Background: Traumatic Brain Injury (TBI) is a leading cause of morbidity and mortality among adults in the US (Ma, Chan, & Carruthers, 2014; Raj et al., 2015). According to epidemiological estimates put forth by the CDC, of the 1.7 million TBIs that occur annually in the United States, 80% are mild TBI (mTBI) (Ma, Chan, & Carruthers, 2014). At the sub-acute stage, mTBI patients often report experiencing post-concussion symptoms that include somatic (nausea, headache, dizziness), cognitive (poor attention, memory, and executive function), and behavioral or emotional changes (irritability, depression, emotional lability, anxiety) following their injury (Levin & Diza-Arrastia, 2015).
Study Aims: The specific aims of the current study were to: 1) investigate the relationship between mood, subjective complaints of cognitive symptoms, and executive functioning (EF) performance in mTBI and control participants at the sub-acute time point; 2) evaluate the role of mood in understanding group differences in EF and subjective cognitive symptom complaints; 3) examine changes in mood and subjective cognitive symptom complaints in the mTBI group over time and determine if demographic factors, specifically ethnicity, impact mood, EF, and their relationship.
Participants and Methods: Participants were 52 individuals recruited from the Departments of Neurosurgery and Emergency Medicine from UNMHSC within two weeks following a mTBI. Control participants included 32 sex- and age- matched individuals from the Albuquerque, New Mexico community. Participants attended two assessment sessions; the first session was 3-14 days post injury and the second session was ~2 months post injury. Participants completed self-report measures of post-concussion symptoms (the Neurobehavioral Symptom Inventory, the Frontal Systems Behavior Scale, the Patient-Reported Measurement Information System, the Rivermead Post-Concussion Symptoms Questionnaire) and a depression measure (BDI-II), as well as an objective neuropsychological functioning measure (the Executive Abilities: Measure and Instruments for Neurobehavioral Evaluation and Research assessment battery (NIH-EXAMINER) and a measure of premorbid intelligence (the Test of Premorbid Intelligence).
Results: mTBI patients reported experiencing significantly worse mood and more subjective cognitive symptom complaints compared to healthy controls at two weeks post injury. While mTBI participants and healthy controls differed in estimates of premorbid intelligence, they did not differ in objectively measured EF. Across all self-report measures individuals with a mTBI did not demonstrate improvements in mood or symptoms between the first and second session. The current estimate of a small, non-significant effect size (d = .14) for group differences on the NIH-EXAMINER is consistent with reports from previous studies. Effect sizes for mood (d = .90) and subjective symptom reporting (d = .94) were much larger, and represent important targets for clinical intervention.
Conclusions: EF deficits were not present in the sub-acute time frame, but group differences in depressive mood and the number of subjective complaints were prominent. Depression appears to be a critical treatment target for improving quality of life in mTBI patients, in contrast to EF functioning.
Level of Degree
First Committee Member (Chair)
Ronald Yeo, Ph.D.
Second Committee Member
Steven Verney, Ph.D.
Third Committee Member
Richard Campbell, Ph.D.
Fourth Committee Member
James Cavanagh, Ph.D.
Mild Traumatic Brain Injury, mTBI, Brain Injury, Executive Function, Subjective Cognitive Complaints, NIH-EXAMINER
Seaman, Brandi. "Subjective Cognitive Complaints, Affective Distress, and Objective Cognitive Performance in Mild Traumatic Brain Injury." (2020). https://digitalrepository.unm.edu/psy_etds/309