The Temporal Relationship of Mental Health Problems and Functional Limitations following mTBI: A TRACK-TBI and TED Study

Abstract

Mental health problems, such as depression and anxiety, are often associated with functional limitations after traumatic brain injury (TBI), prompting researchers to explore which of these TBI-related sequelae tends to precede the other. Past studies among patients with injuries ranging in severity have predominantly reported that functional impairments predict subsequent psychological concerns, rather than the other way around; however, it remains unclear whether this directionality holds for individuals with mild TBI (mTBI). The present study utilized a cross-lagged panel design within a structural equation modeling analytical framework to explore the longitudinal relationships of symptoms of depression and anxiety to functional status among 717 adult mTBI patients, with assessments occurring at 2 weeks and 3 months postinjury. Symptoms of both depression and anxiety significantly predicted subsequent functional limitations (ks =-0.21 and-0.25), whereas the reverse effects were nonsignificant (ks =-0.05 and-0.03); thus, psychological concerns appeared to function as a precursor to functional impairment. This pattern was particularly pronounced among patients with normal head computed tomography (CT) results; however, results were less clear cut among those subjects whose injuries were accompanied by intracranial abnormalities detected on CT imaging, suggesting the possibility of a more reciprocal relationship in the case of CT-positive mTBI. These results may serve to partially explain the incidence of persistent functional limitations observed among subsets of mTBI patients in past studies. Findings likewise highlight the importance of assessment and treatment for mental health problems after mTBI as an important factor to promote psychological wellbeing and functional recovery.

Neuroimaging and Psychometric Assessment of Mild Cognitive Impairment After Traumatic Brain Injury

“…By contrast, these symptoms can become more limiting after msTBI, as they are often more intense and can persist longer ( Arciniegas and Wortzel, 2014 ). Post-concussive anxiety and PCDSs are the most common emotional disturbances following mTBI, and their magnitude often predicts that of other symptomatology in addition to functional outcome and recovery ( Mooney and Speed, 2001 ; Meares et al, 2008 ; Levin and Diaz-Arrastia, 2015 ; Zahniser et al, 2018 ). Above and beyond affect-related symptoms, studying the poor ability, desire or motivation to invest effort into cognitive tasks after injury is also fundamental because inadequate effort—which has been reported in many TBI samples—can significantly confound psychometric measures ( Stulemeijer et al, 2007 ).…”

A Live Video Mind-Body Treatment to Prevent Persistent Symptoms Following Mild Traumatic Brain Injury: Protocol for a Mixed Methods Study

“…Unlike moderate-to-severe traumatic brain injury (TBI), the prognosis of mTBI is not well correlated with injury severity or clinical findings [ 7 ]. Rather, symptom persistence after mTBI reflects a complex mind-body interaction, with anxiety playing a prominent role [ 7 , 8 ]. Anxiety may contribute to symptom persistence after mTBI by mimicking or amplifying symptoms, increasing hypervigilance and misattributions, and motivating activity avoidance [ 9 ].…”

An integrated perspective linking physiological and psychological consequences of mild traumatic brain injury

“…Furthermore, there still exists a lively debate as to whether the influence of psychological factors may outweigh that of the physiological consequences of the injury itself in the causation of persistent symptoms and poor outcome after mTBI. Psychological factors, such as the presence of anxiety and depression, and the employment of certain coping styles, are known to exert a strong influence on recovery after mTBI [ 5 , 13 – 15 ]. Not surprisingly, stressful events such as sustaining a traumatic brain injury, can result in an increased demand on coping skills, especially in the current busy and often stressful modern environment.…”