Audrey Folsom

Background/Objectives: Concussions produce a wide array of symptoms that are often subtle and difficult to quantify. One such symptom involves reaction or response time (RT), consisting of perceptual latency time (LT) and movement time (MT). This pilot study examined the relationship between concussion history, mental health, and perceptual-motor performance among military veterans using a virtual reality (VR)-based assessment. The primary outcome was intraindividual variability (IIV), defined as the standard deviation of an individual’s responses across repeated trials. Methods: Of 78 veterans who volunteered, 29 (22 males, 7 females) provided complete VR data. Participants completed surveys assessing concussion and combat history, mental health issues, and suicide ideation. During VR testing, participants responded to 40 trials requiring neck rotation, arm reach, and a step toward left or right virtual targets. Associations between predictors (e.g., concussion, mental health) and VR outcomes (RT, LT, IIV) were evaluated using Receiver Operating Characteristic (ROC) Area Under the Curve (AUC) values. Results: Concussion history was the strongest predictor of performance deficits. IIV metrics were sensitive indicators of both concussion and mental health issues. Univariable analyses yielded AUC values of 0.944–0.806 all of which were statistically significant (p ≤ 0.001), and multivariable analyses produced AUCs of 0.950–0.870 all of which were also statistically significant (p ≤ 0.001). Incongruent movements and longer LT values were especially discriminative. Conclusions: Veterans with concussion and mental health histories demonstrated quantifiable perceptual-motor impairments in VR environments. Findings support VR assessment as a feasible, sensitive tool for detecting subtle residual effects of concussion.

Background/Objectives: Suicides among U.S. military veterans are alarmingly high, driven by factors such as mental health issues, combat exposure, and history of mild traumatic brain injury (mTBI)/concussion. This study aims to examine the relationship between concussion history, combat experience, and their effects on mental health issues and suicide ideation among military veterans. Additionally, this study investigates the impact of post-traumatic stress disorder (PTSD) on these variables. Methods: A total of 78 veterans (62 males, 16 females) participated in this study. Participants completed a demographic survey and the Global Well-being Index (GWI) to assess concussion history and residual symptoms. A licensed social worker interviewed the veterans using the 9-Item Patient Health Questionnaire (PHQ-9) for depression, the Generalized Anxiety Disorder survey (7 Items) (GAD-7) for anxiety, and the Columbia-Suicide Severity Rating Scale (C-SSRS) for suicide ideation. A 2 × 2 cross-tabulation analysis examined the relationships between concussion history, combat experience, and outcomes of anxiety, depression, and suicide ideation. PTSD was also assessed as both a predictor and an outcome. Statistical analyses yielded odds ratios (OR) with 95% confidence intervals (CI), Chi-square, and Cramer’s V (V) correlations along with associated p-values. Results: The combination of concussion history and combat experience strongly predicted either anxiety, depression, or suicide ideation (OR = 7.97, 95% CI: 1.70, 37.44; V = 0.334, (p = 0.003)), more than either factor alone. Combat experience was the strongest predictor of PTSD (OR = 11.12, 95% CI: 3.30, 37.47; V = 0.485, p ≤ 0.001), both individually and when combined with concussion history. PTSD strongly influenced mental health issues and suicide ideation (OR = 8.16, 95% CI: 1.74, 38.25; V = 0.339, p = 0.003). Stratification by PTSD status (positive or negative) affected the relationships between independent and dependent variables. Small cell counts resulted in a wide 95% CI for some ORs, though some statistically significant Fisher’s Exact Test results were observed. Credibility analysis using the critical prior interval (CPI) metric confirmed the intrinsic credibility of the results. Conclusions: This study provides insights into the relationships between concussion history, combat experience, and their impacts on mental health issues and suicide ideation among military veterans.