- •Twelve-month prospect cohort study of 188 patients with severe TBI.
- •First investigation of postinjury relation between PTS and HRQoL.
- •PTS associated with mental but not physical HRQoL post-TBI.
- •PTS associated with interpersonal and cognitive functioning post-TBI.
- •PTS associated with total and emotional functioning if patients ≤50 years of age.
To investigate the relation between posttraumatic stress (PTS) symptom severity and health-related quality of life (HRQoL) after severe traumatic brain injury (TBI).
Longitudinal prospective multicenter, cohort study on severe TBI in Switzerland (2007–2011).
Hospital, rehabilitation unit, and/or patient’s living facility.
Patients with severe TBI (N=109) were included in the analyses. Injury severity was determined using the Abbreviated Injury Score of the head region after clinical assessment and initial computed tomography scan.
Main Outcome Measures
HRQoL (Medical Outcomes Study 12-Item Short-Form Health Survey Physical and Mental Component Summaries) and self-reported emotional, cognitive, and interpersonal functioning (Patient Competency Rating Scale for Neurorehabilitation).
Multilevel models for patients >50 and ≤50 years of age revealed significant negative associations between PTS symptom severity and interpersonal functioning (P<.001 and P=.002), respectively. Among patients ≤50 years of age, PTS symptom severity was significantly associated with total functioning (P=.001) and emotional functioning (P<.001). Among all patients, PTS symptom severity was significantly associated with cognitive functioning (P<.001) and mental HRQoL (P=.01).
Findings indicate that PTS symptoms after severe TBI are negatively associated with HRQoL and emotional, cognitive, and interpersonal functioning.
List of abbreviations:DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th edition), GCS (Glasgow Coma Scale), HAIS (Abbreviated Injury Scale of the head region), HRQoL (health-related quality of life), MCS (Mental Component Summary), PCS (Physical Component Summary), PCRS-NR (Patient Competency Rating Scale for Neurorehabilitation), PEBITA TRAST-MI (Patient-relevant Endpoints after Brain Injury from Traumatic Accidents Trajectories of Recovery After Severe TBI - Matter in Families), PTS (posttraumatic stress), PTSD (posttraumatic stress disorder), SF-12 (Medical Outcomes Study 12-Item Short-Form Health Survey), TBI (traumatic brain injury)
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- Informal care four years after a severe traumatic brain injury: results from the PariS-TBI study.Ann Phys Rehabil Med. 2012; 55: e359-e360
- Family burden after severe brain injury.Patient. 2011; 4: 55-65
- Post-traumatic stress symptoms in relatives in the first weeks after severe traumatic brain injury.Brain Inj. 2011; 25: 259-265
- Hospitalised and fatal head injuries in Viti Levu, Fiji: findings from an island-wide trauma registry (TRIP 4).Neuroepidemiology. 2012; 38: 179-185
- Trends in head injury outcome from 1989 to 2003 and the effect of neurosurgical care: an observational study.Lancet. 2005; 366: 1538-1544
- Using a cost-benefit analysis to estimate outcomes of a clinical treatment guideline: testing the Brain Trauma Foundation guidelines for the treatment of severe traumatic brain injury.J Trauma Acute Care Surg. 2007; 63: 1271-1278
- Autopsies and death certification in deaths due to blunt trauma: what are we missing?.Can J Surg. 2000; 43: 130
- Rate of psychiatric illness 1 year after traumatic brain injury.Am J Psych. 1999; 153: 374-378
- Psychiatric disorders following traumatic brain injury: their nature and frequency.J Head Trauma Rehabil. 2009; 24: 324-332
- Coping style and post-traumatic stress disorder following severe traumatic brain injury.Brain Inj. 2000; 14: 175-180
- Can traumatic brain injury cause psychiatric disorders?.J Neuropsychiatr Clin Neurosci. 2000; 12: 316-327
Association AP. Diagnostic and statistical manual of mental disorders: DSM-5. Washtington, DC; American Psychiatric Publishing: 2013.
- Posttraumatic stress disorder after severe traumatic brain injury.Am J Psychiatry. 2000; 12: 316-327
- Psychiatric challenges in the first 6 years after traumatic brain injury: cross-sequential analyses of axis I disorders.Arch Phys Med Rehabil. 2004; 85: 36-42
- Recovery of cognitive function after traumatic brain injury: a multilevel modeling analysis of Canadian outcomes.Arch Phys Med Rehabil. 2008; 89: S3-S15
- Axis I psychopathology in individuals with traumatic brain injury.J Head Trauma Rehabil. 1998; 13: 24-39
- The evolution of posttraumatic stress disorder following moderate to severe traumatic brain injury.J Neurotrauma. 2015; 33: 825-831
- Longitudinal analysis of the relationship between symptoms and quality of life in veterans treated for posttraumatic stress disorder.J Consult Clin Psychol. 2006; 74: 707-713
- Post-traumatic stress disorder and service utilization in a sample of service members from Iraq and Afghanistan.Mil Med. 2007; 172: 359-363
- Domains of quality of life and symptoms in male veterans treated for posttraumatic stress disorder.J Trauma Stress. 2007; 20: 955-964
- Health-related quality of life and posttraumatic stress disorder in survivors of the acute respiratory distress syndrome.Crit Care Med. 1998; 26: 651-659
- Posttraumatic stress disorder and health-related quality of life in long-term survivors of acute respiratory distress syndrome.Am J Psychiatry. 2004; 161: 45-52
- The impact of PTSD symptoms on physical and mental health functioning in returning veterans.J Anxiety Disord. 2014; 28: 310-317
- Quality of life in the anxiety disorders: a meta-analytic review.Clin Psychol Rev. 2007; 27: 572-581
- Affective and cognitive correlates of PTSD: electrocortical processing of threat and perseverative errors on the WCST in combat-related PTSD.Prog Neuropsychopharmacol Biol Psychiatry. 2017; 75: 63-69
- Emotion regulation and anxiety disorders.J Anxiety Disord. 2008; 22: 211-221
- Functional neuroimaging of anxiety: a meta-analysis of emotional processing in PTSD, social anxiety disorder, and specific phobia.Am J Psychiatry. 2007; 164: 1476-1488
- The physical health consequences of PTSD and PTSD symptoms: a meta-analytic review.J Anxiety Disord. 2013; 27: 33-46
- Health-related quality of life during the first year after traumatic brain injury.Arch Pediatr Adolesc Med. 2006; 160: 252-260
- Health-related quality of life of children and adolescents after traumatic brain injury.Pediatrics. 2002; 109: E34
- Longitudinal linkages between perceived social support and posttraumatic stress symptoms: sequential roles of social causation and social selection.J Trauma Stress. 2008; 21: 274-281
- Posttraumatic stress disorder in an interpersonal context.in: Beck J.G. Interpersonal processes in the anxiety disorders: Implications for understanding psychopathology and treatment. American Psychological Association, Washtington, DC2010: 179-208
- Employment outcomes and PTSD symptom severity.Ment Health Serv Res. 2005; 7: 89-101
- Traumatic brain injury (TBI) 10-20 years later: a comprehensive outcome study of psychiatric symptomatology, cognitive abilities and psychosocial functioning.Brain Inj. 2001; 15: 189-209
- Longitudinal follow-up of patients with traumatic brain injury: outcome at two, five, and ten years post-injury.J Neurotrauma. 2014; 31: 64-77
- Recovery of function following severe traumatic brain injury: a retrospective 10-year follow-up.Brain Inj. 1995; 9: 285-299
- Severe traumatic brain injury in a high-income country: an epidemiological study.J Neurotrauma. 2013; 30: 1934-1942
- Diagnostic value of the Glasgow Coma Scale for traumatic brain injury in 18,002 patients with severe multiple injuries.J Neurotrauma. 2011; 28: 527-534
- The use of Glasgow Coma Scale in injury assessment: a critical review.Brain Inj. 2009; 23: 371-384
- Mindful creativity matters: trajectories of reported functioning after severe traumatic brain injury as a function of mindful creativity in patients’ relatives: a multilevel analysis.Qual Life Res. 2017; 26: 893-902
- Trajectory of disability and quality-of-life in non-geriatric and geriatric survivors after severe traumatic brain injury.Brain Inj. 2017; 31: 319-328
- The relatives’ big five personality influences the trajectories of recovery of patients after severe TBI: a multilevel analysis.J Pers. 2017; 85: 481-493
- An overview of the injury severity score and the new injury severity score.Inj Prev. 2001; 7: 10-13
- Abbreviated injury scale unification: the case for a unified injury system for global use.J Trauma Acute Care Surg. 1999; 47: 309-323
- A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity.Med Care. 1996; 34: 220-233
- Modification of the Patient Competency Rating Scale for use on an acute neurorehabilitation unit: the PCRS-NR.Brain Inj. 2003; 17: 847-853
- Short screening scale for DSM-IV posttraumatic stress disorder.Am J Psychiatry. 1999; 156: 908-911
- Psychological adaptation to life-threatening injury in dyads: the role of dysfunctional disclosure of trauma.Eur J Psychotraumatol. 2011; 2
- [German version of the Short DSM-IV Screening Scale to detect posttraumatic stress disorder].Trauma und Gewalt. 2010; 4 ([German]): 208-213
- Assessment of coma and impaired consciousness: a practical scale.Lancet. 1974; 304: 81-84
- Traumatic events and post-traumatic stress disorder in the community: prevalence, risk factors and comorbidity.Acta Psychiatr Scand. 2000; 101: 46-59
Gelman A, Hill J. Data analysis using regression and multilevel/hierarchical models. New York: Cambridge University Press; 2007.
- Quality of life after traumatic brain injury: a review of research approaches and findings.Arch Phys Med Rehabil. 2004; 85: 21-35
- Neuropsychological outcomes of mild traumatic brain injury, post-traumatic stress disorder and depression in Iraq-deployed US Army soldiers.Br J Psychiatry. 2012; 201: 186-192
- Impact of depression and post-traumatic stress disorder on functional outcome and health-related quality of life of patients with mild traumatic brain injury.J Neurotrauma. 2015; 32: 853-862
- Psychosocial functioning and health-related quality of life associated with posttraumatic stress disorder in male and female Iraq and Afghanistan war veterans: the VALOR registry.J Womens Health (Larchmt). 2015; 24: 1038-1046
- Posttraumatic stress disorder and psychosocial functioning after severe traumatic brain injury.J Nerv Ment Dis. 2001; 189: 109-113
- Beyond PTSD: emotion regulation and interpersonal problems as predictors of functional impairment in survivors of childhood abuse.Behav Ther. 2005; 36: 119-124
- Understanding the relationship between PTSD and social support: the role of negative network orientation.Behav Res Ther. 2009; 47: 237-244
- A multi-perspective concept mapping study of problems associated with traumatic brain injury.Brain Inj. 2005; 19: 1077-1085
- Emotion regulation difficulties in trauma survivors: the role of trauma type and PTSD symptom severity.Behav Ther. 2010; 41: 587-598
- A preliminary investigation of the relationship between emotion regulation difficulties and posttraumatic stress symptoms.Behav Ther. 2007; 38: 303-313
- Effective regulation of the experience and expression of negative affect in old age.J Gerontol B Psychol Sci Soc Sci. 2008; 63: P138-P145
Haller CS, Walder B. Severe traumatic brain injury in high-income countries.
- Severe neurotrauma in Switzerland: have short-term outcomes improved?.Swiss Med Wkly. 2015; 145: w14177
Published online: March 12, 2018
© 2018 by the American Congress of Rehabilitation Medicine