A new military study found that soldiers who suffered concussions in Iraq were not only at higher risk of developing post-traumatic stress disorder (PTSD) and depression, but also that the depression and PTSD, not the head injuries, may be the cause of ongoing physical symptoms.

Researchers at the Walter Reed Army Institute of Research surveyed 2,500 soldiers who were sent to fight in Iraq. They were given questionnaires asking about missed war days and dozens of physical and emotional difficulties, as well as symptoms of PTSD. In their first months back home they reported a variety of symptoms, including headaches, sleep problems, dizziness, which they associate with brain injuries.

They were also asked about concussions and their severity. The researchers found that 384 of the soldiers or 15 percent reported at least one concussion.  Soldiers who lost consciousness experienced the worst symptoms. About 44 percent of them met the criteria for post-traumatic stress, compared with 16 percent of soldiers with non-head injuries, and only 9 percent of those with no injuries.

“There’s a lot we don’t know about these injuries, but we do know that context is important. Being in combat you’re going to be in a physiologically heightened state already; now imagine a blast that knocks you unconscious — an extremely close call on your own life, and maybe your buddy went down. So you’ve got the trauma and maybe the effect of the concussion is to make it worse.” said the lead author, Dr. Charles W. Hoge, director of psychiatry and neuroscience at the Walter Reed Army Institute of Research.

Hoge said that the symptoms accused by the soldiers appear to be the results of PTSD or depression, where recovery is possible.
“The symptoms and health problems that we expected to be due to concussion actually proved to be related to PSTD and depression. There isn't a clear delineation between a psychological and a physical problem,” Hoge said.

Dr. James Kelly, a neurology professor at the University of Colorado fears that doctors will attribute lingering health problems to psychological issues.

“I think if people misunderstand or overextend beyond what this survey shows, they could dismiss true brain injury features as psychological only. It would be a terrible disservice to our military for that to happen,” Kelly said.

Hoge presented the survey Wednesday at a military health conference in Washington. Results of the survey will also be published in Thursday’s New England Journal of Medicine.

“PTSD and depression may be the primary problem. Soldiers should not be led to believe that they have a brain injury that will result in permanent change,” said Richard Bryant, a psychologist at the University of New South Wales in Sydney, Australia, in an editorial, which will accompany the report in the journal.

About 8 million American adults have PTSD. A 2003 New England Journal of Medicine Study found that 15 percent to 17 percent of Iraq and Afghanistan veterans were suffering from PTSD, and more than 60 percent of those showing symptoms were unlikely to seek help because of fears of stigmatization or loss of career advancement opportunities.