Distinct trajectories of neuropsychiatric symptoms in the 12 months following traumatic brain injury (TBI): a TRACK-TBI study

Karen A. Martinez; Ehri Ryu; Christopher J. Patrick; Nancy R. Temkin; Murray B. Stein; Brooke E. Magnus; Michael A. McCrea; Geoffrey T. Manley; Lindsay D. Nelson; the TRACK-TBI Investigators

doi:10.1017/S0033291724001211

Distinct trajectories of neuropsychiatric symptoms in the 12 months following traumatic brain injury (TBI): a TRACK-TBI study

Published online by Cambridge University Press: 04 September 2024

Karen A. Martinez

Ehri Ryu ,

Christopher J. Patrick ,

Lindsay D. Nelson and

the TRACK-TBI Investigators

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Karen A. Martinez*: Affiliation:
Departments of Neurosurgery & Neurology, Medical College of Wisconsin, Milwaukee WI, USA
Ehri Ryu: Affiliation:
Department of Psychology and Neuroscience, Boston College, Boston, MA, USA
Christopher J. Patrick: Affiliation:
Department of Psychology, Florida State University, Tallahassee, FL, USA
Nancy R. Temkin: Affiliation:
Departments of Neurological Surgery and Biostatistics, University of Washington, Seattle, USA
Murray B. Stein: Affiliation:
Department of Psychiatry, University of California, San Diego, USA Herbert Wertheim School of Public Health, University of California, San Diego, USA VA San Diego Healthcare System, San Diego, California, USA
Brooke E. Magnus: Affiliation:
Department of Psychology and Neuroscience, Boston College, Boston, MA, USA
Michael A. McCrea: Affiliation:
Departments of Neurosurgery & Neurology, Medical College of Wisconsin, Milwaukee WI, USA
Geoffrey T. Manley: Affiliation:
Department of Neurological Surgery, University of California, San Francisco, USA
Lindsay D. Nelson*: Affiliation:
Departments of Neurosurgery & Neurology, Medical College of Wisconsin, Milwaukee WI, USA
*: Corresponding author: Karen A. Martinez; Email: kmartinez@mcw.edu; Lindsay D. Nelson; Email: linelson@mcw.edu
Corresponding author: Karen A. Martinez; Email: kmartinez@mcw.edu; Lindsay D. Nelson; Email: linelson@mcw.edu

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Abstract

Background

Neuropsychiatric symptoms are common after traumatic brain injury (TBI) and often resolve within 3 months post-injury. However, the degree to which individual patients follow this course is unknown. We characterized trajectories of neuropsychiatric symptoms over 12 months post-TBI. We hypothesized that a substantial proportion of individuals would display trajectories distinct from the group-average course, with some exhibiting less favorable courses.

Methods

Participants were level 1 trauma center patients with TBI (n = 1943), orthopedic trauma controls (n = 257), and non-injured friend controls (n = 300). Trajectories of six symptom dimensions (Depression, Anxiety, Fear, Sleep, Physical, and Pain) were identified using growth mixture modeling from 2 weeks to 12 months post-injury.

Results

Depression, Anxiety, Fear, and Physical symptoms displayed three trajectories: Stable-Low (86.2–88.6%), Worsening (5.6–10.9%), and Improving (2.6–6.4%). Among symptomatic trajectories (Worsening, Improving), lower-severity TBI was associated with higher prevalence of elevated symptoms at 2 weeks that steadily resolved over 12 months compared to all other groups, whereas higher-severity TBI was associated with higher prevalence of symptoms that gradually worsened from 3–12 months. Sleep and Pain displayed more variable recovery courses, and the most common trajectory entailed an average level of problems that remained stable over time (Stable-Average; 46.7–82.6%). Symptomatic Sleep and Pain trajectories (Stable-Average, Improving) were more common in traumatically injured groups.

Conclusions

Findings illustrate the nature and rates of distinct neuropsychiatric symptom trajectories and their relationship to traumatic injuries. Providers may use these results as a referent for gauging typical v. atypical recovery in the first 12 months post-injury.

Keywords

Growth mixture modeling mental health orthopedic injury psychological health resilience; symptoms traumatic brain injury

Information

Type: Original Article
Information: Psychological Medicine , Volume 54 , Issue 11 , August 2024 , pp. 3089 - 3098

DOI: https://doi.org/10.1017/S0033291724001211 [Opens in a new window]
Copyright: Copyright © The Author(s), 2024. Published by Cambridge University Press

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