Treatment for depression following mild traumatic brain injury in adults: A meta-analysis

Primary objective: Development of depression after TBI is linked to poorer outcomes. The aim of this manuscript is to review evidence for the effectiveness of current treatments. Research design: Two meta-analyses were undertaken to examine the effectiveness of both pharmacological and non-pharmacological interventions for depression after mild TBI Method and procedures: PubMed, Medline, PsychInfo, Web of Science and Digital Dissertations were searched and 13 studies located. Meta Analyst Beta 3.13 was used to conduct analyses of pre- vs post-effects then to examine treatment group vs control group effects. Main outcomes and results: Studies using a pre–post design produced an overall effect size of 1.89 (95% CI = 1.20–2.58, p < 0.001), suggesting that treatments were effective; however, the overall effect for controlled trials was 0.46 (95% CI = −0.44–1.36, p < 0.001), which favoured the control rather than treatment groups. Conclusions: This study highlights the need for additional large well-controlled trials of effective treatments for depression post-TBI

Further validation of the New Zealand test of adult reading (NZART) as a measure of premorbid IQ in a New Zealand sample

Premorbid IQ estimates are used to determine decline in cognitive functioning following trauma or illness. This study aimed to: 1) further validate the New Zealand Adult Reading Test (NZART) in a New Zealand population and compare its performance to the UK developed National Adult Reading Test, and 2) develop regression formulae for the NZART to estimate Wechsler Adult Intelligence Scale-IV (WAIS–IV) IQ scores. The 67 participants (53 females; 16 Māori), aged 16 to 90 years old (mean age = 46.07, SD 23.21) completed the WASI-IV, the NART and the NZART. The NZART predicted Verbal Comprehension Index (VCI) scores slightly better than the NART (r =.63 vs. r = .62) and explained 33% of the variance in FSIQ scores. Reasons for developing regression formulae for the NZART are discussed, regression formulas for the NZART based on the WAIS–IV are included and suggestions of alternate ways of determining premorbid IQ are made

Model of posttraumatic stress reactions to sexual abuse in females / by Suzanne L. Barker-Collo.

Sexual abuse is identified by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (4th edition) (DSM-IV, APA, 1994) as a possible precipitator of Posttraumatic Stress Disorder (PTSD). An estimated 50% of sexual abuse survivors will develop PTSD (Kiser, Heston, Millsap, & Pruitt, 1991; O’Neil & Gupta, 1991). Therefore, while exposure to a traumatic stressor such as sexual abuse is necessary in the development of PTSD, it is not sufficient A number of models have been proposed that attempt to describe the process of coping and symptom development associated with PTSD, and to account for individual differences in this process. One such model is Joseph, Williams, and Yule’s (1995) integrative cognitive-behavioural model of response to traumatic stress (see Figure I). The present stucfy evaluated Joseph, et al.’s (1995) model when applied to a sample of 122 female sexual abuse survivors from across Ontario, Canada. Participants completed survey packages which included measures for each of the variables presented in Joseph et al ’s (1995) model. The variable Event Stimuli was measured using the Sexual Experiences Survey (Koss & Orso, 1982; see Appendix A). Personality was measured using Neuroticism items of the NEO-PIR (Costa & McCrae, 1992; see Appendix C). Appraisal of the abuse was measured using a modified version of the Attributional Style Questionnaire (Peterson, Semmel, Baqrer, Abramson, Metalsky, & Seligman, 1982; see Appendix D). Coping and Crisis Support were measured using the Coping Responses Inventory (Moos, 1993; see Appendix E) and the Crisis Support Scale (Joseph, Andrews, Williams, & Yule, 1992; see Appendix F), respectively. Symptom outcomes, as indicated by the model variables Event Cognitions and Emotional States, were assessed by specified items of the Trauma Symptom Checklist- 40 (Elliott & Briere, 1991; see Appendix G). This study makes three main empirical contributions. First, MANOVA results indicate that response to abuse was significantly influenced by ethnicity, age at which abuse first occurred, and the type of mental health services currently being received. Caucasian individuals rated themselves lower on use of problem-focused coping strategies, vulnerability, impulsiveness, and self-blame than individuals of Native American ancestry. Those 15 years of age or less when first abused rated themselves higher on anxiety and lower on social supports while those in older age groups rated themselves in the opposite direction, individuals currently in counselling or on a waiting list rated themselves lower on anxiety, depression, and vulnerability. Conversely, those currently in support groups rated themselves as higher on depression, anxiety, and vulnerability. Those currently in both counselling and a support group and those receiving no clinical services scored moderately on the three variables. Second, path analysis indicated that Joseph et al.’s (1995) model did not fit the data X[superscript 2](9) = 24.81, p .4 (see Figure 7). As hypothesized, one modification that improved the fit of the model was the addition of a path from characteristics of the abuse to engagement of social support In the modified model, the sign of the path from crisis support to appraisals indicated that increased levels of crisis support were associated with maladaptive appraisals (i.e., self-blame). This relationship is opposite to that proposed by Joseph et al. (1995), where increased crisis support is proposed to lead to more adaptive appraisals, but is consistent with the second hypothesized modification to the model. When examined as a single construct, coping strategies was not found to significantly influence any other variables in the model. Finally, relationships between coping, appraisal, neuroticism and symptom subscales were evaluated. Individuals who coped through cognitive avoidance, emotional discharge, acceptance/resignation, and logical analysis following abuse reported more event cognitions, negative emotional states, sexual problems, and somatic complaints. Increased sexual and somatic complaints, negative emotional states, and event cognitions were accompanied by decreased depression, self-consciousness, anxiety, vulnerability, and impulsiveness, in contrast those who engaged in less cognitive avoidance, sought less support from others and engaged in less problem solving behaviours reported fewer sexual or somatic complaints. Reduced symptomatology (i.e., event cognitions, negative emotional states, somatic symptoms) was also associated with increased trait levels of anxiety, depression, and vulnerability and decreased impulsiveness. Implications of the findings for assessment and therapeutic interventions and for future research were explored

Communication and behavioral assessment of persons with developmental disabilities

Communication affects many areas of daily life. Therefore, support programs to assist persons with developmental disabilities should identify individuals who would especially benefit from communication training. Forty individuals with developmental disabilities were assessed on Vineland Adaptive Behavioral Scales (VABS) (Sparrow, Balia, &Cicchetti, 1984), the Assessment of Basic Learning Abilities (ABLA) test (Kerr, Meyerson, & Flora, 1977), and a Communication Status Survey developed for this study. ABLA level was correlated with all VABS scales except gross motor skills and maladaptive behaviors. These correlations validate the use of the ABLA as a measure of cognitive ability. Ability to use formal communication modes (speech, sign language, symbols) was significantly (p= 0.001) related to ABLA level. Examination of individual cases suggested that the ABLA may be predictive of the ability to acquire formal communication. All persons able to pass ABLA level 2 or higher who had received previous communication training had some formal communication ability. In contrast, five individuals who were able to pass ABLA level 2 or 3 and lacked formal communication had not received communication training. The importance of formal communication is confirmed since persons without formal communication were unable to provide information about immediate and external environments or request clarification. Training in formal communication may be of benefit in allowing clients to perform these skills

Computerised tomography indices of raised intracranial pressure and traumatic brain injury severity in a New Zealand sample

After traumatic brain injury (TBI) complex cellular and biochemical processes occur¹ including changes in blood flow and oxygenation of the brain; cerebral swelling; and raised intracranial pressure (ICP).² This can dramatically worsen the damage³ and contributes to mortality

Attention deficits after incident stroke in the acute period: Frequency across types of attention and relationships to patient characteristics and functional outcomes

Background: Attention deficits are common post stroke and result in poorer functional outcomes. This study examined the frequency of attention deficits after incident stroke and their correlates. Method: Attention of 94 stroke survivors was assessed using the Bells test, Trails Making Test A/B, 2.4- and 2.0-second trials of the Paced Auditory Serial Addition Test (PASAT), and Integrated Auditory Visual Continuous Performance Test (IVA-CPT) within 3 weeks post stroke. Wider functioning was assessed using the Medical Short Form-36 (SF-36) Physical and Mental Component Summary scores (PCS and MCS), London Handicap Scale, Modified Rankin Scale, General Health Questionnaire-28, and Cognitive Failures Questionnaire (CFQ). Results: Most participants were impaired or very impaired on the IVA-CPT (z scores > 3 SDs below normative mean) but not other attention measures. Functional independence and cognitive screening test (Mini-Mental State Examination) performance were significantly related to IVA-CPT, Trails A/B, and Bells tests but not PASAT. Better performance across the Bells test was related to better SF-36 PCS, whereas Trails A and the PASAT were related to SF-36 MCS. Better CFQ naming was related to Trails B, whereas worse CFQ memory was related to better PASAT performance. Conclusion: Attention deficits are common post stroke, though frequency varies widely across the forms of attention assessed, with tests of neglect and speeded attention tasks being linked to quality of life. This variability of performance and linking to wider outcomes suggests the need for comprehensive assessment of attention and that attention is a viable target for rehabilitative efforts

Population-based cohort study of the impacts of mild traumatic brain injury in adults four years post-injury

There is increasing evidence that some people can experience persistent symptoms for up to a year following mild TBI. However, few longitudinal studies of mild TBI exist and the longerterm impact remains unclear. The purpose of this study is to determine if there are long-term effects of mild traumatic brain injury (TBI) four-years later. Adults (aged 16 years) identified as part of a TBI incidence study who experienced a mild-TBI four-years ago (N = 232) were compared to age-sex matched controls (N = 232). Sociodemographic variables, prior TBI and symptoms were assessed at the time of injury. Four years post-injury participants completed the Rivermead Post-Concussion Symptom Questionnaire, Hospital Anxiety and Depression Scale, Pittsburgh Sleep Quality Index and the Participation Assessment with Recombined Tools. Analysis of covariance was used to compare differences between TBI cases four years post-injury and controls, controlling for prior TBI and depression. A multiple regression model was used to identify the predictors of increased symptoms and reduced participation. The mild-TBI sample experienced significantly increased self-reported cognitive symptoms (F = 19.90, p = <0.01) four years post-injury than controls. There were no differences between the groups for somatic (F = 0.02, p = 0.89) or emotional symptoms (F = 0.31, p = 0.58). Additionally, the mild-TBI group reported significantly poorer community participation across all three domains: productivity (F = 199.07, p = <0.00), social relations (F = 13.93, p = <0.00) and getting out and about (F = 364.69, p = <0.00) compared to controls. A regression model accounting for 41% of the variance in cognitive symptoms in TBI cases revealed a history of TBI, receiving acute medical attention and baseline cognitive symptoms, sleep quality, anxiety and depression were predictive of outcome. The results indicate that whilst somatic and emotional symptoms resolve over time, cognitive symptoms can become persistent and that mild TBI can impact longer-term community participation. Early intervention is needed to reduce the longer-term impact of cognitive symptoms and facilitate participation

Trajectories in health recovery in the 12 months following a mild traumatic brain injury in children: Findings from the BIONIC Study

Introduction: There is growing consensus that adverse child outcomes may be evident in the early recovery phase following mild traumatic brain injury (TBI). However, controversy remains around the nature of children's longer-term recovery. Aim: To examine child cognitive, behavioural and quality-of-life outcomes over 12 months following mild injury, and to identify prognostic factors associated with outcomes. Methods: A prospective sample of 222 children (aged 2-15 years at injury) with mild TBI was assessed using a cognitive testing battery and parent-report questionnaires at ≤ 14 days, 1, 6 and/or 12-months post-injury. RESULTS Parents reported significant improvements in their child's behavioural adjustment between baseline and 6 months (P = 0.003), with further improvements at 12 months following inju ry (P = 0.001). Cognitive recovery and quality-of-life improvements were more gradual with minimal changes in the first month (P > 0.05), but significant improvements by 12-months post-injury (P = 0.03, P = 0.02, respectively). Time since injury, male gender, living rurally and parent anxiety were associated with extent of recovery beyond the acute period. CONCLUSIONS Children's recovery from mild TBI continues beyond the initial 6 months following injury. Health-care providers need to be vigilant about the varying trajectories in children's recovery from TBI. On-going monitoring of children following injury will enable timely and proactive responses to persistent difficulties, with a view to minimising longer-term adverse consequences

Changes over time in family members of adults with mild traumatic brain injury

Objective: The impact of traumatic brain injury (TBI) extends beyond the person who was injured. Family caregivers of adults with moderate to severe TBI frequently report increased burden, stress and depression. Few studies have examined the well-being of family members in the mild TBI population despite the latter representing up to 95% of all TBIs. Methods: Five areas of well-being were examined in 99 family members (including parents, partners, siblings, other relatives, adult children, friends or neighbours) of adults (aged ≥16 years) with mild TBI. At 6- and 12-month post-injury, family members completed the Bakas Caregiver Outcomes Scale, Short Form-36 Health Survey, EQ-5D-3L, Hospital Anxiety and Depression Scale and the Pittsburgh Sleep Quality Index. Outcomes and change over time and associated factors were examined. Results: At 6 months, group mean scores for health-related quality of life for mental and physical components and overall health status were similar to the New Zealand (NZ) population. Mean scores for sleep, anxiety and depression were below clinically significant thresholds. From 6 to 12 months, there were significant improvements in Bakas Caregiver Outcomes Scale scores by 2.61 (95% confidence interval: 0.72–4.49), health-related quality of life (mental component) and EQ-5D-3L overall health (P = 0.01). Minimally clinically important differences were observed in overall health, anxiety, health-related quality of life and depression at 12 months. Female family members reported significant improvements in physical health over time, and more positive life changes were reported by those caring for males with TBI. Conclusions: The findings suggest diminished burden over time for family members of adults with mild TBI

Persistent problems 1 year after mild traumatic brain injury: a longitudinal population study in New Zealand

Background: Mild traumatic brain injury (mTBI) is a common problem in general practice settings, yet previous research does not take into account those who do not attend hospital after injury. This is important as there is evidence that effects may be far from mild. Aim To determine whether people sustain any persistent effects 1 year after mTBI, and to identify the predictors of health outcomes. Design and setting: A community-based, longitudinal population study of an mTBI incidence cohort (n = 341) from a mixed urban and rural region (Hamilton and Waikato Districts) of the North Island of New Zealand (NZ). Method: Adults (>16 years) completed assessments of cognitive functioning, global functioning, postconcussion symptoms, mood, and quality of life over the year after injury. Results: Nearly half of participants (47.9%) reported experiencing four or more post-concussion symptoms 1 year post-injury. Additionally, 10.9% of participants revealed very low cognitive functioning. Levels of anxiety, depression, or reduced quality of life were comparable with the general population. Having at least one comorbidity, history of brain injury, living alone, non-white ethnic group, alcohol and medication use, and being female were significant predictors of poorer outcomes at 12 months. Conclusion: Although some people make a spontaneous recovery after mTBI, nearly half continue to experience persistent symptoms linked to their injury. Monitoring of recovery from mTBI may be needed and interventions provided for those experiencing persistent difficulties. Demographic factors and medical history should be taken into account in treatment planning