Psychological Medicine

Original Articles

Symptoms of post-concussional syndrome are non-specifically related to mild traumatic brain injury in UK Armed Forces personnel on return from deployment in Iraq: an analysis of self-reported data

N. T. Feara1 c1, E. Jonesa2, M. Grooma3, N. Greenberga1, L. Hulla2, T. J. Hodgettsa4 and S. Wesselya2

a1 Academic Centre for Defence Mental Health, King's College London, London, UK

a2 King's Centre for Military Health Research, King's College London, London, UK

a3 Defence Medical Services, Ministry of Defence, London, UK

a4 Royal College of Defence Medicine, Ministry of Defence, Birmingham, UK


Background Mild traumatic brain injury (mTBI) is being claimed as the ‘signature’ injury of the Iraq war, and is believed to be the cause of long-term symptomatic ill health (post-concussional syndrome; PCS) in an unknown proportion of military personnel.

Method We analysed cross-sectional data from a large, randomly selected cohort of UK military personnel deployed to Iraq (n=5869). Two markers of PCS were generated: ‘PCS symptoms’ (indicating the presence of mTBI-related symptoms: none, 1–2, 3+) and ‘PCS symptom severity’ (indicating the presence of mTBI-related symptoms at either a moderate or severe level of severity: none, 1–2, 3+).

Results PCS symptoms and PCS symptom severity were associated with self-reported exposure to blast whilst in a combat zone. However, the same symptoms were also associated with other in-theatre exposures such as potential exposure to depleted uranium and aiding the wounded. Strong associations were apparent between having PCS symptoms and other health outcomes, in particular being a post-traumatic stress disorder or General Health Questionnaire case.

Conclusions PCS symptoms are common and some are related to exposures such as blast injury. However, this association is not specific, and the same symptom complex is also related to numerous other risk factors and exposures. Post-deployment screening for PCS and/or mTBI in the absence of contemporaneous recording of exposure is likely to be fraught with hazards.

(Received April 10 2008)

(Revised July 10 2008)

(Accepted September 05 2008)

(Online publication October 23 2008)


c1 Address for correspondence: N. T. Fear, D.Phil. (Oxon), Academic Centre for Defence Mental Health, King's College London, Weston Education Centre, 10 Cutcombe Road, London SE5 9RJ, UK. (Email: