Post-traumatic stress disorder in UK civilians with traumatic brain injury: an observational study of TBI clinic attendees to estimate PTSD prevalence and its relationship with radiological markers of brain injury severity

Abstract

ObjectivesTo estimate the prevalence of post-traumatic stress disorder (PTSD) in a large civilian population with traumatic brain injury (TBI), and to assess whether brain injury severity is correlated with PTSD symptoms.DesignObservational, cross-sectional study.Setting and participantsOutpatient clinic in a major UK trauma centre and secondary care hospital. Estimates of PTSD prevalence are based on 171 sampled individuals attending TBI clinic within an 18-month period. Analysis of the relationship between TBI severity and PTSD was performed on the subset of 127 patients for whom injury severity data were also available.MethodsCivilian TBI clinic attendees completed validated self-report questionnaires assessing PTSD (PTSD Checklist Civilian Version (PCL-C)) and other psychiatric symptoms. From this, the prevalence of PTSD was estimated in our cohort. Postresuscitation Glasgow Coma Score and Marshall grade on CT brain scan were recorded as indicators of brain injury severity. A hierarchical regression explored whether TBI severity may predict PTSD scores.ResultsA high prevalence of PTSD was estimated (21% with PCL-C score >50). Higher Marshall grading displayed a slight negative correlation with PTSD symptoms. This statistically significant relationship persisted after confounding factors such as depression and postconcussion symptoms were controlled for.ConclusionsPTSD and TBI frequently coexist, share antecedents and overlap in their resultant symptoms. This complexity has given rise to conflicting hypotheses about relationships between the two. This research reveals that PTSD is common in civilians with TBI (adding to evidence drawn from military populations). The analysis indicated that more severe brain injury may exert a slight protective influence against the development of PTSD—potentially by disrupting implicit access to traumatic memories, or via overlapping neuropsychiatric symptoms that impede diagnosis. The association suggests that further research is warranted to explore the reuse of routine clinical and neuroimaging data—investigating its potential to predict risk of psychiatric morbidity.

Survivors of avalanche accidents: posttraumatic stress disorder symptoms and quality of life: a multicentre study

“…In a meta-analysis, Ophuis et al identified post-traumatic stress one year after any physical trauma in 16 to 27% of victims [ 22 ]. Qureshi et al found PTSD in 21% of patients 18 months after a head injury [ 23 ]. Finally, two meta-analyses found a prevalence of post-traumatic stress ranging from 3.7 to 60%, two years after a natural disaster [ 3 , 4 ].…”

Head Injury Exposure in Veterans Presenting to Memory Disorders Clinic: An Observational Study of Clinical Characteristics and Relationship of Event-Related Potentials and Imaging Markers

“…Additionally, the neuropsychological and clinical characterization of veterans with a history of TBI is partly complicated by potential over-laying mood disorders either related to a relatively increased incidence of PTSD in this population (61,62), or mood symptoms that may co-occur with neurodegenerative diseases itself including AD and CTE, both of which have been reported to have prominent mood symptoms (19,(63)(64)(65)(66). Consistent with this literature, our head injury patients showed elevations in scales of depression and mood lability.…”

The man who used to shrug – one man’s lived experience of TBI

“…Stress is common to the experience of TBI (e.g., Qureshi et al, 2019). Cannon (1932) was one of the first academics to apply the concept of stress to homeostasis in humans (Romero, Dickens, & Cyr, 2008).…”