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The Veterans Health Administration (VHA) screens veterans who deployed in support of the wars in Afghanistan and Iraq for traumatic brain injury (TBI) and mental health (MH) disorders. Chronic symptoms after mild TBI overlap with MH symptoms, for which there are already established screens within the VHA. It is unclear whether the TBI screen facilitates treatment for appropriate specialty care over and beyond the MH screens. Our primary objective was to determine whether TBI screening is associated with different types (MH, Physical MedicineRehabilitation [PMR], and Neurology) and frequency of specialty services compared with the MH screens. A retrospective cohort design examined veterans receiving VHA care who were screened for both TBI and MH disorders between Fiscal Year (FY) 2007 and FY 2018 (N = 241,136). We calculated service utilization counts in MH, PMR, and Neurology in the six months after the screens. Zero-inflated negative binomial regression models of encounters (counts) were fit separately by specialty care type and for a total count of specialty services. We found that screening positive for TBI resulted in 2.38 times more specialty service encounters than screening negative for TBI. Compared with screening positive for MH only, screening positive for both MH and TBI resulted in 1.78 times more specialty service encounters and 1.33 times more MH encounters. The TBI screen appears to increase use of MH, PMR, and Neurology services for veterans with post-deployment health concerns, even in those also identified as having a possible MH disorder.

Early response after 2 to 4 weeks of antidepressant therapy has been shown to predict remission by 8 to 12 weeks. Most of the work to date on early response has been done using data from randomized controlled trials.This naturalistic study uses archival data from a national tele-mental health company. The positive and negative predictive values as well as sensitivity and specificity were calculated using different drops in baseline Patient Health Questionnaire 9 scores at various periods. Demographic and clinical characteristics were compared between early responders versus those lacking early response. Binary logistic regression analyses determined if early response was predictive of remission, response, and greater than minimal improvement at 14 weeks. For those who do not show early improvement, treatments were investigated using binary logistic regression to see if changes predicted later outcomes.Positive predictive values for all endpoints improved with the strength of early response but did not improve much with the time allowed for that response to occur. In contrast, negative predictive values increased substantially with time. Using a definition of 30% drop in Patient Health Questionnaire 9 score at week 4, 56.5% of patients were early responders. Early responders were ~3.2 times more likely to achieve remission than those lacking early response. Of nonresponders by week 4, those prescribed atypical antipsychotics (+SSRI) had significantly reduced odds of response at week 14, whereas those prescribed a norepinephrine and dopamine reuptake inhibitor had increased odds.Early response may be associated with better outcomes at 14 weeks. In those with lack of response by week 4, patients prescribed a norepinephrine and dopamine reuptake inhibitor may achieve superior outcomes.

BackgroundTelemental health platforms may increase access to care for older adults. Historically, older adults have tended to adopt new technologies at a slower rate which creates a perception that they may not be able to benefit from them. The purpose of this study was to determine whether or not older adult patients receiving psychiatric care for depression via a telemental health platform achieve the same outcomes as younger adults.MethodParticipant data utilized in the current investigation were obtained from a national mental health telehealth company (i.e., Brightside) and consisted of 12,908 U.S.-based adult patients receiving psychiatric care for depression between October, 2018 and January, 2022. Propensity matching was used to create an older and younger sample (n = 141 in each) using 23 covariates. These samples were then compared using repeated measures ANOVA on Patient Health Questionnaire-9 (PHQ-9) scores at start of treatment, 6 weeks, 8 weeks, 10 weeks, 12 weeks, 14 weeks, and 16 weeks.ResultsDespite matching, the groups still significantly differed on prior mental health treatment, such that more older adults reported having had prior mental health treatment. There were no other differences between the groups on assessed variables. Both younger and older adults had decreasing scores over time with no significant differences between them.ConclusionOlder adults have similar improvement in depression symptom severity over time following initiation of psychiatric treatment via a telehealth platform. These findings suggest that age is not a barrier to benefitting from telepsychiatric care.

Emerging evidence suggests that repeated blast exposure (RBE) is associated with brain injury in military personnel. United States (U.S.) Special Operations Forces (SOF) personnel experience high rates of blast exposure during training and combat, but the effects of low-level RBE on brain structure and function in SOF have not been comprehensively characterized. Further, the pathophysiological link between RBE-related brain injuries and cognitive, behavioral, and physical symptoms has not been fully elucidated. We present a protocol for an observational pilot study, Long-Term Effects of Repeated Blast Exposure in U.S. SOF Personnel (ReBlast). In this exploratory study, 30 active-duty SOF personnel with RBE will participate in a comprehensive evaluation of: 1) brain network structure and function using Connectome magnetic resonance imaging (MRI) and 7 Tesla MRI; 2) neuroinflammation and tau deposition using positron emission tomography; 3) blood proteomics and metabolomics; 4) behavioral and physical symptoms using self-report measures; and 5) cognition using a battery of conventional and digitized assessments designed to detect subtle deficits in otherwise high-performing individuals. We will identify clinical, neuroimaging, and blood-based phenotypes that are associated with level of RBE, as measured by the Generalized Blast Exposure Value. Candidate biomarkers of RBE-related brain injury will inform the design of a subsequent study that will test a diagnostic assessment battery for detecting RBE-related brain injury. Ultimately, we anticipate that the ReBlast study will facilitate the development of interventions to optimize the brain health, quality of life, and battle readiness of U.S. SOF personnel.

OBJECTIVE To summarize challenges and best practices relevant to providing care for mental health comorbidities in veterans and service members (V/SM) treated in the Polytrauma System of Care (PSC) and to review themes that emerged during a May 2017 meeting of rehabilitation professionals on this topic. Management of comorbid mental health conditions remains a critical issue within the PSC, given the high rate of these comorbidities and the impact of mental health conditions on treatment planning and outcomes. DESIGN To identify the challenges of concomitantly treating TBI-related symptoms and mental health comorbidities in V/SM treated within the PSC, describe specialty programs within the Veterans Health Administration designed to treat these comorbid conditions, and report on the themes and recommendations identified by rehabilitation professionals at the 2017 meeting. CONCLUSION To further develop mental health treatment within the PSC, the following recommendations were made: (1) continued support for family members as critical members of the rehabilitation team; (2) adding measures and mechanisms to monitor mental health within the PSC; and (3) exploration of modern technologies to enhance care of existing polytrauma clients and to better prepare to serve clients with all types of acquired brain injury.

The military has a long history with neuropsychology and its precursors. From developing intelligence tests during World War I, to developing early capacity and personality assessments during World War II, to forward deploying for the evaluation and treatment of frequent concussive brain injuries during more recent conflicts, clinical neuropsychology has been at the forefront of military selection, healthcare and research. The objective of this special issue is to provide an overview of the latest clinical research relevant to military neuropsychology-some contributors address assessment and treatment issues that are relevant to current practice and others foretell the future of our field.We solicited papers from established researchers and issued a general call for papers for the special issue on military neuropsychology. Results: We received submissions from several authors, eleven of which are included in this issue. These submissions cover assessment and treatment issues, as well as healthcare utilization and return to duty issues. Two apparent themes are the importance of assessing, treating, and attending to comorbidities following traumatic brain injury (TBI) and future assessment techniques moving beyond traditional cognitive performance assessment.The issue highlights the importance of research in clinical neuropsychology to the practice and advancement of military neuropsychology.

To identify prevalence and predictors of tobacco smoking among veterans and military service members (V/SM) with traumatic brain injury (TBI) admitted for rehabilitation.Participants were drawn from the VA TBI Model Systems multicentre longitudinal research study. Tobacco smoking was assessed both preinjury and at 1- or 2-year post-TBI follow-up for 336 participants.Smoking prevalence was 32% preinjury and 28% at follow-up. Most participants had a stable smoking pattern but 12% of preinjury non-smokers became smokers at follow-up. Preinjury smoking was the strongest predictor of post-TBI smoking. Higher cognitive function also predicted smoking at follow-up. In univariate analyses, smoking was predicted by lower education, preinjury mental health (MH) history, selected TBI severity metrics, and higher functional status at rehabilitation hospital discharge (Disability Rating Scale [DRS] and motor subscale of the Functional Independence Measure [FIM]).Study findings may help clinicians and administrators recognize who is at high risk for smoking following TBI, to plan for in-hospital and postdischarge screening and interventions.

Population-based post-deployment screening programs within the Departments of Defense and Veterans Affairs have been implemented to assess for mental health conditions and traumatic brain injury. The purpose of this paper is to systematically review the literature on post-deployment screening within this context and evaluate evidence compared to commonly accepted screening implementation criteria. Findings reflected highly variable psychometric properties of the various screens, variable treatment referral rates following screening, low to moderate treatment initiation rates following screening, and no information on treatment completion or long-term outcomes following screening. In sum, the evidence supporting population based post-deployment screening is inconclusive. Implications are discussed.

Objective: The purpose of this study was to examine the prevalence and stability of symptom reporting in a healthy military sample and to develop reliable change indices for two commonly used self-report measures in the military health care system. Participants and method: Participants were 215 U.S. active duty service members recruited from Fort Bragg, NC as normal controls as part of a larger study. Participants completed the Neurobehavioral Symptom Inventory (NSI) and Posttraumatic Checklist (PCL) twice, separated by approximately 30 days. Results: Depending on the endorsement level used (i.e. ratings of ‘mild’ or greater vs. ratings of ‘moderate’ or greater), approximately 2–15% of this sample met DSM-IV symptom criteria for Postconcussional Disorder across time points, while 1–6% met DSM-IV symptom criteria for Posttraumatic Stress Disorder. Effect sizes for change from Time 1 to Time 2 on individual symptoms were small (Cohen’s d = .01 to .13). The test–retest reliability for the NSI total s...

Expectations may play a large role in health-related outcomes, but they may not be fully addressed or considered in medical–legal contexts. Contextual factors can influence a patient’s expectations for recovery following a concussion, including explicit or implicit messages from the media, healthcare providers and systems of care, and the forensic arena. This article discusses these factors as nocebo effects, that is, various inherently “inert” factors may create negative expectancies for recovery and therefore impede a given patient’s progress and recovery. It is argued that the negligence theory upon which the legal system is based tends to compound these nocebo effects. In accident-related concussions, both the accident itself and subsequent nocebo effects including potential healthcare and medical–legal provider negligence can create legal liability.

Purpose/Objective: The authors present a study aimed at pilot testing a novel delivery method, namely a computer intervention, for postconcussive symptom reduction in active duty, veteran, and civilian patients with acute and chronic complaints. Following a concussion/mild traumatic brain injury (MTBI), most individuals recover completely, but a significant proportion report postconcussive symptoms months to years following the injury. Psychoeducational intervention has shown to be effective in reducing postconcussive symptoms in studies done with acute civilian samples, but the efficacy of psychoeducational interventions with individuals who served in combat or have chronic complaints remains unclear. Research Method/Design: Twenty-five active duty, veteran, and civilian participants took part in this study. At baseline, each participant completed a self-run psychoeducational computer-based treatment. Participants were reassessed 1-month postintervention via phone to evaluate postconconcussive symptom severity. Results: Participants reported significantly fewer postconcussive symptoms at follow-up than baseline (d = .99). Intervention satisfaction was reported, with feedback related to ease of use and quality. Conclusions/Implications: Extending previous studies, current findings demonstrated that psychoeducational intervention following MTBI was associated with postconcussive symptom complaint reduction in both acute and chronic patients. These data also confirm the feasibility of using computerized psychoeducation and speak to the importance of providing education to both acute and chronic patients across settings. Feedback from participants was generally positive. Further investigation with a control group is warranted. (PsycINFO Database Record (c) 2013 APA, all rights reserved). Language: en

The purpose of this study was to examine the relationship between postconcussion symptom complaint (PCS) severity and positive coping factors (knowledge, self-efficacy, and attributions) in a sample of individuals who have sustained a mild TBI, above and beyond the demographic and psychiatric predictors that have been most commonly examined. Ninety-one people with a history of reported mild TBI were surveyed. Hierarchical regression analyses revealed that demographic variables and psychiatric symptom severity predicted PCS severity. Consistent with our hypotheses, knowledge, self-efficacy, and attributions, when taken together, made an independent and significant contribution to prediction of PCS severity (21% of additional variance). The most potent factor was attribution, or the extent to which one attributes symptoms to mild TBI versus other causes. Those who attribute their symptoms to TBI are more likely to report greater symptom severity overall. Taken together, knowledge, self-efficacy, and attributions contribute independently to PCS severity. Additional research is needed to determine if these factors are amenable to intervention.

Belanger HG, Vanderploeg RD, Soble JR, Richardson M, Groer S. Validity of the Veterans Health Administration's traumatic brain injury screen. Objective To compare the results of Veterans Affairs' (VA's) initial traumatic brain injury (TBI) Clinical Reminder Screen with the more extensive second-level Comprehensive TBI Evaluation in a national sample. Design Criterion-standard. Setting Veterans Health Administration system of polytrauma care. Participants The data were from VA's centralized database Patient Care Services on the TBI Clinical Reminder Screen and Comprehensive TBI Evaluation results of veterans (N=48,175). Interventions None. Main Outcome Measures Sensitivity, specificity, positive predictive value, and negative predictive value of the TBI Clinical Reminder Screen were calculated by using the Comprehensive TBI Evaluation findings as the comparative standard for TBI confirmation. Results The TBI Clinical Reminder Screen has generally good sensitivity (.87–.90) but poor specificity (.13–.18). In addition, the TBI Clinical Reminder Screen, when compared with the Comprehensive TBI Evaluation by a clinician, has generally poor negative predictive power (.31–.49) in this sample. However, negative predictive power is good with an estimated Veterans Health Administration system-wide TBI prevalence rate of 15% (.89). Positive predictive power was acceptable (.77) in this sample. The screen performs comparably across patient demographic and symptom severity characteristics, as well as across level of polytrauma care. Systematic evaluations by clinicians primarily reveal mental health–perceived causes of ongoing symptoms. Conclusions In summary, VA's Clinical Reminder Screen, when evaluated against the follow-up Comprehensive TBI Evaluation, has good sensitivity but poor specificity.

The purpose of this study is to examine the implications of various less-examined psychometric issues in the interpretation of neuropsychological data. Using a dataset of 4371 independent functioning and community-dwelling individuals who underwent neuropsychological evaluations, it was demonstrated that many common measures are not normally distributed. Non-normalized data can lead to erroneously pathological conclusions, particularly on the lower end of negatively skewed distributions. Another issue involves scatter. In line with previous studies, the current study found that approximately 67% of the 4371 participants showed discrepancies of three or more standard deviations between their highest and lowest test scores on 21 measures. However, in contradiction to the existing literature, in the current study mean scatter levels were relatively stable across increasing levels of intelligence. It is argued that this is due to regression to the mean. As an individual moves away from the population average in either direction, scores on other measures will regress from that person's IQ score toward the population mean. The lower a test correlates with IQ, the greater will be the regression toward the mean. Therefore the test battery in question must be considered during the interpretation process, in addition to the individual's premorbid IQ.

Belanger HG, King-Kallimanis B, Nelson AL, Schonfeld L, Scott SG, Vanderploeg RD. Characterizing wandering behaviors in persons with traumatic brain injury residing in Veterans Health Administration nursing homes. Objective To examine the prevalence and correlates of wandering in persons with traumatic brain injury (TBI) in nursing homes (NHs). Design Using a cross-sectional design, logistic regression modeling was used to analyze a national database. Setting One hundred thirty-four NH facilities operated by the Veterans Health Administration. Participants NH residents (N=625) with TBI as well as a sample (n=164) drawn from a larger dataset of NH residents without TBI using 1:K matching on age. Interventions Not applicable. Main Outcome Measure Wandering. Results Wanderers with and without TBI did not differ significantly overall. The prevalence of wandering among patients with TBI was 14%, compared with 6.5% of the general nursing home population. The results of the multivariate logistic regression suggested that wandering was associated with poor memory, poor decision making, behavior problems, independence in locomotion and ambulation, and dependence in activities of daily living related to basic hygiene. Conclusions Wandering is relatively common in NH residents with TBI. As expected, it is associated with cognitive, social, and physical impairments. Further research with a larger sample should examine those with comorbid dementia and/or psychiatric diagnoses.

There is increasing interest in the potential neuropsychological impact of sports-related concussion. A meta-analysis of the relevant literature was conducted to determine the impact of sports-related concussion across six cognitive domains. The analysis was based on 21 studies involving 790 cases of concussion and 2014 control cases. The overall effect of concussion (d= 0.49) was comparable to the effect found in the non-sports-related mild traumatic brain injury population (d= 0.54; Belanger et al., 2005). Using sports-concussed participants with a history of prior head injury appears to inflate the effect sizes associated with the current sports-related concussion. Acute effects (within 24 hr of injury) of concussion were greatest for delayed memory, memory acquisition, and global cognitive functioning (d= 1.00, 1.03, and 1.42, respectively). However, no residual neuropsychological impairments were found when testing was completed beyond 7 days postinjury. These findings were moderated by cognitive domain and comparison group (control groupversuspreconcussion self-control). Specifically, delayed memory in studies utilizing a control group remained problematic at 7 days. The implications and limitations of these findings are discussed. (JINS, 2005,11, 345–357.)

Mild traumatic brain injury (MTBI) is common, yet few studies have examined neuropsychological outcomes more than 1 year postinjury. Studies of nonreferred individuals with MTBI or studies with appropriate control groups are lacking, but necessary to draw conclusions regarding natural recovery from MTBI. We examined the long-term neuropsychological outcomes of a self-reported MTBI an average of 8 years postinjury in a nonreferred community-dwelling sample of male veterans. This was a cross-sectional cohort study derived from the Vietnam Experience Study. Three groups matched on premorbid cognitive ability were examined, those who (1) had not been injured in a MVA nor had a head injury (Normal Control;n= 3214), (2) had been injured in a motor vehicle accident (MVA) but did not have a head injury (MVA Control;n= 539), and (3) had a head injury with altered consciousness (MTBI;n= 254). A MANOVA found no group differences on a standard neuropsychological test battery of 15 measures. Across 15 measures, the average neuropsychological effect size of MTBI compared with either control group was −.03. Subtle aspects of attention and working memory also were examined by comparing groups on Paced Auditory Serial Addition Test (PASAT) continuation rate and California Verbal Learning Test (CVLT) proactive interference (PI). Compared with normal controls, the MTBI group evidenced attention problems in their lower rate of continuation to completion on the PASAT (odds ratio = 1.32,CI= 1.0–1.73) and in excessive PI (odds ratio = 1.66,CI= 1.11–2.47). Unique to the MTBI group, PASAT continuation problems were associated with left-sided visual imperceptions and excessive PI was associated with impaired tandem gait. These results show that MTBI can have adverse long-term neuropsychological outcomes on subtle aspects of complex attention and working memory. (JINS, 2005,11, 228–236.)

The objective of this study was to evaluate the utility of the Behavioral Dyscontrol Scale (BDS) as a measure of behavioral regulation in Alzheimer's disease (AD) and mild cognitive impairment (MCI). Two patients groups (n=40 MCI and 40 AD) recruited from a memory clinic and an elderly control (EC) group (n=40) recruited from the community were administered a battery of neuropsychological tests including the BDS and a measure of functioning of activities of daily living (ADLs). Results of ROC analyses revealed that performance on the BDS discriminated between the AD group and the MCI and EC groups but did not discriminate between the MCI and EC groups. Performance on the BDS was an independent predictor of ADLs in patient groups after controlling for the effects of performance on a memory measure.

This study evaluated the Beery Visual-Motor Integration Test (VMI) as a measure of construction ability in Alzheimer's disease (AD) and mild cognitive impairment (MCI). Construction deficits are an early sign of Alzheimer's disease. Commonly used tests of construction abilities are complex, often intimidating to impaired elders, and lack a range of items. The VMI has items ranging from very easy to difficult, allowing even impaired patients to enter task set, and elderly norms are available. It has not yet been validated for use in diagnosis of AD or MCI. Two patients groups (n = 43 MCI and 40 AD) recruited from a memory clinic and a non-demented control group (n = 43) recruited from the community were administered a battery of neuropsychological measures including the VMI. Results revealed that the VMI is useful for discriminating AD from MCI. Qualitative errors produced on the VMI provide additional information beyond the standard score about the patient's cognitive status.

In this study we examined the independent and interactive effects of lifetime patterns of drinking and smoking on cognitive performance in elderly African Americans. A sample of 230 individuals with varying histories of alcohol and cigarette use was drawn from the Hillsborough Elder African American Life Study, a community-based, cross-sectional study of older adults aged 60 to 84. Dependent variables were the results of a neuropsychological battery that provided measures of general cognitive ability, executive function, and memory. Specifically, our study addressed (1) whether individuals with a lifetime history of sustained smoking and/or drinking show lower levels of cognitive performance in comparison to lifetime abstainers, (2) whether cumulative lifetime doses of alcohol or cigarettes, or of the two substances in interaction, have an effect on cognition, and (3) whether individuals who have histories of periodic, intense use of either alcohol or cigarettes show lower levels of cognitive performance in comparison to lifetime abstainers. When significant results were obtained, effect sizes were small, not exceeding 5% of the variance. A single exception occurred for the intensity analyses, in which drinking explained approximately 16% of the variance in global cognitive ability after adjusting for the contributions of control variables. In these analyses, drinking was found to have a U-shaped effect on global cognitive ability and total acquisition in the memory trials. Specifically, moderate users performed at a lower level than abstainers or heavy users, who did not differ from each other. (JINS, 2003, 9, 690–697.)

The prevailing theory in the literature concerning the lateralization of Stroop effects involves a speed of processing account (see ). Because the left hemisphere (LH) demonstrates an overall advantage relative to the right hemisphere (RH) on most verbal tasks, interference effects are hypothesized to be greater in the LH than in the RH. Inspection of the data, however, reveals that many studies find no difference in magnitude of Stroop interference between the hemispheres. Given findings within the lateralized semantic priming literature, this is not surprising. A meta-analysis on a subset of lateralized Stroop experiments was conducted to determine whether or not the LH produces significantly more interference than the RH in this paradigm. Based on a number of exclusionary criteria, a total of 19 different studies were included, representing a potential 26 effect size estimates of differential interference. The effect size representing interference using congruent conditions as the baseline (d+=.06) reveals that there is no significant difference between the hemispheres in magnitude of the Stroop interference effect. The LH interference effect was d+=.73, which is significant. Likewise, the RH interference effect, d+=.67, was significant. In summary, while there was no significant difference between the hemispheres, each hemisphere, when examined independently, did exhibit significant within hemisphere interference effects. These findings are presented in light of the lateralized semantic priming literature.

The Key Behaviors Change Inventory (KBCI) was developed to assess executive, behavioral, and emotional functioning following brain insults and to track the course of recovery. The purpose of this study was to investigate, in an elderly memory disorder clinic sample, the convergent and discriminant validity of the KBCI by examining the relationships between various measures of executive functioning and the KBCI scales that theoretically relate to executive functions. The KBCI was administered to the caregivers of 97 consecutive patients who came to a memory disorders clinic seeking services. The KBCI scales of Inattention, Apathy, Unawareness of Problems, and Communication Problems were significantly correlated with cognitive measures of executive functioning but not with measures of memory, visuospatial abilities or global cognitive functioning. In contrast, KBCI scales of Interpersonal Difficulties, Somatic Difficulties, and Emotional Adjustment were not related to any cognitive measures, either executive or nonexecutive. Contrary to predicted findings, the Impulsivity Scale was not associated with cognitive measures of executive functioning. This lack of relationship most likely reflects the failure to include executive measures of orbitofrontal functioning in this study. Results provide convergent and discriminant validity support for the KBCI. The KBCI may be a useful tool for assessing and tracking the executive, behavioral, and emotional sequelae of neurologic disorders.

The objectives of this study were to evaluate the reliability, validity, and utility of a newly developed clinical syndrome approach to assessing cancer-related fatigue. Fifty-one patients who underwent blood or marrow transplantation an average of 6.9 months previously were administered a standardized interview designed to identify the presence of a clinical syndrome of cancer-related fatigue. Patients also completed self-report measures of fatigue, depression, and health-related quality of life. Comparisons among independent raters demonstrated high rates of reliability for the presence or absence of a cancer-related fatigue syndrome and its symptoms. Twenty-one percent of patients (n = 11) were found to meet criteria for diagnosis of a cancer-related fatigue syndrome. Compared to patients not meeting the diagnostic criteria, patients meeting the criteria reported fatigue that was greater (Por = 0.05) in its severity, frequency, pervasiveness, and interference with quality of life. Patients who met criteria also demonstrated poorer role functioning, less vitality, and more depressive symptomatology (Por = 0.05). These findings provide preliminary evidence of the reliability and validity of the methods used to assess the proposed clinical syndrome and suggest their utility in identifying patients experiencing clinically significant cancer-related fatigue.

Background: Both the Departments of Defense and Veterans Health Administration have developed and implemented screening procedures for identification of possible deployment-related traumatic brain injury (TBI). Objective: To review population-based screening procedures for TBI, particularly mild TBIs, and discuss potential harms/costs versus benefits of such TBI screening. Methods: The principles commonly used in population-based screening for various medical conditions are identified. These principles are applied to screening for TBI. The potential harms and costs are compared with potential benefits of screening for mild TBI. Results: The core conditions essential for beneficial medical screening—progressive disease, symptoms related to the identified disease, suitable tests or examinations for accurate diagnosis, and accepted and effective treatment—are not present within the context of TBI screening. Potential harms/costs outweigh any potential benefits of population-based screening for TBI. Conclusion: On the basis of generally accepted medical screening principles and assumptions, population screening for mild TBI is unnecessary at best and potentially harmful at worst. Because nonspecific, postconcussion-like symptoms can be effectively treated in a symptom-specific manner, tying them to concussion through a screening and evaluation process is wasteful and potentially harmful.

This study is a meta-analysis of available literature examining the effect of an observer on cognitive task performance. Of the 210 identified relevant articles, 62 met inclusion criteria yielding a final sample with 4405 individuals (2496 observed cases, 1909 not observed). The overall effect size was significant (d=-0.24), i.e., the presence of an observer was associated with poorer performance. However results were moderated by the effect size calculation method, cognitive domain, visibility of the observer, and number of observers. Attention, learning/memory, and delayed recall tasks were most adversely impacted by the presence of an observer.