The symptom checklist-90-revised and mild traumatic brain injury

Good Health-Related Quality of Life in Older Patients One Year after mTBI despite Incomplete Recovery: An Indication of the Disability Paradox?

Background: Older adults (OAs) with mild traumatic brain injury (OA-mTBI) are a growing population, but studies on long-term outcomes and quality of life are scarce. Our aim was to determine the health-related quality of life (HRQoL) in OA-mTBI one year after injury and to assess the early predictors of HRQoL. Methods: Data from a prospective follow-up study of 164 older (≥60 years) and 289 younger mTBI patients (<60 years) admitted to the emergency department were analyzed. Post-traumatic complaints, emotional distress and coping were evaluated 2 weeks post-injury using standardized questionnaires. At 12 months post-injury, HRQoL and functional recovery were determined with the abbreviated version of the World Health Organization Quality of Life scale and Glasgow Outcome Scale Extended (GOSE), respectively. Results: One year post-injury, 80% (n = 131) of the OA-mTBI rated their HRQoL as "good" or "very good", which was comparable to younger patients (79% (n = 226), p = 0.72). Incomplete recovery (GOSE <8) was present in 43% (n = 69) of OA-mTBI, with 67% (n = 46) reporting good HRQoL. Two weeks post-injury, fewer OA-mTBI had (≥2) post-traumatic complaints compared to younger patients (68% vs. 80%, p = 0.01). In the multivariable analyses, only depression-related symptoms (OR = 1.20 for each symptom, 95% CI = 1.01-1.34, p < 0.01) were predictors of poor HRQoL in OA-mTBI. Conclusions: Similar to younger patients, most OA-mTBI rated their HRQoL as good at one year after injury, although a considerable proportion showed incomplete recovery according to the GOSE, suggesting a disability paradox. Depression-related symptoms emerged as a significant predictor for poor HRQoL and can be identified as an early target for treatment after mTBI.

Evaluating the Psychometric Properties of 3 Depression Measures in a Sample of Persons With Traumatic Brain Injury and Major Depressive Disorder

OBJECTIVES

To explore the psychometric properties of 3 widely used measures of depression in a sample of individuals with traumatic brain injury (TBI) and major depressive disorder and refine them to maximize efficiency.

DESIGN

Secondary analysis of data from a randomized controlled trial of cognitive-behavioral therapy for depression after TBI.

SETTING

Nationwide recruitment from community and clinical settings.

PARTICIPANTS

One hundred adults within 10 years of complicated mild to severe TBI.

INTERVENTION

Telephone and in-person cognitive-behavioral therapy.

MAIN MEASURES

Patient Health Questionnaire-9 (PHQ-9), Symptom Checklist-20, and Hamilton Depression Rating Scale.

RESULTS

We used Rasch rating scale analysis and multilevel modeling to investigate the 3 measures. Measurement properties of each of the depression measures were strong. We explored modifications to the rating scales to improve efficiency while retaining strong psychometric characteristics. Correlations among these revised measures were high. Treatment effects of each revised depression measure were compared using a multilevel model, and effect size estimates were comparable among the revised PHQ-9, Symptom Checklist-20, and Hamilton Depression Rating Scale.

CONCLUSIONS

Although each of the 3 measures demonstrated adequate reliability, the efficiency of all 3 instruments was improved with rating scale analysis. The PHQ-9 required the fewest modifications and functions well as a measure of depression among those with TBI.

Comparison of long-term outcomes following traumatic injury: what is the unique experience for those with brain injury compared with orthopaedic injury?

OBJECTIVE

Whilst it has been well-demonstrated that traumatic brain injury (TBI) results in long-term cognitive, behavioural and emotional difficulties, less is understood about how these outcomes differ from those following traumatic orthopaedic injury (TOI). The aim of this study was to compare self-reported outcomes at 5-10 years post-injury for those with TBI, TOI, and uninjured controls. It was hypothesised that participants with TBI would have greater cognitive difficulties; participants with TOI and TBI would have similar functional and physical outcomes, both being poorer than controls; and participants with TBI would have poorer psychosocial outcomes than those with TOI.

PARTICIPANTS AND METHODS

Eighty-eight individuals with complicated mild to severe TBI and 96 with TOI recruited during inpatient rehabilitation were followed up 5-10 years post-injury, together with 48 controls followed over a similar period. Self-report measures of global functioning (GOS-E), quality of life (SF-36), psychological wellbeing (SCL-90-R, HADS, PCL-S), psychosocial difficulties (SIP), cognitive difficulties (SF-36 COG), pain (BPI), and fatigue (FSS) were administered.

RESULTS

Outcomes for individuals with TBI and TOI differed significantly from controls, with poorer global functioning, and greater psychological distress and interference from pain. Only participants with TBI reported greater cognitive difficulties and anxiety than controls, and were less likely to be employed or in a relationship. Participants with TBI reported greater anxiety, PTSD, psychological distress and psychosocial difficulties than those with TOI.

CONCLUSIONS

Both TOI and TBI cause long-term disability, interference from pain, and psychological distress. However, cognitive impairments, unemployment, lack of long-term relationships, anxiety and PTSD are more substantial long-term problems following TBI. Findings from this study have implications for managing risks associated with these injury groups and tailoring rehabilitation to improve long-term outcomes.

Evidence of cognitive decline in older adults after remote traumatic brain injury: an exploratory study

Separate bodies of literature indicate that a history of a traumatic brain injury (TBI) and natural aging may result in overlapping cognitive profiles, yet little is known about their combined effect. We predicted that a remote TBI would compound normal age-related cognitive decline, particularly affecting executive function. Neuropsychological task performance was compared between a group of older adults who sustained a TBI in their distant past (N = 9) and a group of older adults with no history of head injury (N = 15). While all participants scored in the normal range on the Mini-Mental State Examination, the TBI group scored lower than the non-TBI group. Also, in line with predictions, the TBI group made more errors on measures of executive functioning compared to the non-TBI group (the Trail Making B test and the incongruent condition of the Stroop Test), but performed similarly on all tasks with little executive requirements. Findings from this exploratory study indicate that a past TBI may put older adults at a higher risk for exacerbated age-related cognitive decline compared to older adults with no history of TBI.

Effects of "diagnosis threat" on cognitive and affective functioning long after mild head injury

Persistent cognitive complaints are common following a mild head injury (MHI), but deficits are rarely detected on neuropsychological tests. Our objective was to examine the effect of symptom expectation on self-report and cognitive performance measures in MHI individuals. Prior research suggests that when MHI participants are informed they may experience cognitive difficulties, they perform worse on neuropsychological tests compared to MHI participants who are uninformed. In this study, undergraduate students with and without a prior MHI were either informed that the study's purpose was to investigate the effects of MHI on cognitive functioning ("diagnosis threat" condition) or merely informed that their cognitive functioning was being examined, with no mention of status ("neutral" condition). "Diagnosis threat" MHIs self-reported more attention failures compared to "diagnosis threat" controls and "neutral" MHIs, and more memory failures compared to "diagnosis threat" controls. In the "neutral" condition, MHIs reported higher anxiety levels compared to controls and compared to "diagnosis threat" MHIs. Regardless of condition, MHIs performed worse on only one neuropsychological test of attention span. "Diagnosis threat" may contribute to the prevalence and persistence of cognitive complaints made by MHI individuals found in the literature, but may not have as strong of an effect on neuropsychological measures.

A meta-analytic review of the emotional symptoms associated with mild traumatic brain injury

Given the prevalence of mild traumatic brain injury (mTBI) and enduring subjective complaints known as postconcussion symptoms (PCS), it is important to investigate the nature and extent of these difficulties. This study used meta-analytic techniques to integrate the available information on the emotional symptoms associated with mTBI. Small effect sizes were found across all domains (depression, anxiety, coping, and psychosocial disability); however, significance depended upon the weighting method employed. The results indicate that mTBI had a small to negligible effect on emotional symptom reporting. This has implications for the etiology of PCS, the delivery of therapeutic interventions, and medico-legal disputations.