Use of a Traumatic Brain Injury (TBI) Screen in a Veteran Mental Health Population

The primary aims of this study are to: 1) Establish the concurrent criterion-related validity
of four traumatic brain injury (TBI) screening questions (TBI-4) using the Ohio State
University TBI Identification Method (OSU TBI-ID) and 2) Establish the concurrent
criterion-related validity of the TBI-4 with the addition of detailed information elicited by
the four questions. Secondary aims include: 1) Determining if the addition of detailed
information elicited by the TBI-4 results in increased specificity; 2) Determining whether
the prevalence of traumatic brain injury (TBI) in this sample is concordant with previous
research; and 3) Determining whether psychiatric outcomes are worse for veterans with
traumatic brain injury (TBI) than those with no traumatic brain injury(TBI).

Primary Hypotheses:

Hypothesis 1a: The sensitivity and specificity of the TBI-4 will be significantly greater
than 0.75 and 0.80, respectively.

Hypothesis 1b: The sensitivity and specificity of the TBI-4 with the addition of detailed
information elicited by these questions (i.e., free text information entered by the clinician
who administered the TBI-4) will be significantly greater than 0.75 and 0.80, respectively.

Secondary Hypotheses:

Hypothesis 1c: The specificity of the TBI-4 with the addition of detailed information
elicited by these questions (i.e., free text information entered by the clinician who
administered the TBI-4) will be significantly greater than that of the four questions alone.

Hypothesis 2: A significant difference in psychiatric outcomes (psychiatric hospitalizations,
suicidal ideation, suicide attempts and completions, and mental health-related contacts) will
be identified in those with a history of TBI versus those without a history of TBI as
determined, first, by the TBI-4 and, second, by the OSU TBI-ID.

Hypothesis 3: The prevalence of Traumatic Brain Injury- Loss of Consciousness (TBI-LOC) in
this population will be similar to that identified by Walker et al1 (31.7% of individuals
will report 1 or more TBI-LOC).

Inclusion Criteria:

- Veteran must be at least 18 years of age.

- Veteran must have had a mental health intake no earlier than January of 2007.

Exclusion Criteria:

- Failure to provide informed consent as evidenced by inability to respond to the above
stated questions.

- No Mental Health Intake note in the medical record.

- Presence of a Mental Health Intake note in the computer which does not contain the
TBI-4