title: Preinjury resilience and mood as predictors of early outcome following mild traumatic brain injury.
abstract: There is significant heterogeneity in outcomes following mild traumatic brain injury (mTBI). While several host factors (age, gender, and preinjury psychiatric history) have been investigated, the influence of preinjury psychological resilience and mood status in conjunction with mild TBI remains relatively unexplored. Euthymic mood and high resilience are potentially protective against anxiety and postconcussion symptoms, but their relative contributions are currently unknown. This prospective study obtained preinjury estimates of resilience and mood measures in addition to measures of anxiety (Acute Stress Disorder Scale and PTSD-Checklist-Civilian form) and postconcussion symptom severity (Rivermead Post Concussion Symptoms Questionnaire) <24 hours (Baseline), 1 week, and 1 month postinjury in patients with either mTBI (n=46) or a comparison group with orthopedic injuries not involving the head (OI, n=29). The groups did not differ on preinjury resilience or mood status at baseline, but differed significantly on measures of anxiety and postconcussion symptom severity at each subsequent study occasion. Multivariate linear regression analyses were conducted to determine if preinjury resilience and mood were significant contributors to anxiety and postconcussion symptoms during the first month postinjury after accounting for other known host factors (e.g., age at injury, gender, and education). Injury group and preinjury mood status were significant predictors for all three dependent variables at each study occasion (all p<0.007). Preinjury resilience showed a positive trend only for acute stress severity at baseline, but demonstrated significant prediction of all three dependent measures at one week and one month postinjury. These results suggest that preinjury depressed mood and resilience are significant contributors to the severity of postinjury anxiety and postconcussion symptoms, even after accounting for effects of other specific host factors.
authors.affiliation: Physical Medicine and Rehabilitation Alliance of Baylor College of Medicine and the University of Texas-Houston Medical School, Houston, Texas, USA. mccauley@bcm.edu
authors.forename: Stephen R
authors.initials: SR
authors.lastname: McCauley
authors.forename: Elisabeth A
authors.initials: EA
authors.lastname: Wilde
authors.forename: Emmy R
authors.initials: ER
authors.lastname: Miller
authors.forename: Melissa L
authors.initials: ML
authors.lastname: Frisby
authors.forename: Hector M
authors.initials: HM
authors.lastname: Garza
authors.forename: Reni
authors.initials: R
authors.lastname: Varghese
authors.forename: Harvey S
authors.initials: HS
authors.lastname: Levin
authors.forename: Claudia S
authors.initials: CS
authors.lastname: Robertson
authors.forename: James J
authors.initials: JJ
authors.lastname: McCarthy
mesh_terms: D000328:Adult; D000339:Affect / Q000502:physiology; D001930:Brain Injuries / Q000150:complications / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D038223:Post-Concussion Syndrome / Q000150:complications* / Q000523:psychology*; D020127:Recovery of Function; D055500:Resilience, Psychological; D016896:Treatment Outcome