Application of Second-Order Growth Mixture Modeling (SO-GMM) to Longitudinal TBI Outcome Research: 15-year Trajectories of Life Satisfaction in Adolescents and Young Adults (AYA) as an Example

Longitudinal associations of time-varying homeboundness and life satisfaction after traumatic brain injury

PURPOSE/OBJECTIVE

To examine the association of changes in homebound status (i.e., never/rarely leaving the home) with life satisfaction in the first 10 years after traumatic brain injury (TBI).

RESEARCH METHOD/DESIGN

We analyzed data from 2,294 individuals with moderate-to-severe TBI from the TBI Model Systems National Database using a longitudinal multilevel model with time-varying predictors to account for within-person changes over time as well as between-person differences. We measured homebound status (defined as leaving the home ≤ 2 days/week) and life satisfaction (defined as the total score on the Satisfaction With Life Scale) at 1, 2, 5, and 10 years post-TBI. We adjusted the models for demographic and injury-related covariates and used inverse probability weighting to account for selection bias.

RESULTS

Forty-five (2%) individuals were homebound at all follow-up visits, 523 (22.8%) were homebound at least one follow-up visit, and 1,726 (75.2%) were never homebound. Individuals with TBI who were consistently homebound had > 1 SD lower life satisfaction compared to those who were never homebound, β = -8.07, 95% confidence interval (CI) = [-9.39, -6.76], p < .001. Individuals who became homebound experienced a significant, but modest, decline in life satisfaction (β = -2.13, 95% CI = [-2.66, -1.61], p < .001).

CONCLUSIONS/IMPLICATIONS

Our results indicate that being homebound and becoming homebound are associated with decreased life satisfaction. Homeboundness is a potentially modifiable target to improve life satisfaction, and elucidation of contributing factors to homebound status will help develop interventions to ameliorate post-TBI homeboundness. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Evidence That Growth Mixture Model Results Are Highly Sensitive to Scoring Decisions

Interest in identifying latent growth profiles to support the psychological and social-emotional development of individuals has translated into the widespread use of growth mixture models (GMMs). In most cases, GMMs are based on scores from item responses collected using survey scales or other measures. Research already shows that GMMs can be sensitive to departures from ideal modeling conditions and that growth model results outside of GMMs are sensitive to decisions about how item responses are scored, but the impact of scoring decisions on GMMs has never been investigated. We start to close that gap in the literature with the current study. Through empirical and Monte Carlo studies, we show that GMM results-including convergence, class enumeration, and latent growth trajectories within class-are extremely sensitive to seemingly arcane measurement decisions. Further, our results make clear that, because GMM latent classes are not known a priori, measurement models used to produce scores for use in GMMs are, almost by definition, misspecified because they cannot account for group membership. Misspecification of the measurement model then, in turn, biases GMM results. Practical implications of these results are discussed. Our findings raise serious concerns that many results in the current GMM literature may be driven, in part or whole, by measurement artifacts rather than substantive differences in developmental trends.

A scoping review of research on potential impact of implicit bias in healthcare settings for children with acquired brain injuries

PURPOSE/OBJECTIVE

Acquired brain injury (ABI) is a leading cause of disability in children and adolescents. Implicit biases within pediatric ABI healthcare settings may exert negative effects on clinical interactions and medical decision-making processes. This study aimed to conduct a scoping review of current research that examines the potential impact of implicit biases in such healthcare settings for children with ABI.

RESEARCH METHOD/DESIGN

Following PRISMA-ScR guidelines, a search among five databases (CINAHL, Cochrane CENTRAL, PubMed, PsycArticles, and PsycInfo) was conducted, followed by abstract/full-text screening and data extraction. Main characteristics of the included studies, including research design, relevance to implicit biases, and public health impact were synthesized. The risk of bias of included studies was assessed.

RESULTS

Out of the 203 articles returned from the literature search, a total of three studies met the inclusion criteria for the present review. All studies examined the relevance of racial/ethnic biases for evaluating abusive head trauma or nonaccidental trauma. The included studies had an overall unclear to low risk of biases.

CONCLUSIONS/IMPLICATIONS

This scoping review identified scarce but emerging evidence of the presence and detrimental impact of potential implicit biases on the access and quality of care received by children with ABI. More research is needed to examine the causes, process mechanisms, and consequences of implicit biases in pediatric ABI healthcare settings. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Correlates of Longitudinal Trajectories of Depressive Symptoms in Adolescents With Traumatic Brain Injuries

OBJECTIVE

Depression poses a significant threat to the health and well-being of adolescents with traumatic brain injury. Existing research has limitations in longitudinal follow-up period, consideration of sample heterogeneity, and outcome measurement modeling. This study aimed to address these gaps by applying the second-order growth mixture model (SO-GMM) to examine the 10-year post-injury depression trajectories in adolescents with TBI.

METHODS

A total of 1,989 adolescents with TBI 16-21 years old from the Traumatic Brain Injury Model System National Data Bank were analyzed up to 10 years post-injury. Depressive symptoms were measured by Patient Health Questionnaire-9. Covariates included age, sex, race/ethnicity, employment, Functional Independence Measure Cognition, TBI severity, pre-injury disability, and substance use. Longitudinal measurement invariance was tested at the configural, metric, and scalar levels before SO-GMM was fit. Logistic regression was conducted for disparities in depression trajectories by covariates.

RESULTS

A 2-class SO-GMM was identified with a low-stable group (85% of the sample) and a high-increasing group (15% of the sample) on depression levels. Older age, being a Native American, and having Hispanic origin was associated with a higher likelihood of being in the high-increasing class (odds ratios [ORs] = 1.165-4.989 and 1.609, respectively), while patients with higher education and being male were less likely to be in the high-increasing class (ORs = 0.735 and 0.557, respectively).

CONCLUSIONS

This study examined the disparities in depression among two distinct longitudinal groups of adolescents with TBI 10 years post-injury. Findings of the study are informative for intervention development to improve long-term mental health in adolescents with TBI.

Long-Term Vocational Outcome at 15 Years from Severe Traumatic and Non-Traumatic Brain Injury in Pediatric Age

BACKGROUND

Recent studies suggest that acquired brain injury with impaired consciousness in infancy is related to more severe and persistent effects and may have a cumulative effect on ongoing development. In this work, we aim to describe vocational outcome in a group of patients at 15 years from a severe brain lesion they suffered in developmental age.

METHODS

This study included a total of 147 patients aged 1.5 to 14 years with acquired brain lesion. Clinical and functional details ("Glasgow Outcome Scale", "Functional Independent Measure" and Intelligence Quotient) were collected at the time of their first hospitalization and vocational outcome was determined after 15 years.

RESULTS

94 patients (63.9%) presented with traumatic brain injury, while 53 patients (36.1%) presented with a brain lesion of other origin. Traumatic patients had a higher probability of being partly or fully productive than non-traumatic ones: 75.5% of traumatic subjects were working-taking into account limitations due to the traumatic event-versus 62.3% of non-traumatic ones. A relationship between some clinical variables and the vocational outcome was found.

CONCLUSIONS

Rehabilitation should adequately emphasize "vocational rehabilitation" because a significant proportion of people experiencing a disorder of consciousness in childhood may show good social integration in adult age.

Traumatic brain injury as a chronic disease: insights from the United States Traumatic Brain Injury Model Systems Research Program

Traumatic brain injury (TBI) is a global health priority, associated with substantial burden. Historically conceptualised as an injury event with finite recovery, TBI is now recognised as a chronic condition that can affect multiple domains of health and function, some of which might deteriorate over time. Many people who have had a TBI remain moderately to severely disabled at 5 years, are rehospitalised up to 10 years post-injury, and have a reduced lifespan relative to the general population. Understanding TBI as a chronic disease process can be highly informative for optimising care, which has traditionally focused on acute care. Chronic brain injury care models must be informed by a holistic understanding of long-term outcomes and the factors that can affect how care needs evolve over time. The United States Traumatic Brain Injury Model Systems of Care follows up individuals with moderate-to-severe TBI for over 30 years, allowing characterisation of the chronic (2-30 years or more post injury) functional, cognitive, behavioural, and social sequelae experienced by individuals who have had a moderate-to-severe TBI and the implications for their health and quality of life. Older age, social determinants of health, and lower acute functional status are associated with post-recovery deterioration, while younger age and greater functional independence are associated with risky health behaviours, including substance misuse and re-injury. Systematically collected data on long-term outcomes across multiple domains of health and function are needed worldwide to inform the development of models for chronic disease management, including the proactive surveillance of commonly experienced health and functional challenges.

Trait mindfulness facets as a protective factor for the development of postpartum depressive symptoms

BACKGROUND

Postpartum depression has a prevalence rate of up to 17%. As there are many negative consequences of postpartum depressive symptoms, it is important to examine possible protective factors, such as trait mindfulness. Since postpartum depressive symptoms are variable over time between and within individuals, this study focused on the possible association between facets of trait mindfulness and trajectories of postpartum depressive symptoms throughout the first postpartum year.

METHODS

A subsample of 713 women that participated in the HAPPY study completed the Three Facet Mindfulness Questionnaire-Short Form at 22 weeks of pregnancy and the Edinburgh Postnatal Depression Scale (EPDS) at six weeks, four months, eight months, and twelve months postpartum. Possible different EPDS trajectories were obtained by means of growth mixture modeling.

RESULTS

Two EPDS trajectories (classes) were found: a low stable symptom class (N = 647, 90.7%) and an increasing-decreasing symptom class (N = 66, 9.3%). Women in the low stable class showed higher 'acting with awareness' and 'non-judging' scores. A higher score on the 'non-judging' facet of trait mindfulness was associated with a higher likelihood of belonging to the low stable class (OR = 0.79, 95% CI [0.72, 0.87], p < 0.001), adjusted for confounders and the other mindfulness facets.

CONCLUSIONS

The non-judging facet of trait mindfulness was associated with low stable levels of depressive symptoms during the first postpartum year. Mindfulness-based programs, focusing on enhancing non-judging may be of benefit for pregnant women to possibly decrease the risk of developing postpartum depressive symptoms after childbirth.