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Dharsee S, Laliberté Durish C, Tang K, Brooks BL, Noel M, Ware AL, Beauchamp MH, Craig W, Doan Q, Freedman SB, Goodyear BG, Gravel J, Zemek R, Yeates KO. Association of Psychological Resilience, Cognitive Reserve, and Brain Reserve with Post-Concussive Symptoms in Children with Mild Traumatic Brain Injury and Orthopedic Injury: An A-CAP Study. J Neurotrauma 2024. [PMID: 38874919 DOI: 10.1089/neu.2024.0076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024] Open
Abstract
Protective factors, including psychological resilience, cognitive reserve, and brain reserve, may be positively associated with recovery after pediatric mild traumatic brain injury (mTBI) but are yet to be studied concurrently. We sought to examine these factors as moderators of post-concussive symptoms (PCS) in pediatric mTBI compared with mild orthopedic injury (OI). Participants included 967 children (633 mTBI, 334 OI) aged 8-16.99 years, recruited from 5 Canadian pediatric emergency departments as part of a prospective longitudinal cohort study. At 10 days post-injury, psychological resilience was measured using the Connor-Davidson Resilience Scale and brain reserve was measured using total brain volume derived from structural magnetic resonance imaging. Cognitive reserve was measured at 3 months post-injury using IQ scores from the Wechsler Abbreviated Scale of Intelligence-Second Edition. Cognitive and somatic PCS were measured using child and parent ratings on the Health and Behavior Inventory, completed weekly for 3 months and biweekly to 6 months. Analyses involved generalized least-squares regression models using restricted cubic splines. Covariates included age at injury, sex, racialized identity, material and social deprivation, pre-injury migraine and concussion history, and retrospective pre-injury PCS. Psychological resilience moderated group differences in parent-reported PCS. At 30 days post-injury, estimated group differences in parent-reported cognitive and somatic PCS (mTBI > OI) were larger at higher (75th percentile) resilience scores (Est = 2.25 [0.87, 3.64] and Est = 2.38 [1.76, 3.00], respectively) than at lower (25th percentile) resilience scores (Est = 1.44 [0.01, 2.86] and Est = 2.08 [1.45, 2.71], respectively). Resilience did not moderate group differences in child-reported PCS but was negatively associated with child-reported PCS in both groups (ps ≤ 0.001). Brain reserve (i.e., total brain volume [TBV]) also moderated group differences, but only for parent-reported somatic PCS (p = 0.018). Group difference (mTBI > OI) at 30 days was larger at smaller (25th percentile) TBV (Est = 2.78 [2.17, 3.38]) than at larger (75th percentile) TBV (Est = 1.95 [1.31, 2.59]). TBV was not associated with parent-reported cognitive PCS or child-reported PCS. IQ did not moderate PCS in either group but had a significant non-linear association in both groups with child-reported somatic PCS (p = 0.018) and parent-reported PCS (p < 0.001), with higher PCS scores at both lower and higher IQs. These findings suggest that higher resilience predicts fewer PCS, but less strongly after mTBI than OI; greater brain reserve may reduce the effect of mTBI on somatic PCS; and cognitive reserve has an unexpected curvilinear association with PCS across injury types. The results highlight the importance of protective factors as predictors of recovery and potential targets for intervention following pediatric mTBI.
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Affiliation(s)
- Safira Dharsee
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | | | - Ken Tang
- Independent Statistical Consulting, Richmond, British Columbia, Canada
| | - Brian L Brooks
- Departments of Pediatrics, Clinical Neurosciences, and Psychology, Alberta Children's Hospital Research Institute, University of Calgary; Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Melanie Noel
- Department of Psychology, Alberta Children's Hospital Research Institute, and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Ashley L Ware
- Department of Psychology, Georgia State University, Georgia, USA
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | | | - William Craig
- Department of Pediatrics, University of Alberta and Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Quynh Doan
- Department of Pediatrics, University of British Columbia and BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Stephen B Freedman
- Departments of Pediatrics and Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Bradley G Goodyear
- Department of Radiology, Cumming School of Medicine, and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Jocelyn Gravel
- Department of Pediatric Emergency Medicine, CHU Sainte-Justine Hospital Research Center, Montréal, Québec, Canada
- Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada
| | - Roger Zemek
- Departments of Pediatrics and Emergency Medicine, University of Ottawa and Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Keith Owen Yeates
- Department of Psychology, Alberta Children's Hospital Research Institute, and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
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Gornall A, Takagi M, Clarke C, Babl FE, Cheng N, Davis GA, Dunne K, Anderson N, Hearps SJC, Rausa V, Anderson V. Psychological Predictors of Mental Health Difficulties After Pediatric Concussion. J Neurotrauma 2024; 41:e1639-e1648. [PMID: 38661521 DOI: 10.1089/neu.2023.0116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
Children often experience mental health difficulties after a concussion. Yet, the extent to which a concussion precipitates or exacerbates mental health difficulties remains unclear. This study aimed to examine psychological predictors of mental health difficulties after pediatric concussion. Children (5 to <18 years of age, M = 11.7, SD = 3.3) with concussion were recruited in a single-site longitudinal prospective cohort study conducted at a tertiary children's hospital (n = 115, 73.9% male). The primary outcomes included internalizing (anxious, depressed, withdrawn behaviors), externalizing (risk-taking, aggression, attention difficulties), and total mental health problems, as measured by the Child Behavior Checklist at 2 weeks (acute) and 3 months (post-acute) after concussion. Predictors included parents' retrospective reports of premorbid concussive symptoms (Post-Concussion Symptom Inventory; PCSI), the child and their family's psychiatric history, child-rated perfectionism (Adaptive-Maladaptive Perfectionism Scale), and child-rated resilience (Youth Resilience Measure). Higher premorbid PCSI ratings consistently predicted acute and post-acute mental health difficulties. This relationship was significantly moderated by child psychiatric history. Furthermore, pre-injury learning difficulties, child psychiatric diagnoses, family psychiatric history, lower resilience, previous concussions, female sex, and older age at injury were associated with greater mental health difficulties after concussion. Pre-injury factors accounted for 23.4-39.9% of acute mental health outcomes, and 32.3-37.8% of post-acute mental health outcomes. When acute mental health was factored into the model, a total of 47.0-68.8% of variance was explained by the model. Overall, in this sample of children, several pre-injury demographic and psychological factors were observed to predict mental health difficulties after a concussion. These findings need to be validated in future research involving larger, multi-site studies that include a broader cohort of children after concussion.
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Affiliation(s)
- Alice Gornall
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Turner Institute for Brain and Mental Health, Monash University, School of Psychological Sciences, Melbourne, Victoria, Australia
| | - Michael Takagi
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Turner Institute for Brain and Mental Health, Monash University, School of Psychological Sciences, Melbourne, Victoria, Australia
- School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Cathriona Clarke
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Franz E Babl
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Emergency Department, The Royal Children's Hospital, Melbourne, Victoria, Australia
- Department of Pediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Nicholas Cheng
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Turner Institute for Brain and Mental Health, Monash University, School of Psychological Sciences, Melbourne, Victoria, Australia
| | - Gavin A Davis
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Kevin Dunne
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Pediatrics, University of Melbourne, Melbourne, Victoria, Australia
- Department of Rehabilitation Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Nicholas Anderson
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | | | - Vanessa Rausa
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Vicki Anderson
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Turner Institute for Brain and Mental Health, Monash University, School of Psychological Sciences, Melbourne, Victoria, Australia
- School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Pediatrics, University of Melbourne, Melbourne, Victoria, Australia
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Luszawski CA, Plourde V, Sick SR, Galarneau JM, Eliason PH, Brooks BL, Mrazik M, Debert CT, Lebrun C, Babul S, Hagel BE, Dukelow SP, Schneider KJ, Emery CA, Yeates KO. Psychosocial Factors Associated With Time to Recovery After Concussion in Adolescent Ice Hockey Players. Clin J Sport Med 2024; 34:256-265. [PMID: 37707392 DOI: 10.1097/jsm.0000000000001187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 08/06/2023] [Indexed: 09/15/2023]
Abstract
OBJECTIVE To investigate the association between psychosocial factors and physician clearance to return to play (RTP) in youth ice hockey players after sport-related concussion. DESIGN Prospective cohort study, Safe to Play (2013-2018). SETTING Youth hockey leagues in Alberta and British Columbia, Canada. PARTICIPANTS Three hundred fifty-three ice hockey players (aged 11-18 years) who sustained a total of 397 physician-diagnosed concussions. INDEPENDENT VARIABLES Psychosocial variables. MAIN OUTCOME MEASURES Players and parents completed psychosocial questionnaires preinjury. Players with a suspected concussion were referred for a study physician visit, during which they completed the Sport Concussion Assessment Tool (SCAT3/SCAT5) and single question ratings of distress and expectations of recovery. Time to recovery (TTR) was measured as days between concussion and physician clearance to RTP. Accelerated failure time models estimated the association of psychosocial factors with TTR, summarized with time ratios (TRs). Covariates included age, sex, body checking policy, days from concussion to the initial physician visit, and symptom severity at the initial physician visit. RESULTS Self-report of increased peer-related problems on the Strengths and Difficulties Questionnaire (TR, 1.10 [95% CI, 1.02-1.19]), higher ratings of distress about concussion outcomes by participants (TR, 1.06 [95% CI, 1.01-1.11]) and parents (TR, 1.05 [95% CI, 1.01-1.09]), and higher parent ratings of distress about their child's well-being at the time of injury (TR, 1.06 [95% CI, 1.02-1.09]) were associated with longer recovery. CONCLUSIONS Greater pre-existing peer-related problems and acute distress about concussion outcomes and youth well-being predicted longer TTR. Treatment targeting these psychosocial factors after concussion may promote recovery.
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Affiliation(s)
- Caroline A Luszawski
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - Vickie Plourde
- School of Psychology, Université de Moncton, Moncton, New Brunswick, Canada
- Centre de Formation médicale du Nouveau-Brunswick, Université de Sherbrooke, Sherbrooke, New Brunswick, Canada
- Faculté Saint-Jean, University of Alberta, Edmonton, Alberta, Canada
| | - Stacy R Sick
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Jean-Michel Galarneau
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Paul H Eliason
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Brian L Brooks
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
- Alberta Children's Hospital, Neurosciences Program, Calgary, Alberta, Canada
- Departments of Pediatrics and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Martin Mrazik
- Department of Educational Psychology, University of Alberta, Edmonton, Alberta, Canada
| | - Chantel T Debert
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Constance Lebrun
- Glen Sather Sports Medicine Clinic, Department of Family Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Shelina Babul
- Department of Pediatrics, Faculty of Medicine, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Brent E Hagel
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Departments of Pediatrics and Community Health Sciences, Cumming School of Medicine, O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Sean P Dukelow
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; and
| | - Kathryn J Schneider
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Sport Medicine Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Carolyn A Emery
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Departments of Pediatrics and Community Health Sciences, Cumming School of Medicine, O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Keith Owen Yeates
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
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Ledoux AA, Zemek R, Cairncross M, Silverberg N, Sicard V, Barrowman N, Goldfield G, Gray C, Harris AD, Jaworska N, Reed N, Saab BJ, Smith A, Walker L. Smartphone App-Delivered Mindfulness-Based Intervention for Mild Traumatic Brain Injury in Adolescents: Protocol for a Feasibility Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e57226. [PMID: 38602770 PMCID: PMC11046387 DOI: 10.2196/57226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 02/27/2024] [Accepted: 03/04/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Concussion in children and adolescents is a significant public health concern, with 30% to 35% of patients at risk for prolonged emotional, cognitive, sleep, or physical symptoms. These symptoms negatively impact a child's quality of life while interfering with their participation in important neurodevelopmental activities such as schoolwork, socializing, and sports. Early psychological intervention following a concussion may improve the ability to regulate emotions and adapt to postinjury symptoms, resulting in the greater acceptance of change; reduced stress; and recovery of somatic, emotional, and cognitive symptoms. OBJECTIVE The primary objective of this study is to assess the feasibility of conducting a parallel-group (1:1) randomized controlled trial (RCT) to evaluate a digital therapeutics (DTx) mindfulness-based intervention (MBI) in adolescents aged 12 to <18 years. The attention-matched comparator intervention (a math game also used in previous RCTs) will be delivered on the same DTx platform. Both groups will be provided with the standard of care guidelines. The secondary objective is to examine intervention trends for quality of life; resilience; self-efficacy; cognition such as attention, working memory, and executive functioning; symptom burden; and anxiety and depression scores at 4 weeks after concussion, which will inform a more definitive RCT. A subsample will be used to examine whether those randomized to the experimental intervention group have different brain-based imaging patterns compared with those randomized to the control group. METHODS This study is a double-blind Health Canada-regulated trial. A total of 70 participants will be enrolled within 7 days of concussion and randomly assigned to receive the 4-week DTx MBI (experimental group) or comparator intervention. Feasibility will be assessed based on the recruitment rate, treatment adherence to both interventions, and retention. All outcome measures will be evaluated before the intervention (within 7 days after injury) and at 1, 2, and 4 weeks after the injury. A subset of 60 participants will undergo magnetic resonance imaging within 72 hours and at 4 weeks after recruitment to identify the neurophysiological mechanisms underlying the potential benefits from MBI training in adolescents following a concussion. RESULTS The recruitment began in October 2022, and the data collection is expected to be completed by September 2024. Data collection and management is still in progress; therefore, data analysis is yet to be conducted. CONCLUSIONS This trial will confirm the feasibility and resolve uncertainties to inform a future definitive multicenter efficacy RCT. If proven effective, a smartphone-based MBI has the potential to be an accessible and low-risk preventive treatment for youth at risk of experiencing prolonged postconcussion symptoms and complications. TRIAL REGISTRATION ClinicalTrials.gov NCT05105802; https://classic.clinicaltrials.gov/ct2/show/NCT05105802. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/57226.
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Affiliation(s)
- Andrée-Anne Ledoux
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Department of Cellular Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, ON, Canada
- University of Ottawa Brain and Mind Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Roger Zemek
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- University of Ottawa Brain and Mind Research Institute, University of Ottawa, Ottawa, ON, Canada
- Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Molly Cairncross
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Noah Silverberg
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
- Rehabilitation Research Program, Centre for Aging SMART, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Veronik Sicard
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Nicholas Barrowman
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Gary Goldfield
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, ON, Canada
- University of Ottawa Brain and Mind Research Institute, University of Ottawa, Ottawa, ON, Canada
- Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Clare Gray
- Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Ashley D Harris
- Department of Radiology, Hotchkiss Brain Institute, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Natalia Jaworska
- Department of Cellular Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- University of Ottawa Brain and Mind Research Institute, University of Ottawa, Ottawa, ON, Canada
- Royal Ottawa Mental Health Centre, Ottawa, ON, Canada
| | - Nick Reed
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | | | - Andra Smith
- School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, ON, Canada
- University of Ottawa Brain and Mind Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Lisa Walker
- School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, ON, Canada
- University of Ottawa Brain and Mind Research Institute, University of Ottawa, Ottawa, ON, Canada
- The Ottawa Hospital, Ottawa, ON, Canada
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Hassan A, Brooks BL, McArthur BA, Beauchamp MH, Craig W, Doan Q, Zemek R, Yeates KO. Dynamic Relations Between Psychological Resilience and Post-Concussion Symptoms in Children With Mild Traumatic Brain Injury Versus Orthopedic Injury: An A-CAP Study. J Neurotrauma 2024; 41:135-146. [PMID: 37485612 DOI: 10.1089/neu.2023.0014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023] Open
Abstract
Higher psychological resilience is correlated with less severe post-concussion symptoms (PCS) after mild traumatic brain injury (mTBI) in children, but the directional nature of this relationship remains uncertain. Although traditionally regarded as a stable, trait-like construct, resilience may be malleable and potentially influenced by mTBI and post-concussive symptoms. The current study sought to examine the stability of resilience, elucidate the dynamic nature of the resilience-PCS relation, and determine whether resilience-symptom associations are specific to mTBI or applicable to traumatic injury in general. Participants were children aged 8-16.99 years with either mTBI (n = 633) or orthopedic injury (OI; n = 334) recruited to participate in a prospective cohort study after presenting acutely to five Canadian pediatric emergency departments (EDs). Symptoms and psychological resilience were assessed at 1 week, 3 months, and 6 months post-injury. Group differences in resilience over time were examined using a mixed linear model, and associations between resilience and symptoms over time were examined using random intercepts cross-lagged panel modeling (RI-CLPM). The mTBI group reported significantly lower resilience than the OI group, but the difference was significantly larger 1 week post-injury (d = 0.50) than at 3 months (d = 0.08) and 6 months (d = 0.10). Cross-lagged panel models indicated that resilience had both stable and dynamic aspects, and both affected and was affected by PCS, although their association varied by time post-injury, symptom measure, and reporter (parent vs. child). Higher parent-reported cognitive symptom severity at 1 week was significantly associated with higher resilience at 3 months (β = 0.23, p = 0.001). Higher resilience at 3 months was associated with lower levels of parent-reported somatic symptom severity (β = -0.14, p = 0.004) and fewer total symptoms (β = -0.135, p = 0.029) at 6 months. Higher resilience at 3 months was associated with fewer child-reported symptoms at 6 months (β = -0.11, p = 0.030) and, reciprocally, fewer child-reported symptoms at 3 months were associated with higher resilience at 6 months (β = -0.22, p = 0.001). Notably, injury group was not a significant moderator in cross-lagged models, suggesting that resilience-symptom associations are not specific to mTBI. Psychological resilience and symptoms have bidirectional relationships after injury. Interventions designed to foster resilience have the potential to promote recovery after mTBI specifically and injury more generally.
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Affiliation(s)
- Ali Hassan
- Department of Psychology, University of Calgary, Calgary, Canada
| | - Brian L Brooks
- Departments of Pediatrics, Clinical Neurosciences, and Psychology, and Alberta Children's Hospital Research Institute, University of Calgary, Alberta Children's Hospital, Neurosciences Program, Calgary, Alberta, Canada
| | - Brae Anne McArthur
- Departments of Psychology and Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Miriam H Beauchamp
- Department of Psychology, University of Montreal and Sainte-Justine Hospital Research Center, Montreal, Quebec, Canada
| | - William Craig
- Department of Pediatrics, University of Alberta, and Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Quynh Doan
- Department of Pediatrics, University of British Columbia, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Roger Zemek
- Department of Pediatrics and Emergency Medicine, Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Keith Owen Yeates
- Department of Psychology, Alberta Children's Hospital Research Institute, and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
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Ernst N, Eagle S, Trbovich A, Kissinger-Knox A, Bitzer H, Kontos AP. Lower post-injury psychological resilience is associated with increased recovery time and symptom burden following sport-related concussion. APPLIED NEUROPSYCHOLOGY. CHILD 2022; 11:781-788. [PMID: 34410842 DOI: 10.1080/21622965.2021.1964966] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The purpose of this study was to compare athletes with high and low resilience scores on concussion outcomes, and identify significant predictors associated with protracted recovery (>30 days). Forty-five adolescent and young adult athletes (28 males; aged 15.13 ± 2.74; range of 11-22) were diagnosed with an SRC within 14 days of injury (M = 4.9 days) and grouped as high or low resilience based on score on the Connor-Davidson Resilience Scale-10 (CD-RISC-10). Primary dependent measures included days to full clearance, Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT), Depression Anxiety and Stress Scale-21 (DASS-21), and Vestibular/Ocular Motor Screening (VOMS). The low resilience group (n = 22) had a longer recovery (36.0 ± 27.6 vs 17.8 ± 11.2 days), endorsed more mood symptoms (PCSS Affective cluster; 3.8 ± 0.8 vs 0.9 ± 0.7), and were more likely to have VOMS scores above cut off (p = 0.01-0.02), compared to those with high psychological resilience (n = 23). Logistic regression found low resilience scores was the only significant predictor for protracted recovery among injury characteristics and risk factors. Psychological resilience is a critical factor associated with recovery time following sport-related concussions. Low resilience was also associated with other poor clinical outcomes, greater subjective symptom report, more severe vestibular dysfunction, and elevated levels of mood symptoms following injury.
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Affiliation(s)
- Nathan Ernst
- Department of Behavioral Medicine and Psychiatry, West Virginia University, Morgantown, WV, USA
| | - Shawn Eagle
- Department of Orthopedics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Alicia Trbovich
- Department of Orthopedics, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Orthopedics, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - Hannah Bitzer
- Department of Orthopedics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Anthony P Kontos
- Department of Orthopedics, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Orthopedics, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Schmidt M, Babcock L, Kurowski BG, Cassedy A, Sidol C, Wade SL. Usage Patterns of an mHealth Symptom Monitoring App Among Adolescents With Acute Mild Traumatic Brain Injuries. J Head Trauma Rehabil 2022; 37:134-143. [PMID: 35125434 PMCID: PMC9203862 DOI: 10.1097/htr.0000000000000768] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To understand usage patterns of SMART (Self-Monitoring Activity Regulation and Relaxation Treatment) mHealth app among adolescents with acute mild traumatic brain injuries (mTBIs) and to identify individual characteristics that influenced app usage. METHODS SETTING Emergency departments of tertiary care children's medical center. PARTICIPANTS Children aged 11 to 18 years with mTBI in the past 2 weeks, English-speaking, no evidence of severe TBI, and no preexisting neurological impairment. DESIGN Nested cohort of the intervention arm of a randomized clinical trial (n = 34). MHEALTH APP INTERVENTION SMART was a month-long educational program on mTBI designed to promote self-monitoring and management of recovery. SMART included digital symptom and activity self-monitoring surveys, feedback on symptom changes, and 8 modules providing psychoeducation, strategies for symptom management, and training in active problem solving. MAIN MEASURES App usage time, navigation, and interaction data were automatically collected. Usage involved inputting symptom ratings/activities and reviewing modules. Patterns of symptom/activity reporting and completion of learning modules data were analyzed. Predictors of app utilization, including individual characteristics, resilience (Connor-Davidson Resilience Scale), and coping (Coping Strategies Inventory-Short Form), were analyzed using Spearman correlations. RESULTS Participants completed symptom monitoring an average of 9 days over the month. Participants completed an average of 1.87 learning modules out of 7. Parent income and education, comorbid attention-deficit/hyperactivity disorder (ADHD), and emotional engagement coping style predicted symptom monitoring. Parental income, comorbid ADHD, and greater reliance on emotional engagement coping predicted module completion. SIGNIFICANT ADVERSE EVENTS None. CONCLUSION Adolescents of higher socioeconomic status and those who manage their emotions using active engagement spent more time on both components of the SMART program.
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Affiliation(s)
- Matthew Schmidt
- Educational Technology, College of Education, University of Florida, Gainesville (Dr Schmidt); Cincinnati Children's Hospital Medical Center (Drs Babcock, Kurowski, Cassedy, Sidol, and Wade), Division of Pediatric Rehabilitation Medicine (Drs Kurowski and Wade), and Departments of Pediatrics and Neurology and Rehabilitation Medicine (Dr Kurowski), University of Cincinnati College of Medicine, Cincinnati, Ohio
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8
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Ledoux AA, Webster RJ, Clarke AE, Fell DB, Knight BD, Gardner W, Cloutier P, Gray C, Tuna M, Zemek R. Risk of Mental Health Problems in Children and Youths Following Concussion. JAMA Netw Open 2022; 5:e221235. [PMID: 35254429 PMCID: PMC8902648 DOI: 10.1001/jamanetworkopen.2022.1235] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Concussion may exacerbate existing mental health issues. Little evidence exists on whether concussion is associated with the onset of new psychopathologies or long-term mental health problems. OBJECTIVE To investigate associations between concussion and risk of subsequent mental health issues, psychiatric hospitalizations, self-harm, or suicides. DESIGN, SETTING, AND PARTICIPANTS This population-based retrospective cohort study including children and youths aged 5 to 18 years with a concussion or orthopedic injury incurred between April 1, 2010, and March 31, 2020, in Ontario, Canada. Participants had no previous mental health visit in the year before the index event for cohort entry and no prior concussion or traumatic brain injury 5 years before the index visit. Data were collected from provincewide health administrative databases. Participants with concussion were included in the exposed cohort, and those with an orthopedic injury were included in the comparison cohort; these groups were matched 1:2, respectively, on age and sex. EXPOSURES Concussion or orthopedic injury. MAIN OUTCOMES AND MEASURES The primary outcome was mental health problems, such as psychopathologies and psychiatric disorders, identified from health care visits in emergency departments, hospitalizations, or primary care settings. Secondary outcomes were psychiatric hospitalizations, self-harm health care visits, and death by suicide (identified in health care or vital statistics databases). RESULTS A total of 152 321 children and youths with concussion (median [IQR] age, 13 [10-16] years; 86 423 [56.7%] male) and 296 482 children and youths with orthopedic injury (median [IQR] age, 13 [10-16] years; 171 563 [57.9%] male) were matched by age and sex. The incidence rates of any mental health problem were 11 141 per 100 000 person-years (exposed group) and 7960 per 100 000 person-years (unexposed group); with a difference of 3181 (95% CI, 3073-3291) per 100 000 person-years. The exposed group had an increased risk of developing a mental health issue (adjusted hazard ratio [aHR], 1.39; 95% CI, 1.37-1.40), self-harm (aHR, 1.49; 95% CI, 1.42-1.56), and psychiatric hospitalization (aHR, 1.47; 95% CI, 1.41-1.53) after a concussion. There was no statistically significant difference in death by suicide between exposed and unexposed groups (HR, 1.54; 95% CI, 0.90-2.61). CONCLUSIONS AND RELEVANCE Among children and youths aged 5 to 18 years, concussion was associated with an increased risk of mental health issues, psychiatric hospitalization, and self-harm compared with children and youths with an orthopedic injury.
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Affiliation(s)
- Andrée-Anne Ledoux
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Department of Cellular Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Richard J. Webster
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | | | - Deshayne B. Fell
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- ICES uOttawa, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Braden D. Knight
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- ICES uOttawa, Ottawa, Ontario, Canada
| | - William Gardner
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Paula Cloutier
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Clare Gray
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Department of Psychiatry, Children’s Hospital of Eastern, Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Meltem Tuna
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Roger Zemek
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Department of Pediatrics, Children’s Hospital of Eastern, Ontario, University of Ottawa, Ottawa, Ontario, Canada
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Validity and reliability of resiliency measures trialled for the evaluation of a preventative Resilience-promoting social-emotional curriculum for remote Aboriginal school students. PLoS One 2022; 17:e0262406. [PMID: 35015776 PMCID: PMC8752014 DOI: 10.1371/journal.pone.0262406] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 12/23/2021] [Indexed: 11/19/2022] Open
Abstract
Purpose We aimed to test the reliability and validity of two brief measures of resilience adopted for the evaluation of a preventative social-emotional curriculum implemented for Aboriginal middle school students from socially disadvantaged remote communities in Australia’s Northern Territory. The questionnaires chosen were intended to measure psychological resilience and socio-cultural resilience as complementary dimensions of the capacity to cope in circumstances of significant life stress and risk of self-harm. Methods Confirmatory factor analysis (CFA) was conducted to assess construct validity of the 10-item Connor-Davidson Resilience Scale (CD-RISC-10), a measure of psychological resilience, and the 12-item Child and Youth Resilience Measure (CYRM-12), a measure of socio-cultural resilience, with a sample of 520 students. Associations between resilience and psychological distress and emotional and behavioural difficulty were analysed in relation to life stressors to assess criterion validity of the scales. Results CFA provided support for the validity of the respective constructs. There was good fit for both scales. However, assessment of criterion validity of the scales suggested that the adapted measure of socio-cultural resilience (CYRM-12NT) showed higher reliability and a clearer indication of predictive validity than the measure of psychological resilience (CD-RISC-10). Conclusions The CYRM-12NT appears to be a more useful measure of resilience among Aboriginal youth exposed to significant life stress and disadvantage. However, both measures may require further development to enhance their validity and utility among potentially at-risk adolescents in socially, culturally and linguistically diverse remote Aboriginal communities.
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Gornall A, Takagi M, Morawakage T, Liu X, Anderson V. Mental health after paediatric concussion: a systematic review and meta-analysis. Br J Sports Med 2021; 55:1048-1058. [PMID: 33926965 DOI: 10.1136/bjsports-2020-103548] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE This systematic review and meta-analysis sought to rigorously examine mental health outcomes following paediatric concussion. To date, heterogeneous findings and methodologies have limited clinicians' and researchers' ability to meaningfully synthesise existing literature. In this context, there is a need to clarify mental health outcomes in a homogeneous sample, controlling for key methodological differences and applying a consistent definition of concussion across studies. DESIGN Systematic review and meta-analysis. DATA SOURCES We searched Medline, Embase, PsycINFO, CINAHL, SportDiscus, Scopus and PubMed. ELIGIBILITY Peer-reviewed studies published between 1980 and June 2020 that prospectively examined mental health outcomes after paediatric concussion, defined as per the Berlin Consensus Statement on Concussion in Sport. RESULTS Sixty-nine articles characterising 60 unique samples met inclusion criteria, representing 89 114 children with concussion. Forty articles (33 studies) contributed to a random effects meta-analysis of internalising (withdrawal, anxiety, depression, post-traumatic stress), externalising (conduct problems, aggression, attention, hyperactivity) and total mental health difficulties across three time points post-injury (acute, persisting and chronic). Overall, children with concussion (n=6819) experienced significantly higher levels of internalising (g=0.41-0.46), externalising (g=0.25-0.46) and overall mental health difficulties compared with controls (g=0.18-0.49; n=56 271), with effects decreasing over time. SUMMARY/CONCLUSIONS Our review highlights that mental health is central to concussion recovery. Assessment, prevention and intervention of mental health status should be integrated into standard follow-up procedures. Further research is needed to clarify the mechanisms underlying observed relationships between mental health, post-concussion symptoms and other psychosocial factors. Results suggest that concussion may both precipitate and exacerbate mental health difficulties, thus impacting delayed recovery and psychosocial outcomes.
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Affiliation(s)
- Alice Gornall
- Psychological Sciences, Monash University Faculty of Medicine Nursing and Health Sciences, Clayton, Victoria, Australia.,Brain and Mind Research, Clinical Sciences Theme, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Michael Takagi
- Psychological Sciences, Monash University Faculty of Medicine Nursing and Health Sciences, Clayton, Victoria, Australia.,Brain and Mind Research, Clinical Sciences Theme, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Psychology, The University of Melbourne, Melbourne School of Psychological Sciences, Melbourne, Victoria, Australia
| | - Thilanka Morawakage
- Brain and Mind Research, Clinical Sciences Theme, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Xiaomin Liu
- Brain and Mind Research, Clinical Sciences Theme, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Vicki Anderson
- Brain and Mind Research, Clinical Sciences Theme, Murdoch Children's Research Institute, Parkville, Victoria, Australia .,Psychology, The University of Melbourne, Melbourne School of Psychological Sciences, Melbourne, Victoria, Australia.,Psychology Service, The Royal Children's Hospital, Mebourne, Victoria, Australia
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Levey EJ, Rondon MB, Sanchez S, Williams MA, Gelaye B. Psychometric properties of the Spanish version of the 10-item Connor Davidson Resilience Scale (CD-RISC) among adolescent mothers in Peru. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2021; 14:29-40. [PMID: 33708280 PMCID: PMC7900368 DOI: 10.1007/s40653-019-00295-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The objective of this research is to assess the psychometric properties of the Connor-Davidson Resilience Scale (CD-RISC) in order to contribute to the literature identifying validated resilience measures in low-resource settings where individuals face significant adversity. This cross-sectional study included 789 adolescent mothers who delivered at a maternity hospital in Lima, Peru. The Spanish version of the 10-item CD-RISC was used to measure resilience. Internal consistency and construct validity were assessed by evaluating individual item characteristics as well as the association of CD-RISC score with symptoms of depression, anxiety and sleep disturbance. Exploratory factor analysis (EFA) was performed to test the factorial structure of the CD-RISC. The CD-RISC was found to have good internal consistency (Cronbach's alpha = 0.85). CD-RISC scores were positively associated with school attendance, financial hardship, and history of childhood abuse; scores were negatively associated with household dysfunction, depression, anxiety and poor sleep quality. The results of the EFA showed that the CD-RISC contained a two-factor solution, which accounted for 46% of the variance. Overall, these findings suggest that the Spanish-language version of the CD-RISC-10 is an adequate measure of resilience in this population. Further research is needed to incorporate culturally-specific constructs into resilience measures.
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Affiliation(s)
- Elizabeth J. Levey
- The Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, MA 02114 USA
- Harvard Medical School, Boston, MA 02115 USA
- Institute for Juvenile Research, University of Illinois College of Medicine, Chicago, IL 60608 USA
| | | | - Sixto Sanchez
- Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | | | - Bizu Gelaye
- The Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, MA 02114 USA
- Harvard Medical School, Boston, MA 02115 USA
- Harvard T.H. Chan School of Public Health, Boston, MA 02115 USA
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12
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Seko Y, Lamptey DL, Nalder E, King G. Assessing resiliency in paediatric rehabilitation: A critical review of assessment tools and applications. Child Care Health Dev 2020; 46:249-267. [PMID: 31944352 DOI: 10.1111/cch.12743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 01/12/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUNDS Resiliency has attracted a growing interest in paediatric rehabilitation as a key capacity for disabled children and their families to thrive. This study aimed to identify measures used to assess resiliency of disabled children/youth and their families and critically appraise the current use of resiliency measures to inform future research and practice. METHODS A two-stage search strategy was employed. First, systematic reviews of resiliency measures published since 2000 were searched. Second, full names of measures identified in at least two systematic reviews were searched across four electronic databases. Included studies assessed resiliency among children/youth (0-18 years old) with chronic health conditions and/or disabilities and their families. Identified articles were then analysed to discern the study's definition of resiliency, authors' rationales for measurement selection, and types of perceived adversities facing the study participants. RESULTS From an initial yield of 25 measures identified in five systematic reviews, 11 were analysed in two or more reviews. The second stage yielded 41 empirical studies published between 2012 and 2018, which used 8 of the 11 resiliency measures searched by name. Of 41, 17 studies measured resiliency of disabled children/youth, 23 assessed resiliency within family members, and 1 studied both children/youth and their families. Our critical appraisal identified inconsistencies between the studies' definition of resiliency and chosen measures' operationalization, implicit assumption of disabilities as a developmental risk that automatically results in life adversities, and the tendency among family studies to reduce resiliency down to stress coping skills. Research that encompasses contextual factors and developmental influences is lacking. CONCLUSIONS There is a need for a situated measurement approach that captures multiple interacting factors shaping resiliency over one's life course. Resiliency measures would benefit from a greater focus on a person-environment transaction and an alternative definition of resiliency that accounts for multiple capacities to navigate through disabling environments.
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Affiliation(s)
- Yukari Seko
- School of Professional Communication, Ryerson University, Toronto, Ontario, Canada
| | | | - Emily Nalder
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Gillian King
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
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