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Peer-reviewedCC BYPLOS Mental Health

Association of childhood mild traumatic brain injury with mental and behavioral health outcomes later in life among U.S. Veterans: A LIMBIC-CENC study

  • Dana Waltzman1
  • Juliet Haarbauer-Krupa2
  • Samuel R Walton3,4,5
  • Amani Jridi6
  • Angela P Presson6
  • William C Walker3,4
  • David X Cifu3,4,7
  • Jessie R Oldham3
  • Landon B Lempke3,4,7
7 affiliations
  1. 1Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, Indiana, United States of America.
  2. 2Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, United States of America.
  3. 3Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, Virginia, United States of America.
  4. 4Richmond Veterans Affairs Medical Center, Central Virginia Veterans Affairs Health Care System, Richmond, Virginia, United States of America.
  5. 5Institute for Women's Health, Virginia Commonwealth University, Richmond, Virginia, United States of America.
  6. 6Division of Epidemiology, The University of Utah, Salt Lake City, Utah, United States of America.
  7. 7United States Department of Veterans Affairs, Brain Health Coordinating Center, Richmond, Virginia, United States of America.
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Abstract

Mild traumatic brain injury (mTBI) is a common injury across all age groups and populations, with a high prevalence among military service members and Veterans. The purpose of this cross-sectional study was to use a large, prospective cohort of Veterans to examine the association between childhood mTBI and multimodal mental and behavioral health outcomes, and among those with childhood mTBI, evaluate sociodemographic characteristics associated with worse outcomes. Data came from the Long-term Impact of Military-relevant Brain Injury Consortium-Chronic Effects of Neurotrauma Consortium (LIMBIC-CENC) prospective longitudinal study. This cohort included 1,286 Veterans, 61.3% of whom sustained a childhood mTBI. After adjustment for demographic, behavioral, and military history factors, Veterans with childhood mTBI had higher PTSD symptom scores (Mean Ratio[MR] = 1.36, 95%CI: 1.22–1.51), higher anger scores (MR = 1.08, 95%CI: 1.05–1.10), higher depression scores (MR = 1.31, 95% CI: 1.17–1.46), higher anxiety scores (mean difference [MD]= 4.3, 95% CI: 2.9-5.6), emotional-behavioral dyscontrol scores (MD = 3.2, 95% CI: 2.2–4.3), worse sleep quality (MD = 1.6, 95% CI: 1.1-2.2), worse neurobehavioral symptoms (MD = 6.8, 95% CI: 5.2-8.5), lower satisfaction with life (MD = -1.2, 95% CI: -2.1 to -0.27), and lower resilience scores (MR = 0.96, 95% CI: 0.94–0.99). There were no significant differences after adjustment for alcohol or drug use scores. Among individuals with a history of childhood mTBI, several mental and behavioral health outcomes were worse among those who sustained multiple mTBIs and better among those who were physically active and had higher education. These findings suggest markers of increased riskpresent before military enlistment that may warrant targeted prevention, screening, and treatment strategies. Increased awareness among healthcare providers may help identify Veterans with childhood mTBI history who would benefit from evidence-based treatment and support.

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Cite

BibTeXRIS
BibTeX
@article{waltzman2026association,
  title = {{Association of childhood mild traumatic brain injury with mental and behavioral health outcomes later in life among U.S. Veterans: A LIMBIC-CENC study}},
  author = {Dana Waltzman and Juliet Haarbauer-Krupa and Samuel R Walton and Amani Jridi and Angela P Presson and William C Walker and David X Cifu and Jessie R Oldham and Landon B Lempke},
  journal = {PLOS Mental Health},
  year = {2026},
  month = oct,
  doi = {10.1371/journal.pmen.0000679},
  url = {https://journals.plos.org/mentalhealth/article?id=10.1371/journal.pmen.0000679},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Association of childhood mild traumatic brain injury with mental and behavioral health outcomes later in life among U.S. Veterans: A LIMBIC-CENC study
AU  - Dana Waltzman
AU  - Juliet Haarbauer-Krupa
AU  - Samuel R Walton
AU  - Amani Jridi
AU  - Angela P Presson
AU  - William C Walker
AU  - David X Cifu
AU  - Jessie R Oldham
AU  - Landon B Lempke
PY  - 2026
DA  - 2026/10/21
JO  - PLOS Mental Health
DO  - 10.1371/journal.pmen.0000679
UR  - https://journals.plos.org/mentalhealth/article?id=10.1371/journal.pmen.0000679
AB  - Mild traumatic brain injury (mTBI) is a common injury across all age groups and populations, with a high prevalence among military service members and Veterans. The purpose of this cross-sectional study was to use a large, prospective cohort of Veterans to examine the association between childhood mTBI and multimodal mental and behavioral health outcomes, and among those with childhood mTBI, evaluate sociodemographic characteristics associated with worse outcomes. Data came from the Long-term Impact of Military-relevant Brain Injury Consortium-Chronic Effects of Neurotrauma Consortium (LIMBIC-CENC) prospective longitudinal study. This cohort included 1,286 Veterans, 61.3% of whom sustained a childhood mTBI. After adjustment for demographic, behavioral, and military history factors, Veterans with childhood mTBI had higher PTSD symptom scores (Mean Ratio[MR] = 1.36, 95%CI: 1.22–1.51), higher anger scores (MR = 1.08, 95%CI: 1.05–1.10), higher depression scores (MR = 1.31, 95% CI: 1.17–1.46), higher anxiety scores (mean difference [MD]= 4.3, 95% CI: 2.9-5.6), emotional-behavioral dyscontrol scores (MD = 3.2, 95% CI: 2.2–4.3), worse sleep quality (MD = 1.6, 95% CI: 1.1-2.2), worse neurobehavioral symptoms (MD = 6.8, 95% CI: 5.2-8.5), lower satisfaction with life (MD = -1.2, 95% CI: -2.1 to -0.27), and lower resilience scores (MR = 0.96, 95% CI: 0.94–0.99). There were no significant differences after adjustment for alcohol or drug use scores. Among individuals with a history of childhood mTBI, several mental and behavioral health outcomes were worse among those who sustained multiple mTBIs and better among those who were physically active and had higher education. These findings suggest markers of increased riskpresent before military enlistment that may warrant targeted prevention, screening, and treatment strategies. Increased awareness among healthcare providers may help identify Veterans with childhood mTBI history who would benefit from evidence-based treatment and support.
SN  - 2837-8156
ER  -