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"Symptoms associated with mild TBI often can be overlooked in deference to more obviously visible injuries," she continued. "Nonetheless, war-related TBI is a serious and potentially costly health concern within the VA, and the interplay of TBI and cognitive and affective symptoms in Iraq War veterans over time has not been adequately explored.

"Further, symptoms similar to those associated with TBI may develop from combat experience alone. We're interested in studying returning veterans both with and without TBI, looking at a broader trauma complex.

"Our goal is to provide evidence-based understanding of cognitive and affective correlates of TBI and combat exposure in these veterans, the relationship of symptoms to the use of health care and quality of life, and the evolution of the phenomena over time," Donnelly said.

The study will construct clinical profiles of 500 veterans returning from the wars in Iraq and Afghanistan. Profiles will cover cognitive functioning, psychological symptoms, substance use, TBI status and combat and demographic characteristics, and will examine health care use among those with different diagnoses, quality of life and community participation.

Veterans will be studied at four time points, six months apart. The investigators also are conducting the first large-scale examination of the reliability and validity of the VA TBI screening tool, a brief survey used nationwide to identify veterans who might have sustained TBI in battle.

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