Childhood mild traumatic brain injury linked to worse mental health in U.S. Veterans

U.S. Veterans who sustained a mild traumatic brain injury in childhood had worse mental and behavioral health outcomes, according to a cross-sectional study drawing on the Long-term Impact of Military-relevant Brain Injury Consortium-Chronic Effects of Neurotrauma Consortium (LIMBIC-CENC) prospective longitudinal cohort. The findings suggest that some of the psychological burden carried by Veterans may have roots that predate military service entirely.

The analysis included 1,286 Veterans, of whom 61.3 percent had sustained a mild traumatic brain injury, or mTBI, during childhood. Mild traumatic brain injury is a common injury across all age groups and populations, with a particularly high prevalence among military service members and Veterans. The researchers set out to examine whether childhood mTBI was associated with multimodal mental and behavioral health outcomes in adulthood, and, among those with a childhood injury, which sociodemographic characteristics were linked to worse outcomes.

After adjusting for demographic, behavioral, and military history factors, Veterans with a childhood mTBI scored significantly higher on a range of measures. Their PTSD symptom scores were 36 percent higher on average (mean ratio 1.36, 95 percent CI 1.22–1.51), depression scores were 31 percent higher (mean ratio 1.31, 95 percent CI 1.17–1.46), and anger scores were 8 percent higher (mean ratio 1.08, 95 percent CI 1.05–1.10). Anxiety scores were elevated by a mean difference of 4.3 points (95 percent CI 2.9–5.6), and emotional-behavioral dyscontrol scores by 3.2 points (95 percent CI 2.2–4.3).

The differences extended beyond mood and emotional regulation. Veterans with childhood mTBI reported worse sleep quality (mean difference 1.6, 95 percent CI 1.1–2.2) and worse neurobehavioral symptoms overall (mean difference 6.8, 95 percent CI 5.2–8.5). They also reported lower satisfaction with life (mean difference −1.2, 95 percent CI −2.1 to −0.27) and lower resilience scores (mean ratio 0.96, 95 percent CI 0.94–0.99). Notably, after adjustment for alcohol and drug use scores, there were no significant differences in those substance-related outcomes.

Because the study is cross-sectional, it captures associations at a single point in time rather than proving that childhood mTBI causes later mental health problems. The adjusted associations were consistent across multiple outcome domains, including PTSD, depression, anxiety, anger, sleep, neurobehavioral symptoms, life satisfaction, and resilience.

Within the subgroup of Veterans who had a childhood mTBI, the researchers found that outcomes were not uniform. Several mental and behavioral health measures were worse among those who had sustained multiple mild traumatic brain injuries in childhood. Conversely, outcomes were better among those who were physically active and among those with higher educational attainment, suggesting that these factors may mark a more favorable trajectory even after early brain injury.

The authors interpret the results as identifying markers of increased risk that were present before military enlistment.

The researchers argue that the findings may warrant targeted prevention, screening, and treatment strategies, and that increased awareness among healthcare providers could help identify Veterans with a childhood mTBI history who would benefit from evidence-based treatment and support.

The study’s strengths lie in its size and its use of a well-characterized prospective longitudinal cohort of Veterans, which allowed the investigators to adjust for a broad set of demographic, behavioral, and military history confounders.

Subject of Research: The association between childhood mild traumatic brain injury and mental and behavioral health outcomes among U.S. Veterans

Article Title: Association of childhood mild traumatic brain injury with mental and behavioral health outcomes later in life among U.S. Veterans: A LIMBIC-CENC study

Article References: Waltzman, D., Haarbauer-Krupa, J., Walton, S. R., Jridi, A., Presson, A. P., Walker, W. C., Cifu, D. X., Oldham, J. R., & Lempke, L. B. (2026). Association of childhood mild traumatic brain injury with mental and behavioral health outcomes later in life among U.S. Veterans: A LIMBIC-CENC study. PLOS Mental Health, 3(10), e0000679. https://doi.org/10.1371/journal.pmen.0000679

Image Credits: AI Generated

DOI: 10.1371/journal.pmen.0000679

Keywords: mild traumatic brain injury, childhood mTBI, U.S. Veterans, PTSD, depression, anxiety, sleep quality, resilience, LIMBIC-CENC, neurotrauma, mental health, cross-sectional study