Anxiety, depression, and quality of life among subgroups of individuals with acquired brain injury: The role of anxiety sensitivity and experiential avoidance

Abstract

OBJECTIVES: The objectives of this observational cohort study were to 1) cluster individuals with acquired brain injury (ABI) into subgroups according to their level of anxiety sensitivity (AS) and experiential avoidance (EA), and 2) compare subgroups with respect to anxiety, depression, and quality of life (QoL). METHODS: Individuals were recruited from an ABI outpatient clinic in Ontario, Canada and completed comprehensive psychosocial questionnaires. A two-step cluster analysis was performed to identify unique subgroups based on the clustering variables Anxiety Sensitivity Index (ASI) and Acceptance and Action Questionnaire (AAQ) which measure AS and EA, respectively. Clinical outcome measures were compared between clusters using multivariate analysis of variance: Generalized Anxiety Disorder 7 item (anxiety); Patient Health Questionnaire-9 (depression), and EQ-5D overall health item (QoL). RESULTS: Among 86 participants included for analysis (mean age 47.1 ± 14.2 years, 54.7% female), three unique clusters were produced. ASI and AAQ were significantly different among all groups (p < 0.001). Cluster 1 (n = 26) had the lowest levels of AS and EA whereas Cluster 3 (n = 24) had the highest levels of AS and EA; Cluster 2 (n = 36) had moderate levels of AS and EA. There was no significant difference between groups in age, gender, time since injury, or Glasgow Coma Scale scores. Cluster 3 had significantly higher anxiety and depression scores than Cluster 1 and 2 (p < 0.001 for all). Further, Cluster 2 had significantly higher anxiety and depression scores than Cluster 1 (p < 0.001 for all). There was no significant difference in EQ-5D scores between Clusters 1 and 2 or Cluster 2 and 3; however, Cluster 3 scored significantly lower on EQ-5D than Cluster 1 (p = 0.032). CONCLUSIONS: There exists a subgroup of individuals with ABI that have high levels of AS and EA; this was associated with greater symptoms of anxiety and depression, and poorer QoL. Interventions to address AS and EA may improve mood and QoL in this population.

Introduction to the thematic issue on stress, pain and the brain

“…The examination of the data performed by McGeary et al provides strong evidence for the Fear Avoidance Model as an explanation for the development of chronic pain in this population with a total of nearly 40% of the variance in pain-related disability accounted for by measures of the four components constituting the model with each of the four factors contributing a 6% increase in disability. Of significant interest, particularly in view of the findings reported here by McIntyre et al (2020a;2020b) with respect to the significant deleterious impact of experiential avoidance, is the potential role of fear avoidance as a maladaptive response to concomitant TBI as a contributing factor to the development of chronic pain states in individuals with TBI, given that fear avoidance has also been found to be a potential explanation for persistent symptoms following TBI (Wijenberg et al 2017). McIntyre et al (2020b), in their second paper contributed to this issue, focus on the subgroup of individuals with the combination of high levels of anxiety sensitivity (AS) and experiential avoidance (EA) as important factors associated with reports of depressive symptomatology, increased anxiety and poorer quality of life after ABI.…”

“…Of significant interest, particularly in view of the findings reported here by McIntyre et al (2020a;2020b) with respect to the significant deleterious impact of experiential avoidance, is the potential role of fear avoidance as a maladaptive response to concomitant TBI as a contributing factor to the development of chronic pain states in individuals with TBI, given that fear avoidance has also been found to be a potential explanation for persistent symptoms following TBI (Wijenberg et al 2017). McIntyre et al (2020b), in their second paper contributed to this issue, focus on the subgroup of individuals with the combination of high levels of anxiety sensitivity (AS) and experiential avoidance (EA) as important factors associated with reports of depressive symptomatology, increased anxiety and poorer quality of life after ABI. They found that their experimental population could be subclassified into three unique subgroups such that AS and EA were significantly different between the groups: a group with generally low AS and EA, a second group with moderate levels of AS and EA and a third group with high levels of AS and EA.…”

“…Thus, one key emerging issue is how best to assist a person with such tendencies to shift to active coping and overcome entrenched avoidance beliefs. Positive social experience in group therapy and structured individual psychotherapy, for example in the form of Acceptance and Commitment Therapy, have been advocated (see McIntyre et al 2020b in this issue for further discussion). Psychedelic-assisted psychotherapy may be another avenue open for further research exploration in this vein.…”

“…These individuals may well be the group of 'non-habituators' identified by Peters, McEwen & Friston (2017) as those who are particularly prone to the development of chronic allostatic overload and the accumulation of chronic stress-related conditions that accompany this situation. A variety of different interventions have been proposed to manage and assist this population and McIntyre et al (2020b) review evidence supporting the efficacy of a number of these in the discussion section of their paper. Having in place effective methods for early identification of such individuals so that they can be supported and treated with effective interventions for the facilitation of allostasis, instruction in self-management strategies for reducing and managing anxiety, and, to the extent possible, assistance with the mitigation of the uncertainty driving the anxiety, would appear to be a justifiable goal and the subject of future research.…”

Evaluation of Functional, Cognitive and Emotional Outcomes and Pituitary Hormones According to Trauma Severity in Patients with Traumatic Brain Injury

“…Literatürde yaralanma ciddiyetine bakılmaksızın yaralanma sonrası hem anksiyete hem de depresif belirtilerin yaygın olduğu bildirilmiştir. 23 Ayrıca TBH şiddetinin bilişsel bozuklukların tahmini için de önemli bir değişken olmadığı belirtilmiştir. 24 Ancak sonuçlarımıza göre kronik dönemde orta ve ağır TBH vakalarında fonksiyonel, bilişsel ve emosyonel durum ilk 24 saat içinde belirlenmiş olan GKS ile ilişkiliydi.…”