Research Reports - Emotional symptoms among survivors after severe traumatic brain injury

J Head Trauma Rehabil. 2017 Feb 10. doi: 10.1097/HTR.0000000000000294. [Epub
ahead of print]

Ren D(1), Fan J, Puccio AM, Okonkwo DO, Beers SR, Conley Y.

OBJECTIVES: Depressive symptoms and anxiety are fairly common emotional outcomes
after severe traumatic brain injury (TBI). Life satisfaction is a main factor in
the general construct of subjective well-being. However, there is limited
literature available on the interrelationship between emotional outcomes and life
satisfaction post-severe TBI over time. The purpose of this study was to
characterize distinct patterns of change in depressive symptoms, anxiety, and
life satisfaction over 24 months after severe TBI and evaluate the
interrelationship of different trajectory groups among them as well as associated
subject characteristics.
METHODS: This prospective study used longitudinal data collected from the
University of Pittsburgh Brain Trauma Research Center from survivors of severe
TBI (N = 129). In addition to demographic and injury-related data, depressive
symptoms, anxiety, and life satisfaction were collected at 3, 6, 12, and 24
months postinjury. A group-based trajectory model was performed to identify
distinct longitudinal patterns of depressive symptoms, anxiety, and life
satisfaction. The interrelationships of distinct trajectory groups were examined
using χ tests. A multivariate logistic regression model was used to examine the
predictors of different emotional symptom trajectories.
RESULTS: The group-based trajectory model identified 2 distinct patterns of each
of 3 outcomes: constantly low and constantly high depressive symptoms group
(70.4% vs 29.6%), constantly low and constantly high anxiety group (69.1% vs
30.9%), and low-decreasing and high-stable life satisfaction groups (56.3% vs
43.7%). A strong pairwise association was observed between trajectory group
membership for depressive symptoms and anxiety (P < .0001), depressive symptoms
and life satisfaction (P < .0001), and anxiety and life satisfaction (P < .001).
Subjects with increased severe injury were more likely to belong to the
high-stable depressive symptoms group, while there were no significant
associations between age, gender, race, education, marriage status and distinct
depressive symptoms, anxiety, and life satisfaction trajectory groups.
CONCLUSIONS: A group-based trajectory model revealed patterns of emotional
symptoms that have not been fully explored among survivors of severe TBI. There
appear to be distinct trajectory patterns for depressive symptoms, anxiety, and
life satisfaction, respectively. There was strong interrelationship among
emotional symptoms. The findings add to our understanding of psychosocial
outcomes experienced over time after severe TBI. 

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