Postconcussive Symptom Report in Polytrauma: Influence of Mild Traumatic Brain Injury and Psychiatric Distress

Abstract

Many studies have evaluated the influence of mild traumatic brain injury (mTBI) on neuropsychological test performance and on report of postconcussive symptoms. However, most studies that examine postconcussion syndrome (PCS) do not address the issue of "polytrauma," which is common in military mTBI. This study investigated simultaneously demographic, injury-related, and psychiatric symptom predictors of PCS report in a veteran, polytrauma sample. In prediction of overall report of PCS symptoms with demographic, traumatic brain injury, psychiatric and sleep variables, 60% of the variance was explained. Semipartial correlations revealed that post-traumatic stress disorder uniquely explained 7% of the variance, depression 2%, and sleep dissatisfaction 3%; injury and demographic characteristics accounted for no unique variance. In all 5 hierarchical multiple regressions (prediction of total Neurobehavioral Symptom Inventory score and 4 individual factor scores), the total models were significant (p < 0.001). Accurate diagnosis and treatment necessitates an integrative analysis of PCS, psychiatric, behavioral, and health symptom report in addition to neuropsychological functioning in the polytrauma population. This study demonstrated that emotional distress was uniquely predictive of total report of PCS and that no injury-related characteristics were predictive. This is of particular relevance in a Veteran population given the high rates of both mTBI and psychiatric disturbance.

Multiple Past Concussions Are Associated with Ongoing Post-Concussive Symptoms but Not Cognitive Impairment in Active-Duty Army Soldiers

“…2,22,[35][36][37][38][39] Studies with active-duty service members have shown that those with multiple prior concussions report more postconcussion symptoms in the first 3 months following their next injury 20 and report greater difficulties with depression, traumatic stress, anger, post-concussion symptoms, and cognitive functioning. 22 In contrast to the study by Spira and colleagues, 22 the present study did not reveal an effect of multiple concussions on neurocognitive functioning.…”

Streamlining screening of emotional function in Veterans with traumatic brain injury

“…Given the high frequency of psychiatric complaints among those seeking care for TBI (Department of Veterans Affairs, ; Kraal et al., ; Waldron‐Perrine et al., ), polytrauma clinics are in the position of serving as ports of mental health linkage for our Veterans. Regardless of the route of referral, or the length of time since injury, Veterans undergoing TBI assessment tend to report a high degree of psychiatric symptomatology (Department of Veterans Affairs, ; Kraal et al., ; Waldron‐Perrine et al., ). NSI results can assist clinicians in polytrauma clinics in triaging Veterans for mental health care.…”

“…While six individuals did not report their years of completed education, the mean level of education completed was 13 years (SD = 2). The current sample included participants from other studies from this clinic (Boxley et al,2016;Drag, Spencer, Walker, Pangilinan, & Bieliauskas, 2012;Flaherty, Spencer, Drag, Pangilinan, & Bieliauskas, 2015;Kraal et al, 2015;Spencer et al, 2013;Spencer, Drag, Walker, Pangilinan, & Bieliauskas, 2010;Waldron-Perrine et al, 2014, Waldron-Perrine et al, 2012.…”

“…This study examined the use of psychiatric and neurobehavioral screening measures in a VA polytrauma/TBI clinic. Screening for mental health problems remains important because these individuals are statistically at higher risk for mental health comorbidity (Department of Veterans Affairs, 2007;Vanderploeg, Belanger, & Curtiss, 2009), the most common of which are anxiety, PTSD, and depression (Belanger, Uomoto, & Vanderploeg, 2009;Hoge et al, 2008;Kraal, Waldron-Perrine, Pangilinan, & Bieliauskas, 2015;McCrae, 2008; Waldron-Perrine, Henrick, Spencer, Pangilinan, & Bieliauskas, 2014), and there are empirically validated treatments for these diagnoses. Often, polytrauma/TBI clinics serve as a port of entry into the mental health system for Veterans.…”

Reliability and factor structure of the Hospital Anxiety and Depression Scale in a polytrauma clinic

“…Although a comprehensive evaluation of all psychiatric conditions is not usually practical in a time-limited TBI evaluation, we should screen for conditions that commonly co-occur with or mimic symptoms of TBI. Among the most commonly encountered of these conditions are anxiety and depression [1][2][3]. This study examines the psychometric properties of a brief self-report measure of anxiety and depression, the Hospital Anxiety and Depression Scale (HADS) [4], in a sample of Veterans evaluated in a Department of Veterans Affairs (VA) polytrauma/TBI clinic.…”