"2016","journal-title":"J. Psychiatr. Res."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"17","DOI":"10.2298\/VSP0501017S","article-title":"Comorbidity of posttraumatic stress disorder and mild closed head injury in war veterans: Endocrinological and psychological profiles","volume":"62","year":"2005","journal-title":"Vojnosanit. Pregl."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/j.neuroimage.2016.11.006","article-title":"Multi-scale brain networks","volume":"160","author":"Betzel","year":"2017","journal-title":"Neuroimage"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1497","DOI":"10.1093\/scan\/nsv040","article-title":"Altered functional connectivity in the brain default-mode network of earthquake survivors persists after 2 years despite recovery from anxiety symptoms","volume":"10","author":"Du","year":"2015","journal-title":"Soc. Cogn. Affect. Neurosci."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1016\/j.nicl.2017.10.032","article-title":"Connectome-wide investigation of altered resting-state functional connectivity in war veterans with and without posttraumatic stress disorder","volume":"17","author":"Misaki","year":"2018","journal-title":"NeuroImage Clin."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"15086","DOI":"10.4088\/JCP.13m08796","article-title":"Predictors of long-term treatment outcome in combat and peacekeeping veterans with military-related PTSD","volume":"75","author":"Richardson","year":"2014","journal-title":"J. Clin. Psychiatry"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1176\/appi.neuropsych.16050100","article-title":"Traumatic brain injury in Iraq and Afghanistan veterans: New results from a national random sample study","volume":"29","author":"Lindquist","year":"2017","journal-title":"J. Neuropsychiatry Clin. Neurosci."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e000312","DOI":"10.1136\/bmjopen-2011-000312","article-title":"A case\u2013control study examining whether neurological deficits and PTSD in combat veterans are related to episodes of mild TBI","volume":"2","author":"Ruff","year":"2012","journal-title":"BMJ Open"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"67","DOI":"10.7205\/MILMED-D-12-00110","article-title":"Mild traumatic brain injury screening, diagnosis, and treatment","volume":"177","author":"Marshall","year":"2012","journal-title":"Mil. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1056\/NEJMoa072972","article-title":"Mild traumatic brain injury in US soldiers returning from Iraq","volume":"358","author":"Hoge","year":"2008","journal-title":"N. Engl. J. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1001\/jamapsychiatry.2013.3080","article-title":"Association between traumatic brain injury and risk of posttraumatic stress disorder in active-duty Marines","volume":"71","author":"Yurgil","year":"2014","journal-title":"JAMA Psychiatry"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"935","DOI":"10.1080\/02699050110065295","article-title":"The association between head injuries and psychiatric disorders: Findings from the New Haven NIMH Epidemiologic Catchment Area Study","volume":"15","author":"Silver","year":"2001","journal-title":"Brain Inj."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1007\/s11065-012-9190-5","article-title":"Neuropsychological sequelae of PTSD and TBI following war deployment among OEF\/OIF veterans","volume":"22","author":"Dolan","year":"2012","journal-title":"Neuropsychol. Rev."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1097\/HTR.0b013e318212f814","article-title":"Mild traumatic brain injury in UK military personnel returning from Afghanistan and Iraq: Cohort and cross-sectional analyses","volume":"27","author":"Rona","year":"2012","journal-title":"J. Head Trauma Rehabil."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1097\/HTR.0b013e318268db94","article-title":"Frequent binge drinking after combat-acquired traumatic brain injury among active duty military personnel with a past year combat deployment","volume":"27","author":"Adams","year":"2012","journal-title":"J. Head Trauma Rehabil."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1097\/HTR.0000000000000092","article-title":"Associations between traumatic brain injury, suspected psychiatric conditions, and unemployment in Operation Enduring Freedom\/Operation Iraqi Freedom veterans","volume":"31","author":"Pogoda","year":"2016","journal-title":"J. Head Trauma Rehabil."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e130","DOI":"10.1016\/j.apmr.2017.08.424","article-title":"Variability in Emotional Symptoms and Fatigue Measured via Mobile Ecological Momentary Assessment after TBI","volume":"98","author":"Juengst","year":"2017","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1017\/S1355617715000740","article-title":"Traumatic brain injury as a disorder of brain connectivity","volume":"22","author":"Hayes","year":"2016","journal-title":"J. Int. Neuropsychol. Soc."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s40478-014-0153-3","article-title":"The problem of axonal injury in the brains of veterans with histories of blast exposure","volume":"2","author":"Ryu","year":"2014","journal-title":"Acta Neuropathol. Commun."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"298","DOI":"10.3171\/jns.2005.103.2.0298","article-title":"Diffuse axonal injury in mild traumatic brain injury: A diffusion tensor imaging study","volume":"103","author":"Inglese","year":"2005","journal-title":"J. Neurosurg."},{"key":"ref_21","unstructured":"American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR, American Psychiatric Association. [4th ed.]."},{"key":"ref_22","unstructured":"Segal, D.L., and Coolidge, F.L. (2003). Wiley."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders: DSM-5, American Psychiatric Association. [5th ed.].","DOI":"10.1176\/appi.books.9780890425596"},{"key":"ref_24","unstructured":"Blake, D.D., Weathers, F.W., Nagy, L.M., Kaloupek, D.G., Charney, D.S., and Keane, T.M. (1998). Clinician-Administered PTSD Scale for DSM-IV, National Center for Posttraumatic Stress Disorder."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1192\/bjp.134.4.382","article-title":"A new depression scale designed to be sensitive to change","volume":"134","author":"Montgomery","year":"1979","journal-title":"Br. J. Psychiatry"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"742","DOI":"10.1001\/archpsyc.1988.01800320058007","article-title":"A structured interview guide for the Hamilton Depression Rating Scale","volume":"45","author":"Williams","year":"1988","journal-title":"Arch. Gen. Psychiatry"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1037\/a0027007","article-title":"Does a history of mild traumatic brain injury increase suicide risk in veterans with PTSD?","volume":"57","author":"Barnes","year":"2012","journal-title":"Rehabil. Psychol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1016\/j.janxdis.2013.04.003","article-title":"Posttraumatic stress disorder in OEF\/OIF veterans with and without traumatic brain injury","volume":"27","author":"Ragsdale","year":"2013","journal-title":"J. Anxiety Disord."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1056\/NEJMe078235","article-title":"Disentangling mild traumatic brain injury and stress reactions","volume":"358","author":"Bryant","year":"2008","journal-title":"N. Engl. J. Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"862","DOI":"10.1017\/S1355617709990671","article-title":"Post-traumatic amnesia and the nature of post-traumatic stress disorder after mild traumatic brain injury","volume":"15","author":"Bryant","year":"2009","journal-title":"J. Int. Neuropsychol. Soc."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1016\/j.biopsych.2006.06.004","article-title":"Neurocircuitry models of posttraumatic stress disorder and extinction: Human neuroimaging research\u2014Past, present, and future","volume":"60","author":"Rauch","year":"2006","journal-title":"Biol. Psychiatry"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/j.neuron.2017.11.007","article-title":"From maps to multi-dimensional network mechanisms of mental disorders","volume":"97","author":"Braun","year":"2018","journal-title":"Neuron"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1146\/annurev-psych-122414-033634","article-title":"Modular brain networks","volume":"67","author":"Sporns","year":"2016","journal-title":"Annu. Rev. Psychol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1038\/nrn3339","article-title":"Biological studies of post-traumatic stress disorder","volume":"13","author":"Pitman","year":"2012","journal-title":"Nat. Rev. Neurosci."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1080\/02699050110088263","article-title":"Perseveration of traumatic re-experiencing in PTSD; a cautionary note regarding exposure based psychological treatments for PTSD when head injury and dysexecutive impairment are also present","volume":"16","author":"King","year":"2002","journal-title":"Brain Inj."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1471","DOI":"10.1162\/jocn_a_00810","article-title":"Cognitive network neuroscience","volume":"27","author":"Medaglia","year":"2015","journal-title":"J. Cogn. Neurosci."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"8414","DOI":"10.1038\/ncomms9414","article-title":"Controllability of structural brain networks","volume":"6","author":"Gu","year":"2015","journal-title":"Nat. Commun."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1089\/brain.2015.0406","article-title":"Contrasting effects of posttraumatic stress disorder and mild traumatic brain injury on the whole-brain resting-state network: A magnetoencephalography study","volume":"7","author":"Rowland","year":"2017","journal-title":"Brain Connect."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"849","DOI":"10.1016\/j.jad.2017.11.058","article-title":"Physical health conditions associated with full and subthreshold PTSD in US military veterans: Results from the National Health and Resilience in Veterans Study","volume":"227","author":"Blaney","year":"2018","journal-title":"J. Affect. Disord."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1001\/archgenpsychiatry.2010.172","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":"Arch. Gen. Psychiatry"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1097\/PSY.0b013e318244c604","article-title":"Mild traumatic brain injury (concussion), posttraumatic stress disorder, and depression in US soldiers involved in combat deployments: Association with postdeployment symptoms","volume":"74","author":"Wilk","year":"2012","journal-title":"Psychosom. Med."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/8\/1467\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:34:52Z","timestamp":1760128492000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/8\/1467"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,16]]},"references-count":41,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2023,8]]}},"alternative-id":["medicina59081467"],"URL":"https:\/\/doi.org\/10.3390\/medicina59081467","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8,16]]}}}