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Predicting mood outcome following traumatic brain injury (TBI): PTA & demographic variables

Published online by Cambridge University Press:  26 June 2019

Clive Skilbeck ,
Matt Thomas  and
Kieran Holm
Clive Skilbeck*
Affiliation:
School of Medicine (Psychology), University of Tasmania, Hobart, Tasmania 7005, Australia
Matt Thomas
Affiliation:
School of Psychology, Charles Sturt University, Bathurst, New South Wales 2795, Australia
Kieran Holm
Affiliation:
School of Medicine (Psychology), University of Tasmania, Hobart, Tasmania 7005, Australia
*
*Corresponding author. Email: [email protected]
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Abstract

Background and aims:

Mood disturbance is frequent after traumatic brain injury (TBI), often assessed using the Hospital Anxiety and Depression Scale (HADS). Research supports a three-factor HADS structure (anxiety, depression, and psychomotor), although this has not been used to investigate demographic variables and mood outcome post-TBI. This study examined severity of TBI, demographic variables [age, gender, estimated premorbid IQ (EIQ), relationship status, employment status, socio-economic status (SES)], and mood outcome, using HADS factor scores from a large adult population sample in Tasmania.

Method:

HADS factor scores were calculated for an initial sample of 596 adults. The sample sizes varied according to those attending at 1, 6, 12 and 24 months post-TBI and the available data for each dependent variable.

Results:

Significantly higher anxiety, depression, and psychomotor scores were reported at most follow-ups by females, the middle-aged, and those with lower IQs. Longer post-traumatic amnesia (PTA) was associated with significantly greater mood problems. Occasional significant findings at earlier follow-ups for the factors were noted for those unemployed. Other variables were rarely significant. PTA, premorbid IQ, and Age were included in most Multiple Regression equations predicting outcome for the factors, with Gender included for Anxiety and depression at 6 months after injury.

Conclusions:

Key demographic variables and PTA severity relate to mood post-TBI, and contribute to predicting mood outcome. Differences in findings for the three factors support their use in clinical practice.

Keywords

Traumatic brain injuryhospital anxiety and depression scalemood predictiondemographic variablesgenderageIQrelationship statusemployment statussocio-economic status
Type
Articles
Information
Brain Impairment , Volume 21 , Issue 1 , March 2020 , pp. 65 - 85
Copyright
© Australasian Society for the Study of Brain Impairment 2019 

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References

Always, Y., Gould, K. R., Johnston, L., Mc Kenzie, D., & Ponsford, J. (2016). A prospective examination of Axis 1 psychometric disorders in the first five years following moderate to severe traumatic brain injury. Psychological Medicine, 46, 1331–1341.CrossRefGoogle Scholar
Anson, K., & Ponsford, J. (2006). Coping and emotional adjustment following traumatic brain injury. Brain Injury, 21, 248–259.Google ScholarPubMed
Australian Bureau of Statistics (2016). Incidence of Brain Injury in Australia. Belconnen, ACT2617, Australia. Retrieved from http://www.quickstats.censusdata.abs.gov.au/Google Scholar
Balck, F., & Dinkel, A. (2005). Depressive and anxiety symptoms in brain injured patients and their spouses six months after the incident. Retrieved March 14, 2006 from http://www.medicstream.de/movie/dgnc2003/pdf/poster/p08_05.pdf.Google Scholar
Barth, J., & Martin, C. R. (2005). Factor structure of the Hospital Anxiety and Depression Scale (HADS) in German coronary heart disease patients. Health and Quality of Life Outcomes, 3, 1–12.CrossRefGoogle ScholarPubMed
Bay, E. Sikorskii, A., & Saint-Arnault, D. (2009). Depressive symptoms after mild-to-moderate traumatic brain injury. Journal of Neuroscience Nursing, 41, 298–312.CrossRefGoogle ScholarPubMed
Bennett, T. L., & Raymond, M. J. (1997). Emotional consequences and psychotherapy for individuals with mild brain injury. Applied Neuropsychology, 4, 55–61.CrossRefGoogle ScholarPubMed
Bjelland, I., Dahl, A. A., Haug, T.T., & Neckelmann, D. (2002). The validity of the Hospital Anxiety and Depression Scale: An updated literature review. Journal of Psychosomatic Research, 52, 69–77.CrossRefGoogle Scholar
Bombardier, C. H., Fan, J. R., & Temkin, N. R. (2010). Rates of major depressive disorder and clinical outcomes following traumatic brain injury. Journal of the American Medical Association, 303, 1938–1935.CrossRefGoogle ScholarPubMed
Bowen, A., Chamberlain, M. A., Tennant, A., Neumann, V., & Conner, M. (1999). The persistence of mood disorders following traumatic brain injury: A 1-year follow-up. Brain Injury, 13, 547–553.Google ScholarPubMed
Bowen, A., Neumann, V., Connors, M., Tennant, A., & Chamberlain, M. A. (1998). Mood disorders following traumatic brain injury: identifying the extent of the problem and the people at risk. Brain Injury, 12, 177–190.CrossRefGoogle Scholar
Brown, M., Gordon, W. A., & Spielman, L. (2003). Participation in social and recreational activity in the community by individuals with traumatic brain injury. Rehabilitation Psychology, 48, 266–274.CrossRefGoogle Scholar
Cameron, I. M., Crawford, J. R., Lawton, K., & Reid, I. (2008). Psychometric comparison of PHQ-9 and HADS for measuring depression severity in primary care. British Journal of General Practice, 58, 32–36.CrossRefGoogle ScholarPubMed
Carroll, E., & Coetzer, R. (2011). Identity grief and self-awareness after traumatic brain injury. Neuropsychological Rehabilitation, 21, 289–305.CrossRefGoogle ScholarPubMed
Cohen, J. W. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum Associates.Google Scholar
Corrigan, J. D., Cuthbert, J. P., Harrison-Felix, C., Whiteneck, G. G., Bell, J. M., Miller, A. C., … Pretz, C. R. (2014). US population estimates of health and social outcomes 5 years after rehabilitation for traumatic brain injury. Journal of Head Trauma, 29, 1–9.CrossRefGoogle ScholarPubMed
Crawford, J. R., & Henry, J. D. (2003). The Depression Anxiety Stress Scales (DASS): Normative data and latent structure in a large non-clinical sample. British Journal of Clinical Psychology, 42, 111–131.CrossRefGoogle Scholar
Crowe, S. F. (2008). The behavioural and emotional complications of traumatic brain injury. Hoboken: Psychology Press.Google Scholar
Dahm, J., Wong, D., & Ponsford, J. (2013). Validity of the Depression, Anxiety, Stress Scale in assessing depression & anxiety following traumatic brain injury. Journal of Affective Disorders, 15, 392–396.CrossRefGoogle Scholar
Demakis, G. J., Hammond, F. M., & Knotts, A. (2010). Prediction of depression & anxiety 1 year after moderate-severe traumatic brain injury. Applied Neuropsychology, 17, 183–189.CrossRefGoogle Scholar
DoD/VA Clinical Practice Guideline for Management of Concussion/Mild Traumatic Brain Injury. (2008). Code Proposal Final – 508 compliant, Veterans Health Initiative. Journal of Rehabilitation Research and Development, 46(6), CP1.Google Scholar
Fann, J. R., Burington, B., Leonetti, A., Jaffe, K., Katon, W. R. , & Thompson, R. S. (2004). Psychiatric illness following traumatic brain injury in an adult health maintenance organisation population. Archives of General Psychiatry, 61, 53–61.CrossRefGoogle Scholar
Fann, J. R., Katon, W. J., Uomoto, J. M., & Esselman, P. (1995). Psychiatric disorders and functional disability in outpatients with traumatic brain injuries. American Journal of Psychiatry, 152, 1493–1499.Google ScholarPubMed
Farace, E., & Alves, W. M. (2000). Do women fare worse? A metaanalysis of gender differences in outcome after traumatic brain injury. Neurosurgical Focus, 8, 1–7.CrossRefGoogle ScholarPubMed
First, M. B., Spitzer, R. L., Gibbon, M. & Williams, J. B. (1995). Structured Clinical Interview for DSM. Journal of Personality Disorders, 9, 83–91.CrossRefGoogle Scholar
Fleminger, S., Oliver, D. L., Williams, W. H. & Evans, J. (2003). The neuropsychiatry of depression after brain injury. Neuropsychological Rehabilitation, 13, 65–87.CrossRefGoogle ScholarPubMed
Franulic, A., Carbonell, C. G., Pinto, P., & Sepulveda, I. (2004). Psychological adjustment and employment outcome 2, 5 and 10 years after TBI. Brain Injury, 18, 119–29.CrossRefGoogle ScholarPubMed
Frisch, M. B. (1998). Quality of life therapy & assessment in health care. Clinical Psychology-Science & Practice, 5, 19–40.CrossRefGoogle Scholar
Glenn, M. B., O’Neil-Pirozzi, T., Goldstein, R., Burke, D., & Jacob, L. (2001). Depression amongst outpatients with traumatic brain injury. Brain Injury, 9, 811–818.CrossRefGoogle Scholar
Gould, K. R., Ponsford, J. L., Johnston, L., & Schonberger, M. (2011). The nature, frequency and course of psychiatric disorders in the first year after traumatic brain injury: a prospective study. Psychological Medicine, 41, 2099–2109.CrossRefGoogle ScholarPubMed
Guth, P. E. (2000). The effects of depression in head injured adults as related to educational level, gender, and activity level. University of Pennsylvania, Indiana, USA.Google Scholar
Hart, T., Hoffman, J. M., & Pretz, C. (2012). A longitudinal study of major and minor depression following traumatic brain injury. Archives of Physical Medicine Rehabilitation, 34, 257–261.Google Scholar
Hellawell, D. J., Taylor, R., & Pentland, B. (1999). Cognitive & psychosocial outcome following traumatic brain injury. Brain Injury, 13, 489–504.CrossRefGoogle Scholar
Helps, Y., Henley, G., & Harrison, J. (2008). Hospital separations due to traumatic brain injury, Australia 2004–05. Canberra: Australian Institute of Health and Welfare.Google Scholar
Hermann, C. (1997). International experiences with the Hospital Anxiety and Depression Scale–a review of validation data and clinical results. Journal of Psychosomatic Research, 42, 17–41.CrossRefGoogle Scholar
Hicken, B. L., Putzke, J. D., Novack, T., Sherer, M., & Richards, J. S. (2002). Life satisfaction following spinal cord and traumatic brain injury: A comparative study. Journal of Rehabilitation Research Development, 39, 359–365.Google ScholarPubMed
Hillier, S. J., Hiller, J. E., & Metzer, J. (1997). Epidemiology of traumatic brain injury. Brain Injury, 11, 649–659.Google ScholarPubMed
Jastak, J. & Wilkinson, G. S. (1984). The wide range achievement test-revised. Wilmington: Jastak Associates.Google Scholar
Johnstone, B., Childers, M. K., & Hoerner, J. (1998). The effects of normal ageing on neuropsychological functioning following traumatic brain injury. Brain Injury, 12, 569–576.CrossRefGoogle ScholarPubMed
Jorge, R. E., Robinson, R. G., Moser, D., Tateno, A., Crespo-Facorro, B., & Arndt, S. (2004). Major depression following traumatic brain injury. Archives of General Psychiatry, 61, 42–50.CrossRefGoogle ScholarPubMed
Jourdan, C., Bayen, E., Pradat-Diehl, P., Ghout, I., Darnoux, E., Azerad, S, … Azouvi, P. (2016). A comprehensive picture of 4-year outcome of severe brain injuries. Results from the PariS-TBI study. Annals of Physical and Rehabilitation Medicine, 59, 100–106.CrossRefGoogle ScholarPubMed
Kaydan, V., Mysiw, W. J., Bogner, J. A., Corrigan, J. D., Fugate, L. P., & Clinchot, D. M. (2004). Gender differences in agitation after traumatic brain injury. American Journal of Physical Medicine and Rehabilitation, 83, 747–752.CrossRefGoogle Scholar
Kesler, S. R., Adams, H. F., Blasey, C. M., & Bigler, E. D. (2003). Premorbid intellectual functioning, education, and brain size in traumatic brain injury: An investigation of the cognitive reserve hypothesis. Applied Neuropsychology, 10, 153–162.CrossRefGoogle ScholarPubMed
Khan, F., Baguley, I. J., & Cameron, I. D. (2003). Rehabilitation after traumatic brain injury. The Medical Journal of Australia, 6, 290–295.CrossRefGoogle Scholar
Kraus, J. F., Peek-Asa, C., & McArthur, D. (2000). The independent effect of gender on outcomes following traumatic brain injury: a preliminary investigation. Neurosurgical Focus, 8, 1–9.CrossRefGoogle ScholarPubMed
Langley, J., Johnson, S., Slatyer, M., Skilbeck, C., & Thomas, M. (2010). Issues of loss to follow-up in a population study of traumatic brain injury (TBI) followed to 3 years post-trauma. Brain Injury, 24(7–8), 939–947.CrossRefGoogle Scholar
Levi, Y., Rassovsky, Y., Agranov, E., Sela-Kaufman, M., & Vakil, E. (2013). Cognitive reserve components as expressed in traumatic brain injury. Journal of the International Neuropsychological Society, 19, 664–671.CrossRefGoogle ScholarPubMed
Levin, H. S., O’Donnell, V. M., & Grossman, R. G. (1979). The Galveston orientation and amnesia test. A practical scale to assess cognition after head injury. Journal of Nervous and Mental Disease, 167, 675–684.CrossRefGoogle Scholar
Lippert-Gruner, M., Kuchta, J., Hellmich, M., & Klug, N. (2006). Neurobehavioural deficits after severe traumatic brain injury (TBI). Brain Injury, 20, 569–574.CrossRefGoogle Scholar
Lovibond, S. H., & Lovibond, P. F. (1995). Manual for the depression anxiety stress scales. Sydney: Psychology Foundation.Google Scholar
Millar, K., Nicoll, J. A. R., Thornhill, S., Murray, G. D., & Teasdale, G. M. (2003). Long term neuropsychological outcome after head injury: Relation to APOE genotype. Journal of Neurology, Neurosurgery & Psychiatry, 74, 1047–1052.CrossRefGoogle ScholarPubMed
Mooney, G., & Speed, J. (2001). The association between mild traumatic brain injury and psychiatric conditions. Brain Injury, 15, 865–877.CrossRefGoogle ScholarPubMed
Moore, E. L., Terryberry-Spohr, L., & Hope, D. A. (2006). Mild traumatic brain injury and anxiety sequelae: A review of the literature. Brain Injury, 20, 117–132.CrossRefGoogle ScholarPubMed
National Institute for Clinical Excellence. (2004). Depression: management of depression in primary and secondary care (NICE guideline). Clinical guideline 23. London: National Institute for Clinical Excellence.Google Scholar
Nelson, H. E., & Willison, J. R. (1991). The Revised National Adult Reading Test – Test Manual. Windsor: NFER-Nelson.Google Scholar
Nott, M. T., Chapparo, C., & Baguley, I. J. (2006). Agitation following traumatic brain injury: An Australian sample. Brain Injury, 20, 1175–1182.CrossRefGoogle Scholar
O’Neill, J., Hibbard, M., Brown, M., Jaffe, M., & Vandergoot, D. (1998). The personal and social costs and benefits of working after traumatic brain injury. Journal of Head Trauma Rehabilitation, 13(4), 68–79.Google Scholar
Office for National Statistics. (2014). The national statistics socio-economic classificati on. Australian Bureau of Statistics, Belconnen, ACT 2617, Australia.Google Scholar
Ponsford, J., Willmott, C., Rothwell, A., Cameron, P., Kelly, A. M., Nelms, R., … Kim, N. G. (2000). Factors influencing outcome following mild traumatic brain injury in adults. Journal of the International Neuropsychological Society, 6, 568–579.CrossRefGoogle ScholarPubMed
Rao, V., & Lyketsos, C. G. (2002). Psychiatric aspects of traumatic brain injury. The Psychiatric Clinics of North America, 25, 43–69.CrossRefGoogle ScholarPubMed
Rapoport, M. J., & Feinstein, A. (2001). Age and functioning after mild traumatic brain injury: The acute picture. Brain Injury, 15, 857–864.CrossRefGoogle ScholarPubMed
Rapoport, M. J., McCullagh, S., Shammi, P., & Feinstein, A. (2005). Cognitive impairment associated with major depression following mild and moderate traumatic brain injury, Journal of Neuropsychiatry and Clinical Neuroscience, 17, 61–65.CrossRefGoogle ScholarPubMed
Rapoport, M., McCullagh, S., Streiner, D., & Feinstein, A. (2003). The clinical significance of major depression following mild traumatic brain injury. Psychosomatics, 44, 31–37.CrossRefGoogle ScholarPubMed
Rothweiler, B., Temkin, N. R., & Dikmen, S. S. (1998). Aging effect on psychosocial outcome in traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 79, 881–887.CrossRefGoogle ScholarPubMed
Sander, A., Kreutzer, J. S., & Fernandez, C. C. (1997). Neurobehavioral functioning, substance abuse, and employment after brain injury: Implications for vocational rehabilitation. The Journal of Head Trauma Rehabilitation, 12, 28–41.CrossRefGoogle Scholar
Schneider, E. B., Surr, S., Raymont, V., Duckworth, J., Kowalski, R. G., Efron, D. T., … Stevens, R. D. (2014). Functional recovery after moderate/severe traumatic brain injury: A role for cognitive reserve? Neurology, 82, 1636–1642.CrossRefGoogle ScholarPubMed
Scholten, A. C., Haagsma, J. A., Cnossen, M. C., Olff, M., van Beeck, E. F., & Polinder, S. (2016). Prevalence of and risk factors for anxiety and depressive disorders after traumatic brain injury: A systematic review. Journal of Neurotrauma, 33, 1969–1994.CrossRefGoogle ScholarPubMed
Schonberger, M., & Ponsford, J. (2010). The factor structure of the Hospital Anxiety and Depression Scale in individuals with traumatic brain injury. Psychiatry Research, 179, 342–349.CrossRefGoogle ScholarPubMed
Seel, R. T., Kreutzer, J. S., Rosenthal, M., Hammond, F. M., Corrigan, J. D., & Black, K. (2003). Depression after traumatic brain injury: A national institute on disability and rehabilitation research model systems multicenter investigation. Archives of Physical Medicine Rehabilitation, 84, 177–184.CrossRefGoogle Scholar
Shores, EA., Marosszeky, JE., Sandanam, J., & Batchelor, J. (1986). Preliminary validation of a clinical scale for measuring the duration of post-traumatic amnesia. Medical Journal of Australia, 144, 569–572.CrossRefGoogle ScholarPubMed
Skell, R. L., Johnstone, B., Schopp, L., Shaw, J., & Petroski, G. F. (2000). Neuropsychological predictors of distress following traumatic brain injury. Brain Injury, 14, 705–712.Google ScholarPubMed
Skilbeck, C., Holm, K., Slatyer, M., Thomas, M., & Bell, T. (2011). The factor structure of the Hospital Anxiety and Depression Scale (HADS) in a traumatic brain injury (TBI) population. Brain Impairment, 12, 22–32.CrossRefGoogle Scholar
Smith, A. B., Selby, P. J., Velikova, G., Stark, D., Wright, E. P., Gould, A., … Cull, A. (2002). Factor analysis of the Hospital Anxiety and Depression Scale from a large cancer population. Psychology and Psychotherapy: Theory, Research and Practice, 75, 165–176.CrossRefGoogle ScholarPubMed
Snaith, R. P. (2003). The Hospital Anxiety and Depression Scale. Health and Quality of Life Outcomes, 1, 1–29. Retrieved from http://www.hqlo.com/.CrossRefGoogle ScholarPubMed
Snaith, R. P., & Zigmond, A. S. (1994). The Hospital Anxiety and Depression Scale Manual. Windsor, UK: NFER-Nelson.Google Scholar
Strauss, E., Sherman, E. M. S., & Spreen, O. S. (2006). A compendium of neuropsychological tests. New York, USA: OUP.Google Scholar
Tabachnick, B. G., & Fidell, L. S. (2000). Using multivariate statistics (4th ed.). New York, USA: Allyn & Bacon.Google Scholar
Tate, R. L., MacDonald, S., & Lulham, J. M. (1998). Incidence of hospital treated traumatic brain injury in an Australian community. Australian and New Zealand Journal of Public Health, 22, 419–423.CrossRefGoogle Scholar
Theadom, A., Parag, V., Dowell, T., McPherson, K., Starkey, N., Barker-Collo, S., … Feigin, V. L. (2016). Persistent problems one year after mild traumatic brain injury: A longitudinal population study in New Zealand. Journal of the Royal College of General Practitioners, 66, 16–23.CrossRefGoogle ScholarPubMed
Thomas, M., McGrath, A., & Skilbeck, C. (2012). The psychometric properties of the Quality of Life Inventory in an Australian community sample. Australian Journal of Psychology, 64, 225–234.CrossRefGoogle Scholar
Thomas, M., Skilbeck, C., & Slatyer, M. (2009). Pre-injury estimates of subjective quality of life following Traumatic Brain Injury. Brain Injury, 23, 516–527.CrossRefGoogle ScholarPubMed
Valk-Kleibeuker, L., Heijerbrok-Kal, M., & Ribbers, G. M. (2014). Mood after moderate and severe traumatic brain injury: A prospective cohort study. PLoS One, 9 (2), e87414.CrossRefGoogle ScholarPubMed
Whelan-Goodinson, R., Ponsford, J., Johnston, L., & Grant, F. (2009). Psychiatric disorder following traumatic brain injury: Their nature and frequency. Journal of Head Trauma Rehabilitation, 24, 324–332.CrossRefGoogle Scholar
Whiteneck, G. G., Gerhart, K. A., & Cusick, C. P. (2004). Identifying environmental factors that influence the outcomes of people with traumatic brain injury. Journal of Head Trauma Rehabilitation, 19, 191–204.CrossRefGoogle ScholarPubMed
Wilkinson, G. S. (1993). Wide Range Achievement Test 3: Manual. Wilmingtion, USA: PAR.Google Scholar
Wood, R. L. I., & Rutterford, N. A. (2006). Long-term effect of head trauma on intellectual abilities: A 16-year outcome study. Journal of Neurology and Psychiatry, 77, 1180–1184.CrossRefGoogle ScholarPubMed
Zigmond, A. S., & Snaith, R. P. (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatric Scandinavia, 67, 361–370.CrossRefGoogle ScholarPubMed