Highlights
- •Emotional distress examined prospectively across first decade after TBI
- •Individual symptoms showed similar patterns, but heterogeneity across participants
- •Five distinct trajectory types, including non-linear
- •Personal and injury-related factors predicted trajectories
- •Overall, emotional distress was dynamic, heterogenous, and often chronic
Abstract
Objective
To characterize trajectories of emotional distress across the first decade after moderate-severe
traumatic brain injury (TBI) and explore relationships with personal and injury-related
factors.
Design
Cohort study with follow-ups at 1, 2, 3, 5, and 10 years post-injury.
Setting
Community.
Participants
Participants were sampled from a larger longitudinal study of 4,300 individuals recruited
from consecutive inpatient TBI admissions to a rehabilitation hospital between 1999
and 2021. We analyzed data from 596 unique individuals (13.86% of total dataset; 70.81%
male; Mage=40.11 years, SDage=17.49 years; 7.59% non-English-speaking background) with moderate-severe TBI who
had complete data on all personal and injury-related variables (collected on admission)
and emotional data at three or more time-points. There were 464 participants at the
1-year post-injury time-point, 485 at 2 years, 454 at 3 years, 450 at 5 years, and
248 at 10 years.
Interventions
Not applicable.
Main Outcome Measure
The Hospital Anxiety and Depression Scale (HADS).
Results
Visualization of the individual HADS symptoms (line graph) showed that the most highly
endorsed symptoms at each time-point were feeling slowed down and restlessness. On average, each symptom reduced across the first decade post-TBI, with an overall
mild level of emotional distress at 10 years. However, visualization of participants’
individual trajectories based on the HADS total score (Sankey diagram) revealed significant
heterogeneity. Using latent class analysis, we identified five distinct trajectory
types based on the HADS total score: ‘Gradual Improving’ (38.93%), ‘Resilience’ (36.41%), ‘Gradual Worsening’ (10.40%), and two non-linear trajectories of ‘Worsening-Remitting’ (8.22%) and ‘Improving-Relapsing’ (6.04%). Middle age at injury, lower Glasgow Coma Scale score, comorbid spinal and
limb injuries, and receipt of pre-injury mental health treatment predicted earlier
and/or worsening post-injury emotional distress.
Conclusions
Emotional distress across the first decade after moderate-severe TBI is dynamic, heterogeneous,
and often chronic, underscoring a need for ongoing monitoring and responsive treatment.
Key words
List of abbreviations:
TBI (Traumatic brain injury), HADS (Hospital Anxiety and Depression Scale), GCS (Glasgow Coma Scale), PTA (Post-traumatic amnesia), CT (Computed tomography), BIC (Bayesian information criterion), OR (Odds ratio)To read this article in full you will need to make a payment
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Article info
Publication history
Accepted:
February 28,
2023
Received in revised form:
January 31,
2023
Received:
December 5,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Acknowledgments
The authors wish to acknowledge all participants for so kindly giving their time. We would also like to acknowledge Ms Meagan Carty and all staff at the Monash-Epworth Rehabilitation Research Centre involved in data collection.
Acknowledgment of any presentations of this material: None.
Acknowledgment of financial support
This work was supported by a grant funded by the Transport Accident Commission (TAC), through the Institute for Safety, Compensation and Recovery Research [grant number 135]. JC was supported by an Australian Government Research Training Program (RTP) Scholarship. Sponsors did not have any involvement in the study design; in the collection, analysis or interpretation of data; in the writing of the report; or in the decision to submit the article for publication.
Conflicts of interest: None.
Identification
Copyright
© 2023 Published by Elsevier Inc. on behalf of the American Congress of Rehabilitation Medicine
