Perception of Health and Quality of Life in Minorities After Mild-to-Moderate Traumatic Brain Injury

Abstract

Much has been reported of the influence of age, affective symptoms, and satisfaction on self-ratings of health functioning, but little is known about the extent that race-based perceptions may have on influencing behavior or adjustment after a mild-to-moderate traumatic brain injury (MTBI). We investigated differences in perception of health functioning by race for mental and physical functioning using a global measure of health functioning. MTBI (n = 135) and general trauma (GT, n = 83) patients recruited from an area Level-1 trauma center at 3 months after injury were administered the Medical Outcomes Study: Short Form (SF-36), Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994), Community Integration Questionnaire, Social Support Questionnaire (SSQ), Center for Epidemiological Studies-Depression, and the Visual Analogue Scale of Depression. A significant interaction for Race Group (p < .01) was found on the Physical Component Scale (PCS) of the SF-36. In the MTBI group, African Americans reported worse functioning (p < .04) on the PCS scale; they perceived functioning on subscales General Health Perception (p < .02) and Physical Functioning (p < .04) to be more limited. On the SSQ, Hispanic MTBI patients reported having fewer social supports available to them (p < .05), although the race groups were comparable for satisfaction with their support. Rate of depression across groups was comparable, although subjective reporting by minority MTBI patients indicated greater depressed feelings. Differences in perception of health functioning may be related to the unique interaction created between sustaining an MTBI and variations in cultural expression of disability. Manifestations of physical difficulties may be better accepted for some cultures than having mental illness.

Traumatic brain injury and quality of life: Initial Australian validation of the QOLIBRI

“…The known group analysis (Table 4) suggested the QOLIBRI scales are very sensitive to common TBI sequelae. 6,9,11,21,[60][61][62][63][64] Although consistent with other instruments assessing TBI by known groups, 7,9,61,65 this needs to be supported by responsiveness in a longitudinal study before QOLIBRI validation can be claimed. Importantly, change over time cannot be taken for granted.…”

“…Part A comprises four satisfaction scales: Cognition (7 items), Self (7), Daily life and autonomy (DLA; 7), and Social relationships (6). Part B, comprises two ''bothered'' scales: Emotions (5) and Physical problems (5).…”

“…3 Indicators that have been used in TBI include physiological; 4,5 health status, health function or illness; 6-12 life satisfaction; 5,13-17 psychological health 10 or psychosocial and social functioning. 6,8,11 This suggests few studies have used recognised HRQoL instruments, of which there are two types: (i) generic HRQoL instruments, which provide overviews; and (ii) condition-specific instruments, which provide condition insight.…”

Early Trajectory of Psychiatric Symptoms after Traumatic Brain Injury: Relationship to Patient and Injury Characteristics

“…29 Studies have also found worse self-reported functional outcomes among this racial group, even after adjusting for other demographic factors and injury severity. 30,31 These perplexing findings may relate to unmeasured sources of vulnerability to stress that are not ''factored out'' with statistical adjustment, cultural differences in interpretation of symptoms, or both. Future research might benefit from mixed-methods approaches to explore how people from different backgrounds perceive different symptoms and levels of functional capacity.…”

Traumatic brain injury and functional outcomes: Does minority status matter?

“…For instance, minorities with TBI have a longer wait time to see a physician [15], are less likely to be sent back to the referring physician after emergency department discharge [15] and tend to receive fewer therapy services (physical, occupational, speech and psychotherapy) during inpatient rehabilitation [9]. Moreover, minorities reported having significantly worse health and have less social support available to them after TBI [16]. In terms of functional outcomes, minorities have been found to have lower levels of social functioning and higher rates of alcohol abuse after TBI [17], with lower levels of social integration and community productivity after 1-year post injury [9,11,13,14].…”