Post-traumatic stress disorder and self-reported outcomes after traumatic brain injury in victims of assault

Bown, Dominic; Belli, Antonio; Qureshi, Kasim L.; Davies, David; Toman, Emma; Upthegrove, Rachel

doi:10.1371/journal.pone.0211684

Cited by 13 publications

(8 citation statements)

References 47 publications

(58 reference statements)

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“…We realized that functional outcomes at discharge had no potential to predict PCS appearance in mTBI patients. The evidence of a prior study has corroborated our results in this regard [29].…”

Section: Discussionsupporting

confidence: 91%

Hemorrhages Seen on Brain Images After Mild Traumatic Brain Injury May Increase the Risk of Post-concussion Syndrome

2020

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Background and Aim: Mild Traumatic Brain Injury (mTBI) mostly develops the symptoms that may persist for over three months known as Post-Concussion Syndrome (PCS). However, the PCS potential risk for mTBI victims is not well-identified. Here, we investigated the putative risk factors of PCS. Methods and Materials/Patients: In a cross-sectional study, we collected (HIS) the demographic, clinical, and radiological data using the hospital information system in 388 mTBI patients who passed at least 3 months since the onset of their injury and referred to Poursina hospital from March 2017 to December 2018. The patients were examined to diagnose PCS by a general physician using the phone interview via the Rivermead Post-concussion Symptoms Questionnaire (RPQ). The subjects were separated into groups with and without PCS. Data were analyzed by parametric t-test, Chi-square test and multiple logistic regression. Results: One-hundred ninety one out of 388 mTBI patients consented to complete the RPQ and around 59% of cases experienced PCS. There was no significant difference in the demographic variables and past medical history between groups. However, the previous psychological disease was particularly associated with PCS (P>0.043). Length of hospitalization, functional outcome during discharge, and post-resuscitation consciousness did not show any significant association with PCS (P<0.05). Interestingly, initial abnormal brain scan, fronto-temporal lesion, and accompanied hematoma (hemorrhages) were identified as risk factors of mTBI-induced PCS. The risk of PCS was found to increase by 7.2 times in mTBI patients demonstrated as an abnormality in their initial brain scans (P<0.001). A directly proportional relationship was found between the occurrence of the syndrome and the fronto-temporal lesion (P<0.017). Accompanied hematoma enhanced the risk of PCS by 2.6 times (P<0.04). Conclusion: This study emphasized the significance of early brain scan data for the prediction of PCS and the necessity of proper follow-up care for the at-risk population. The reported data from this study might be applied as an objective trajectory to measure PCS in those who simulated PCS for the litigation.

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Section: Discussionsupporting

confidence: 91%

Hemorrhages Seen on Brain Images After Mild Traumatic Brain Injury May Increase the Risk of Post-concussion Syndrome

2020

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“…21 This is particularly concerning given the very high incidence of PTSD we report among survivors of interpersonal violence, especially the young adult cohort. Conversely, there are prior studies that report a nonsignificant difference in PTSD prevalence in assault victims; 22 however, it must be noted that these studies focus exclusively on traumatic brain injury patients, which may represent a very different patient cohort. 22 We report an approximately 30% difference in PTSD between the interpersonal violence and nonviolent trauma cohorts, and this difference persists even after adjusting for potential confounders.…”

Section: Discussionmentioning

confidence: 93%

“…Conversely, there are prior studies that report a nonsignificant difference in PTSD prevalence in assault victims; 22 however, it must be noted that these studies focus exclusively on traumatic brain injury patients, which may represent a very different patient cohort. 22 We report an approximately 30% difference in PTSD between the interpersonal violence and nonviolent trauma cohorts, and this difference persists even after adjusting for potential confounders. It is also worth mentioning that the overall prevalence of PTSD in this study is notably higher than the 20% prevalence reported in prior work from our group that included all moderate to severely injured trauma patients.…”

Section: Discussionmentioning

confidence: 93%

Patient reported outcomes 6 to 12 months after interpersonal violence: A multicenter cohort study

Castillo-Ángeles

Herrera-Escobar

Toppo

et al. 2021

J Trauma Acute Care Surg

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Violence continues to be a significant public health burden, but little is known about the long-term outcomes of these patients. Our goal was to determine the impact of violence-related trauma on long-term functional and psychosocial outcomes. METHODS:We identified trauma patients with moderate to severe injuries (Injury Severity Score, ≥9) treated at one of three level 1 trauma centers. These patients were asked to complete a survey over the phone between 6 and 12 months after injury evaluating both functional and psychosocial outcomes (12-item Short Form Survey, Trauma Quality of Life, posttraumatic stress disorder [PTSD] screen, chronic pain, return to work). Patients were classified as having suffered a violent injury if the mechanism of injury was a stab, gunshot, or assault. Self-inflicted wounds were excluded. Adjusted logistic regression models were built to determine the association between a violent mechanism of injury and long-term outcomes. RESULTS:A total of 1,050 moderate to severely injured patients were successfully followed, of whom 176 (16.8%) were victims of violence.For the victims of violence, mean age was 34.4 years (SD, 12.5 years), 85% were male, and 57.5% were Black; 30.7% reported newly needing help with at least one activity of daily living after the violence-related event. Fifty-nine (49.2%) of 120 patients who were working before their injury had not yet returned to work; 47.1% screened positive for PTSD, and 52.3% reported chronic pain. On multivariate analysis, a violent mechanism was significantly associated with PTSD (odds ratio, 2.57; 95% confidence interval, 1.59-4.17; p < 0.001) but not associated with chronic pain, return to work, or functional outcomes. CONCLUSION:The physical and mental health burden after violence-related trauma is not insignificant. Further work is needed to identify intervention strategies and social support systems that may be beneficial to reduce this burden.

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“…In one study involving 177 survivors of assault, which may or may not have involved IPV, differences in neurobehavioral symptoms were of borderline signif-icance among those with and without a head injury. 15 The IPV survivor population may also be unique relative to other groups that endure brain injury (eg, veterans); for IPV survivors, for example, head trauma is often repetitive, with little time in between for recovery and with high rates of co-occurring psychological trauma. 2 In fact, IPV is associated with mental health problems such as depression later in life, 16 potentially increasing vulnerability for neurobehavioral symptoms at baseline, or associated PCS and prolonged recovery if brain injury were to occur.…”

mentioning

confidence: 99%

“…Yet, some data examining assault more generally are equivocal. In one study involving 177 survivors of assault, which may or may not have involved IPV, differences in neurobehavioral symptoms were of borderline significance among those with and without a head injury 15. The IPV survivor population may also be unique relative to other groups that endure brain injury (eg, veterans); for IPV survivors, for example, head trauma is often repetitive, with little time in between for recovery and with high rates of co-occurring psychological trauma 2.…”

mentioning

confidence: 99%

Examining the Association Between Childhood Trauma, Brain Injury, and Neurobehavioral Symptoms Among Survivors of Intimate Partner Violence: A Cross-Sectional Analysis

Saadi¹,

Chibnik²,

Valera³

2022

Journal of Head Trauma Rehabilitation

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Objective: Understanding factors contributing to neurobehavioral symptom burden among intimate partner violence (IPV) survivors has important implications for prevention, screening, and intervention in this vulnerable population. This study aimed to (1) identify the relationship between childhood trauma and neurobehavioral symptoms among a shelter-and community-based sample of IPV survivors, including investigating the mediating role of posttraumatic stress symptoms and alexithymia in this relationship; (2) assess the association between IPVrelated brain injury (BI) severity and neurobehavioral symptoms; and (3) assesses whether physical, emotional, or cognitive domains of neurobehavioral symptom burden show differential associations with childhood trauma or IPV-related BI. Setting: Community sites serving women who had experienced IPV such as domestic violence shelters and transitional housing sites. Participants: Women survivors of IPV with and without BI (n = 99), aged 18 to 54 years. Design: Retrospective, cross-sectional study design. Measures: The following self-reported questionnaires were used: Rivermead Post Concussion Questionnaire (RPQ); Childhood Trauma Questionnaire (CTQ); a modified version of the Conflict Tactics Scale; Brain Injury Severity Assessment (BISA); Clinician-Administered PTSD Scale for DSM IV; and Toronto Alexithymia Scale. The final multivariate regression model assessed the association between childhood abuse, BI severity, and neurobehavioral symptoms (as measured by the RPQ) adjusting for age, educational attainment, and abuse in the past year. We created separate models with total neurobehavioral symptom score as an outcome, as well as somatic, emotional, and cognitive symptom scores. We used structural equation modeling to assess whether posttraumatic stress and alexithymia mediated the effect of childhood trauma and neurobehavioral symptoms. Results: Childhood trauma was associated with higher levels (P < .01) of overall neurobehavioral symptom burden in women independent of BI and specifically associated with RPQ Emotional and Somatic subscale symptoms (P ≤ .05). BI was positively associated with somatic symptoms in the full sample and cognitive neurobehavioral symptoms in the sample of women with IPV-related BI (P < .05) independent of childhood trauma. Posttraumatic stress symptoms, but not alexithymia, partially mediated the effect of childhood trauma effect on neurobehavioral symptoms. Conclusion: Childhood trauma and BI should not be overlooked as part of efforts to meet the needs of IPV survivors who may experience a range of emotional, somatic, and cognitive symptoms.

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Post-traumatic stress disorder and self-reported outcomes after traumatic brain injury in victims of assault

Cited by 13 publications

References 47 publications

Hemorrhages Seen on Brain Images After Mild Traumatic Brain Injury May Increase the Risk of Post-concussion Syndrome

Hemorrhages Seen on Brain Images After Mild Traumatic Brain Injury May Increase the Risk of Post-concussion Syndrome

Patient reported outcomes 6 to 12 months after interpersonal violence: A multicenter cohort study

Examining the Association Between Childhood Trauma, Brain Injury, and Neurobehavioral Symptoms Among Survivors of Intimate Partner Violence: A Cross-Sectional Analysis

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