Sex Differences in Emotional Status of Traumatically Brain-Injured Patients

Abstract

At an average post-trauma time of more than 2 years, male but not female headtrauma patients demonstrated significant emotional disturbance. A distress syndrome characterized by impulsivity, depression, anxiety, and a report of unusual experiences was suggested by Minnesota Multiphasic Personality Inventory (MMPI) data. Although residual neurological sequelae contributed to some portion of the scale elevations, the feature that appeared to distinguish the present male head-trauma patient from other neurological groups described in the literature was the MMPI psychopathic deviate (Pd) scale elevation, suggesting significantly greater impulsivity in the current male head-trauma patients. Computed tomography scan data suggest that the Pd elevation was not related to frontal lobe damage. Premorbid emotional difficulties as well as a reaction to the head trauma itself, moderated by age and sex variables, may both contribute to the current suggestion of high impulsivity in these male patients. Key Words: Head traumaImpulsivity—Emotions.Head trauma is primarily a young people's disorder, occurring 62% of the time in the 10-30-year age group, with a second peak usually reported in the elderly (1). It is the third leading cause of death for people under the age of 38 (2). Furthermore, men are more frequently involved, with a male-to-female ratio of 2 or 3 to 1 usually reported (1,3,4). Given the relatively high incidence of new cases, the young age of most of the victims, and the increasing indications of long-lasting disability, further understanding of the specific emotional nature of the head-trauma population is clearly warranted, in order to determine treatment strategies that might aid these people in reentering the community in a productive manner.The long-term social and emotional consequences of head trauma have been described by several researchers. Thomsen (5) studied head-trauma patients over a 10-year period and reported persistence of emotional lability, irritability, listlessness, and generally disturbed behavior. One-fifth were overly aggressive or sexually disinhibited. Lezak (6) reported a pattern of persisting behavioral and social dysfunction in male head-trauma patients with no prior psychiatric history studied up to 5 years post-trauma. As long as 2 years after trauma, a decrease in social functioning was reported by Oddy and Humphrey (7), although 90% of these patients were working in some capacity. Emotional and behavioral problems increase in the year after injury, whereas physical problems decrease (8). Levin and Grossman (9) administered the brief psychiatric rating scale to headtrauma patients and found increased thinking disturbance and withdrawal-retardation related to severity of injury. At least 6 months after injury, these factors were also related to socioeconomic dependence (10).It is of note that Humphrey and Oddy (11) indicate a relationship between preexisting personality problems and a decreased probability of returning to work. The issue of premorbid personality disturbat FLOR...

Depression amongst outpatients with traumatic brain injury

“…Levin et al [3] reported a significant association between female gender and depression in his sample with mild and moderate TBI. However, these findings are at odds with those of other studies [7,12,23].…”

“…The association found between female gender and depression has been reported in the general population [23]. Levin et al [3] reported a significant association between female gender and depression in his sample with mild and moderate TBI.…”

Mood disorders following traumatic brain injury: identifying the extent of the problem and the people at risk

“…This is understandable given that the more severely injured are more likely to come into contact with specialist TBI services. One study investigated only those receiving in-patient rehabilitation [12] (unfortunately an opportunity available to few in the UK). Volunteer members of self-help organizations [13], and attendees at out-patient clinics reporting persisting problems [14], have also been investigated.…”

Traumatic Brain Injury Brief Outcome Interview

“…TBI (Burton & Volpe, 1988Webb, Wrigley, Yoels, & Fine, 1995;Ben-Yishay, Silver, Piasetsky, & Rattok, 1987). Many investigations have thus focused on psychosocial variables, including follow-up studies of up to 5 years postinjury (Burton & Volpe, 1988Webb, Wrigley, Yoels, & Fine, 1995;Klonoff, Snow, & Costa, 1986) as well as long-term outcome studies up to 23 years postinjury (Oddy, Coughlan, Tyerman, & Jenkins, 1985;Klonoff, Clark, & Klonoff, 1993).…”

“…At more than 2 years after traumatic brain injury, Burton and Volpe (1988) reported elevations in the Minnesota Multiphasic Personality Inventory (MMPI) scales which indicated significant depression, anxiety, and impulsivity in male but not female patients. Burton and Volpe (1993) used the Social Adjustment Scale (Weissman & Bothwell, 1976) to evaluate people with TBI and a significant other person over 2 years postinjury.…”