Journal of the International Neuropsychological Society

Critical Review

Factors Associated with Mild Traumatic Brain Injury in Veterans and Military Personnel: A Systematic Review

Maya E. O'Neila1a2a3 c1, Kathleen F. Carlsona1a4, Daniel Storzbacha1a2, Lisa A. Brennera5a6, Michele Freemana1, Ana R. Quiñonesa1a4, Makalapua Motu'apuakaa1 and Devan Kansagaraa1a7

a1 Portland VA Medical Center, Portland, Oregon

a2 Psychiatry, Oregon Health & Science University, Portland, Oregon

a3 Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon

a4 Public Health & Preventive Medicine, Oregon Health & Science University, Portland, Oregon

a5 Denver VA Medical Center, VISN 19 MIRECC, Denver, Colorado

a6 Psychiatry, Neurology, and Physical Medicine and Rehabilitation, University of Colorado Denver, Denver, Colorado

a7 General Internal Medicine, Oregon Health & Science University, Portland, Oregon


A history of mild traumatic brain injury (mTBI) is common among military members who served in Operations Enduring Freedom, Iraqi Freedom, and New Dawn (OEF/OIF/OND). We completed a systematic review to describe the cognitive, mental health, physical health, functional, social, and cost consequences of mTBI in Veteran and military personnel. Of 2668 reviewed abstracts, the 31 included studies provided very low strength evidence for the questions of interest. Cognitive, physical, and mental health symptoms were commonly reported by Veterans/military members with a history of mTBI. On average, these symptoms were not significantly more common in those with a history of mTBI than in those without, although a lack of significant mean differences does not preclude the possibility that some individuals could experience substantial effects related to mTBI history. Evidence of potential risk or protective factors moderating mTBI outcomes was unclear. Although the overall strength of evidence is very low due to methodological limitations of included studies, our findings are consistent with civilian studies. Appropriate re-integration services are needed to address common comorbid conditions, such as treatment for post-traumatic stress disorder, substance use disorders, headaches, and other difficulties that Veterans and members of the military may experience after deployment regardless of mTBI history. (JINS, 2014, 20, 1–13)

(Received July 05 2013)

(Revised December 16 2013)

(Accepted December 16 2013)


  • Mild traumatic brain injury;
  • Veteran;
  • Military;
  • Systematic review;
  • Combat deployment;
  • Cognitive functioning;
  • Deployment related conditions


c1 Correspondence and reprint requests to: Maya E. O'Neil, 3710 SW U.S. Veterans Hospital Road, Mail Code: R&D 71, Portland, OR 97239. E-mail: