Original research| Volume 99, ISSUE 2, P264-271, February 2018

Download started.


Longitudinal Examination of Resilience After Traumatic Brain Injury: A Traumatic Brain Injury Model Systems Study



      To evaluate (1) the trajectory of resilience during the first year after a moderate-severe traumatic brain injury (TBI); (2) factors associated with resilience at 3, 6, and 12 months postinjury; and (3) changing relationships over time between resilience and other factors.


      Longitudinal analysis of an observational cohort.


      Five inpatient rehabilitation centers.


      Patients with TBI (N=195) enrolled in the resilience module of the TBI Model Systems study with data collected at 3-, 6-, and 12-month follow-up.


      Not applicable.

      Main Outcome Measure

      Connor-Davidson Resilience Scale.


      Initially, resilience levels appeared to be stable during the first year postinjury. Individual growth curve models were used to examine resilience over time in relation to demographic, psychosocial, and injury characteristics. After adjusting for these characteristics, resilience actually declined over time. Higher levels of resilience were related to nonminority status, absence of preinjury substance abuse, lower anxiety and disability level, and greater life satisfaction.


      Resilience is a construct that is relevant to understanding brain injury outcomes and has potential value in planning clinical interventions.


      List of abbreviations:

      CD-RISC (Connor-Davidson Resilience Scale), DRS (Disability Rating Scale), GED (General Equivalency Diploma), HS (high school), mTBI (mild traumatic brain injury), PART-O (Participation Assessment with Recombined Tools–Objective), SWLS (Satisfaction With Life Scale), TBI (traumatic brain injury), TBIMS (Traumatic Brain Injury Model System)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Pooley J.A.
        • Cohen L.
        Resilience: a definition in context.
        Aust Community Psychol. 2010; 22: 30-37
        • Norris F.H.
        • Tracy M.
        • Galea S.
        Looking for resilience: understanding the longitudinal trajectories of responses to stress.
        Soc Sci Med. 2009; 68: 2190-2198
        • Connor K.M.
        • Davidson J.R.
        Development of a new resilience scale: the Connor-Davidson Resilience Scale (CD-RISC).
        Depress Anxiety. 2003; 18: 76-82
        • McCauley S.R.
        • Wilde E.A.
        • Miller E.R.
        • et al.
        Preinjury resilience and mood as predictors of early outcome following mild traumatic brain injury.
        J Neurotrauma. 2013; 30: 642-652
        • Merritt V.C.
        • Lange R.T.
        • French L.M.
        Resilience and symptom reporting following mild traumatic brain injury in military service members.
        Brain Inj. 2015; 29: 1325-1336
        • Sullivan K.A.
        • Edmed S.L.
        • Allan A.C.
        • Smith S.S.
        • Karlsson L.J.
        The role of psychological resilience and mTBI as predictors of postconcussional syndrome symptomatology.
        Rehabil Psychol. 2015; 60: 147-154
        • Lukow II, H.R.
        • Godwin E.E.
        • Marwitz J.H.
        • Mills A.
        • Hsu N.H.
        • Kreutzer J.S.
        Relationship between resilience, adjustment, and psychological functioning after traumatic brain injury: a preliminary report.
        J Head Trauma Rehabil. 2015; 30: 241-248
        • Kreutzer J.S.
        • Marwitz J.H.
        • Sima A.P.
        • et al.
        Resilience following traumatic brain injury: a Traumatic Brain Injury Model Systems study.
        Arch Phys Med Rehabil. 2016; 97: 708-713
        • Hanks R.A.
        • Rapport L.J.
        • Waldron Perrine B.
        • Millis S.R.
        Correlates of resilience in the first 5 years after traumatic brain injury.
        Rehabil Psychol. 2016; 61: 269-276
        • Losoi H.
        • Silverberg N.D.
        • Waljas M.
        • et al.
        Recovery from mild traumatic brain injury in previously healthy adults.
        J Neurotrauma. 2016; 33: 766-776
        • Losoi H.
        • Waljas M.
        • Turunen S.
        • et al.
        Resilience is associated with fatigue after mild traumatic brain injury.
        J Head Trauma Rehabil. 2015; 30: E24-E32
        • Losoi H.
        • Silverberg N.D.
        • Waljas M.
        • et al.
        Resilience is associated with outcome from mild traumatic brain injury.
        J Neurotrauma. 2015; 32: 942-949
        • Wagnild G.M.
        • Young H.M.
        Development and psychometric evaluation of the resilience scale.
        J Nurs Meas. 1993; 1: 165-178
        • Sullivan K.A.
        • Kempe C.B.
        • Edmed S.L.
        • Bonanno G.A.
        Resilience and other possible outcomes after mild traumatic brain injury: a systematic review.
        Neuropsychol Rev. 2016; 26: 173-185
        • Harrison-Felix C.
        • Newton C.N.
        • Hall K.M.
        • Kreutzer J.S.
        Descriptive findings from the Traumatic Brain Injury Model Systems National Database.
        J Head Trauma Rehabil. 1996; 11: 1-14
        • Campbell-Sills L.
        • Stein M.B.
        Psychometric analysis and refinement of the Connor-Davidson Resilience Scale (CD-RISC): validation of a 10-item measure of resilience.
        J Trauma Stress. 2007; 20: 1019-1028
        • Campbell-Sills L.
        • Forde D.R.
        • Stein M.B.
        Demographic and childhood environmental predictors of resilience in a community sample.
        J Psychiatr Res. 2009; 43: 1007-1012
        • Bertisch H.
        • Rath J.
        • Long C.
        • Ashman T.
        • Rashid T.
        Positive psychology in rehabilitation medicine: a brief report.
        NeuroRehabilitation. 2014; 34: 573-585
        • Graham D.P.
        • Helmer D.A.
        • Harding M.J.
        • Kosten T.R.
        • Petersen N.J.
        • Nielsen D.A.
        Serotonin transporter genotype and mild traumatic brain injury independently influence resilience and perception of limitations in veterans.
        J Psychiatr Res. 2013; 47: 835-842
        • Rappaport M.
        • Hall K.M.
        • Hopkins K.
        • Belleza T.
        • Cope D.N.
        Disability Rating Scale for severe head trauma: coma to community.
        Arch Phys Med Rehabil. 1982; 63: 118-123
        • Gouvier W.D.
        • Blanton P.D.
        • LaPorte K.K.
        • Nepomuceno C.
        Reliability and validity of the Disability Rating Scale and the Levels of Cognitive Functioning Scale in monitoring recovery from severe head injury.
        Arch Phys Med Rehabil. 1987; 68: 94-97
        • Rao N.
        • Kilgore K.M.
        Predicting return to work in traumatic brain injury using assessment scales.
        Arch Phys Med Rehabil. 1992; 73: 911-916
        • Brown S.A.
        • McCauley S.R.
        • Levin H.S.
        • et al.
        Factor analysis of an outcome interview for use in clinical trials of traumatically brain-injured patients: a preliminary study.
        Am J Phys Med Rehabil. 2001; 80: 196-205
        • Malec J.F.
        • Hammond F.M.
        • Giacino J.T.
        • Whyte J.
        • Wright J.
        Structured interview to improve the reliability and psychometric integrity of the Disability Rating Scale.
        Arch Phys Med Rehabil. 2012; 93: 1603-1608
        • Whiteneck G.G.
        • Bogner J.A.
        • Heinemann A.W.
        Advancing the measurement of participation.
        Arch Phys Med Rehabil. 2011; 92: 540-541
        • Diener E.
        • Emmons R.A.
        • Larsen R.J.
        • Griffin S.
        The Satisfaction With Life Scale.
        J Pers Assess. 1985; 49: 71-75
        • Pavot W.
        • Diener E.
        • Colvin C.R.
        • Sandvik E.
        Further validation of the Satisfaction With Life Scale: evidence for the cross-method convergence of well-being measures.
        J Pers Assess. 1991; 57: 149-161
        • Post M.W.
        • van Leeuwen C.M.
        • van Koppenhagen C.F.
        • de Groot S.
        Validity of the Life Satisfaction questions, the Life Satisfaction Questionnaire, and the Satisfaction With Life Scale in persons with spinal cord injury.
        Arch Phys Med Rehabil. 2012; 93: 1832-1837
        • Bogner J.A.
        • Whiteneck G.G.
        • MacDonald J.
        • et al.
        Test-retest reliability of traumatic brain injury outcome measures: a Traumatic Brain Injury Model Systems study.
        J Head Trauma Rehabil. 2017 Feb 10; ([Epub ahead of print])
        • Davis L.C.
        • Sherer M.
        • Sander A.M.
        • et al.
        Preinjury predictors of life satisfaction at 1 year after traumatic brain injury.
        Arch Phys Med Rehabil. 2012; 93: 1324-1330
        • Williams M.W.
        • Rapport L.J.
        • Millis S.R.
        • Hanks R.A.
        Psychosocial outcomes after traumatic brain injury: life satisfaction, community integration, and distress.
        Rehabil Psychol. 2014; 59: 298-305
        • Tulsky D.S.
        • Kisala P.A.
        • Victorson D.
        • et al.
        TBI-QOL: development and calibration of item banks to measure patient reported outcomes following traumatic brain injury.
        J Head Trauma Rehabil. 2016; 31: 40-51
        • Lange R.T.
        • Brickell T.A.
        • Bailie J.M.
        • Tulsky D.S.
        • French L.M.
        Clinical utility and psychometric properties of the Traumatic Brain Injury Quality of Life Scale (TBI-QOL) in US military service members.
        J Head Trauma Rehabil. 2016; 31: 62-78
        • Kozlowski A.J.
        • Pretz C.R.
        • Dams-O'Connor K.
        • Kreider S.
        • Whiteneck G.
        An introduction to applying individual growth curve models to evaluate change in rehabilitation: a National Institute on Disability and Rehabilitation Research Traumatic Brain Injury Model Systems report.
        Arch Phys Med Rehabil. 2013; 94: 589-596
        • Edwards L.J.
        • Muller K.E.
        • Wolfinger R.D.
        • Qaqish B.F.
        • Schabenberger O.
        An R2 statistic for fixed effects in the linear mixed model.
        Stat Med. 2008; 27: 6137-6157
        • Kenward M.G.
        • Roger J.H.
        An improved approximation to the precision of fixed effects from restricted maximum likelihood.
        Comput Stat Data Anal. 2009; 53: 2583-2595
        • Juengst S.B.
        • Adams L.M.
        • Bogner J.A.
        • et al.
        Trajectories of life satisfaction after traumatic brain injury: influence of life roles, age, cognitive disability, and depressive symptoms.
        Rehabil Psychol. 2015; 60: 353-364