Evolution of Irritability, Anger, and Aggression after Traumatic Brain Injury: Identifying and Predicting Subgroups

The current prospective, multi-center, longitudinal cohort study examined how veterans/service members (V/SM) changed in their irritability, anger, and aggression (IAA) scores from admission to discharge in post-acute rehabilitation settings. The goals were to identify trajectory subgroups, and explore if there were different predictors of the subgroups. V/SM (n = 346) from five Veterans Affairs TBI Model Systems Polytrauma Rehabilitation Centers participated. The sample was mostly men (92%) and identified as white (69%), black (13%), and other races (18%). Median age was 28 years, and 78% had sustained a severe TBI. Staff rated IAA at admission and discharge using the Mayo-Portland Adaptability Inventory-4 item#15. Four IAA trajectory subgroups were identified: (1) no IAA at admission or discharge (n = 89, 25.72%), (2) resolved IAA (n = 61, 17.63%), (3) delayed onset IAA (n = 31, 8.96%), and (4) persistent IAA (n = 165, 47.69%). Greater post-traumatic stress disorder (PTSD) symptoms were the only consistent predictor of belonging to all the subgroups who had IAA compared with the no IAA subgroup. We conclude that IAA had different trajectories after a TBI. The majority of V/SM had persistent impairment from IAA, a quarter of the sample had no impairment from IAA, and fewer participants had resolving or worsening IAA. Findings emphasize the importance of educating providers and family of the different ways and times that IAA can manifest after TBI. Timely diagnosis and treatment of PTSD symptoms during and after rehabilitation are critical treatment targets

Demographic and Mental Health Predictors of Arrests Up to 10 Years Post-Traumatic Brain Injury: A Veterans Affairs TBI Model Systems Study

OBJECTIVE: Examine rates and predictors of arrests in Veterans and Service Members (V/SM) who received inpatient rehabilitation for traumatic brain injury (TBI). SETTING: Veterans Administration (VA) Polytrauma Rehabilitation Centers. PARTICIPANTS: A total of 948 V/SM drawn from the VA TBI Model Systems cohort with arrest data up to 10 years post-TBI. DESIGN: Longitudinal cohort study; secondary analysis of pre-TBI characteristics predicting post-TBI arrests. MAIN MEASURES: Disclosure of arrests pre-TBI and up to10 years post-TBI. RESULTS: Thirty-six percent of the sample had been arrested prior to their TBI; 7% were arrested post-TBI. When considering all variables simultaneously in a multivariate model, pre-TBI mental health treatment (adjusted odds ratio [aOR] = 4.30; 95% confidence interval [CI]: 2.03-9.14), pre-TBI heavy alcohol use (aOR = 3.04; CI: 1.08-8.55), and number of follow-up interviews (aOR = 2.05; CI: 1.39-4.50) were significant predictors of post-TBI arrest. CONCLUSION: Arrest rates of V/SM prior to TBI were consistent with rates of arrest for people of similar ages in the United States. Post-TBI rates were lower for V/SM than published rates of post-TBI arrests in civilians with TBI. As part of rehabilitation planning for V/SM with TBI, providers should assess for preinjury mental health services and alcohol misuse to (1) identify those who may be at risk for postinjury arrests and (2) provide relevant resources and/or supports

Trauma Bonding and Interpersonal Violence

The psychological phenomenon labeled Stockholm syndrome or trauma bonding has been explained as a product of interpersonal trauma whereby the perpetrator elicits fear in the victim that is experienced as venerating gratitude for being allowed to survive. There is no widely accepted theory to explain how perpetrators of trauma emotionally bind their victims to them; however, the general phenomenon of victims developing emotional attachments to their abusers or captors has been observed in situations of intimate partner violence, child abuse, hostage situations, human trafficking, and cults. Despite repeated observations of trauma bonding in victims of interpersonal violence, little research exists regarding its formation or persistence and even less is known about positive resolution in survivors. The chapter begins by presenting the existing theoretical conceptualizations and research findings on trauma bonding along with complexities of intervention and treatment within several diverse contexts. The chapter features those situations or settings which are primarily characterized by interpersonal violence. Next, the chapter reviews critical concerns regarding methodological weaknesses of previous research focused on trauma bonding and recommends several potential avenues for integrated theory and research. Lastly, implications for policy related to trauma bonding within the field of interpersonal violence are explored

Disability adjustment and vocational guidance counseling for individuals with TBI.

Traumatic Brain Injury (TBI) is a multi-faceted and complex injury with unique incidence, prevalence, and consequence that affects health, independent function, and participation in society. Currently, limited long-term funding sources are available to support the vocational rehabilitation needs of individuals with TBI. To improve our understanding of the diverse needs of this population, eight vocational organizations throughout Florida received community capacity-building grants awards. Through these grants, 81 individuals with TBI received vocational guidance counseling and disability adjustment services for a period of one year. Participants completed a project survey upon entry into and exit from the program, with a completion response rate of 48%. Results indicate that the participants’ internal thoughts and beliefs about ability to work showed significant improvement after receipt of customized services. Survey findings suggest that the individuals who received tailored vocational guidance and disability adjustment services showed better adjustment to return to work. Disability Adjustment and Vocational Guidance Counseling for Individuals with Traumatic Brain Injury (PDF Download Available). Available from: https://www.researchgate.net/publication/264551322_Disability_Adjustment_and_Vocational_Guidance_Counseling_for_Individuals_with_Traumatic_Brain_Injury [accessed Jan 4, 2016]

Disability adjustment and vocational guidance counseling for individuals with TBI.

Traumatic Brain Injury (TBI) is a multi-faceted and complex injury with unique incidence, prevalence, and consequence that affects health, independent function, and participation in society. Currently, limited long-term funding sources are available to support the vocational rehabilitation needs of individuals with TBI. To improve our understanding of the diverse needs of this population, eight vocational organizations throughout Florida received community capacity-building grants awards. Through these grants, 81 individuals with TBI received vocational guidance counseling and disability adjustment services for a period of one year. Participants completed a project survey upon entry into and exit from the program, with a completion response rate of 48%. Results indicate that the participants’ internal thoughts and beliefs about ability to work showed significant improvement after receipt of customized services. Survey findings suggest that the individuals who received tailored vocational guidance and disability adjustment services showed better adjustment to return to work. Disability Adjustment and Vocational Guidance Counseling for Individuals with Traumatic Brain Injury (PDF Download Available). Available from: https://www.researchgate.net/publication/264551322_Disability_Adjustment_and_Vocational_Guidance_Counseling_for_Individuals_with_Traumatic_Brain_Injury [accessed Jan 4, 2016]

Traumatic brain injury: unmet support needs of caregivers and families in Florida.

Sustaining a Traumatic Brain Injury results in familial strain due to the significant impact the injury has upon the role and function of individuals and their families at home and in the community. Using the Stress Process Model of Caregiving, a caregiver needs assessment survey was developed and conducted to better understand the needs of individuals with a Traumatic Brain Injury and their caregivers. Survey results indicate that caregivers experience many challenges including unmet needs in areas of relational supports such as maintaining relationships, long-term emotional and financial support for themselves and the survivor, and the need for a patient or caregiver advocate. Implications for future practice are presented

Exploring Vocational Evaluation Practices following Traumatic Brain Injury

IndividInd Individuals with traumatic brain injury (TBI) face many challenges when attempting to return to work (RTW). Vocational evaluation (VE) is a systematic process that involves assessment and appraisal of an individual’s current work-related characteristics and abilities. The aims of this study are to (1) examine demographic and employment characteristics of vocational rehabilitation providers (VRPs), (2) identify the specific evaluation methods that are used in the VE of individuals with TBI, and (3) examine the differences in assessment method practices based upon evaluator assessment preferences. This exploratory case study used a forty-six-item online survey which was distributed to VRPs. Results. One hundred and nine VRPs accessed the survey. Of these, 74 completed the survey. A majority of respondents were female (79.7%), Caucasian (71.6%), and holding a master’s degree (74.3%), and more than half (56.8%) were employed as state vocational rehabilitation counselors (VRCs). In addition, over two-thirds (67.6%) were certified rehabilitation counselors (CRCs). Respondents reported using several specific tools and assessments during the VE process. Study findings reveal differences in use of and rationales for specific assessments amongst VRPs. Understanding VRP assessment practices and use of an evidence-based framework for VE following TBI may inform and improve VE practice