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Psychological Resilience as a Predictor of Symptom Severity in Adolescents With Poor Recovery Following Concussion

Published online by Cambridge University Press:  03 May 2019

Christianne Laliberté Durish ,
Keith Owen Yeates  and
Brian L. Brooks
Christianne Laliberté Durish*
Affiliation:
Department of Psychology, University of Calgary, Calgary, Alberta
Keith Owen Yeates
Affiliation:
Department of Psychology, University of Calgary, Calgary, Alberta
Brian L. Brooks
Affiliation:
Department of Psychology, University of Calgary, Calgary, Alberta
*
Correspondence and reprint requests to: Christianne Laliberté Durish, Department of Psychology, University of Calgary, 2500 University Drive N.W., Calgary, AB, T2N 1N4. E-mail: christianne.lalibert@ucalgary.ca
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Abstract

Objectives: Examine the mediating effects of anxiety and depressive symptoms on the relationship between psychological resilience and post-concussive symptoms (PCS) in children with poor recovery following concussion. Participants and Methods: Adolescents (N=93), ages 13 to 18 years, were assessed at a neuropsychology screening clinic at a children’s hospital. They sustained concussions more than 1 month before the clinic visit (median time since injury=5.1 months; range=42–473 days) and were seen on the basis of poor recovery (i.e., presence of persistent PCS and complaints of cognitive problems). Self-reported psychological resilience was measured using the 10-item version of the Connor-Davidson Resilience Scale; self- and parent-reported anxiety and depressive symptoms were measured using the Behaviour Assessment System for Children – Second Edition; and self- and parent-reported PCS were measured using the Post-Concussion Symptom Inventory. All variables were measured concurrently. Regression-based mediation analyses were conducted to examine anxiety and depressive symptoms as mediators of the relationship between psychological resilience and PCS. Results: Psychological resilience significantly predicted self-reported PCS. Self-reported anxiety and depressive symptoms significantly mediated the relationship between resilience and self-reported PCS, and parent-reported child depressive symptoms significantly mediated the relationship between resilience and self- and parent-reported PCS. Conclusions: Psychological resilience plays an important role in recovery from concussion, and this relationship may be mediated by anxiety and depressive symptoms. These results help shed light on the mechanisms of the role of psychological resilience in predicting PCS in children with prolonged symptom recovery. (JINS, 2019, 25, 346–354)

Keywords

ConcussionPediatricMild traumatic brain injuryHardinessPost-concussive symptomsChild
Type
Regular Research
Information
Journal of the International Neuropsychological Society , Volume 25 , Issue 4 , April 2019 , pp. 346 - 354
Copyright
Copyright © The International Neuropsychological Society, 2019. 

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References

REFERENCES

Babcock, L., Byczkowski, T., Wade, S.L., Ho, M., Mookerjee, S., & Bazarian, J.J. (2013). Predicting postconcussion syndrome after mild traumatic brain injury in children and adolescents who present to the emergency department. Journal of the American Medical Association Pediatrics, 167(2), 156–161.Google ScholarPubMed
Barlow, K.M., Crawford, S., Stevenson, A., Sandhu, S.S., Belanger, F., & Dewey, D. (2010). Epidemiology of postconcussion syndrome in pediatric mild traumatic brain injury. Pediatrics, 126(2), e374–e381.CrossRefGoogle ScholarPubMed
Bazarian, J.J., Mcclung, J., Shah, M.N., Cheng, Y.T., Flesher, W., & Kraus, J. (2005). Mild traumatic brain injury in the United States, 1998-2000. Brain Injury, 19(2), 85–91.CrossRefGoogle ScholarPubMed
Brooks, B.L., McKay, C.D., Mrazik, M., Barlow, K.M., Meeuwisse, W.H., & Emery, C.A. (2013). Subjective, but not objective, lingering effects of multiple past concussions in adolescents. Journal of Neurotrauma, 30, 1469–1475.CrossRefGoogle Scholar
Campbell-Sills, L., Cohan, S.L., & Stein, M.B. (2006). Relationship of resilience to personality, coping and psychiatric symptoms in young adults. Behaviour Research & Therapy, 44, 585–599.CrossRefGoogle ScholarPubMed
Campbell-Sills, L., & Stein, M.B. (2007). Psychometric analysis and refinement of the Connor-Davidson Resilience Scale (CD-RISC): Validation of a 10-item measure of resilience. Journal of Traumatic Stress, 20(6), 1019–1028.CrossRefGoogle ScholarPubMed
Carroll, L.J., Cassidy, J.D., Holm, L., Kraus, J., & Coronado, V.G. (2004). Methodological issues and research recommendations for mild traumatic brain injury: The WHO Collaborating Center Task Force on Mild Traumatic Brain Injury. Journal of Rehabilitation Medicine, 43, 113–125. doi:10.1080/16501960410023877CrossRefGoogle Scholar
Connor, K.M., & Davidson, J.R. (2003). Development of a new resilience scale: The Connor-Davidson Resilience Scale (CD-RISC). Depression and Anxiety, 18, 76–82.CrossRefGoogle Scholar
de Koning, M.E., Gareb, B., El Moumni, M., Scheenen, M.E., van der Horn, H.J., Timmerman, M.E., . . . van der Naalt, J. (2016). Subacute posttraumatic complaints and psychological distress in trauma patients with or without mild traumatic brain injury. Injury, 47, 2041–2047.CrossRefGoogle ScholarPubMed
Duncan, B.L., Miller, S.D., Wampold, B.E., & Hubble, M.A. (2010). The heart and soul of change: Delivering what works in therapy, Second Edition. Washington, DC: American Psychological Association.CrossRefGoogle Scholar
Fineblit, S., Selci, E., Loewen, H., Ellis, M., & Russell, K. (2016). Health-related quality of life after pediatric mild traumatic brain injury/concussion. A systematic review. Journal of Neurotrauma, 33(17), 1561–1568.CrossRefGoogle ScholarPubMed
Gioia, G.A., Janusz, J., Isquith, P., & Vincent, D. (2008). Psychometric properties of the parent and teacher Post-Concussion Symptom inventory (PCSI) for children and adolescents. Journal of the International Neuropsychological Society, 14(Suppl. 1), 204.Google Scholar
Gioia, G.A., Schneider, J.C., Vaughan, C.G., & Isquith, P.K. (2009). Which symptom assessments and approaches are uniquely appropriate for paediatric concussion? British Journal of Sports Medicine, 43(Suppl. 1), i13–i22.CrossRefGoogle ScholarPubMed
Grool, A.M., Aglipay, M., Momoli, F., Meehan, W.P., Freedman, S.B., Yeates, K.O., . . . Pediatric Emergency Research Canada (PERC) Concussion Team. (2016). Association between early participation in physical activity following acute concussion and persistent postconcussive symptoms in children and adolescents. Journal of the American Medical Association, 316(23), 2504–2514.CrossRefGoogle ScholarPubMed
Graves, J.M., Rivara, F.P., & Vavilala, M.S. (2015). Health care costs 1 year after pediatric traumatic brain injury. American Journal of Public Health, 105(10), e35–e41.CrossRefGoogle ScholarPubMed
Grubenhoff, J.A. Currie, D., Comstock, R.D., Juarez-Colnga, E., Bajaj, L., & Kirkwood, M.W. (2016). Psychological factors associated with delayed symptom resolution in children with concussion. Journal of Pediatrics, 174, 27–32.CrossRefGoogle ScholarPubMed
Hawley, C.A., Ward, A.B., Magnay, A.R., & Long, J. (2004). Outcomes following childhood head injury: A population study. Journal of Neurology, Neurosurgery, and Psychiatry, 75(5), 737–742.CrossRefGoogle ScholarPubMed
Hayes, A.F. (2013). Methodology in the social sciences. Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. New York: Guilford Press.Google Scholar
Herrmann, N., Rapoport, M.J., Rajaram, R.D., Chan, F., Kiss, A., Ma, A.K., . . . Lanctot, K.L. (2009). Factor analysis of the Rivermead Post-Concussion Symptoms Questionnaire in mild-to-moderate traumatic brain injury patients. Journal of Neuropsychiatry and Clinical Neurosciences, 21(2), 181–188.CrossRefGoogle ScholarPubMed
Horris, H.B., Elmer, C., & Valovich McLeod, T.C. (2017). Premorbid diagnosis of attention deficit disorder and the association of concussion risk and prolonged recovery: An evidence-based report. Athletic Training and Sports Health Care, 9(1), 39–44.CrossRefGoogle Scholar
IBM Corp. (2016). IBM SPSS Statistics for Windows, Version 24.0. Armonk, NY: IBM Corp.Google Scholar
Iverson, G.L., Gardner, A.J., Terry, D.P., Ponsford, J.L., Sills, A.K., Broshek, D.K., & Solomon, G.S. (2017). Predictors of clinical recovery from concussion: A systematic review. British Journal of Sports Medicine, 51, 941–948.CrossRefGoogle ScholarPubMed
Johnston, M.C., Porteous, T., Crilly, M.A., Burton, C.D., Elliot, A., Iversen, L., . . . Black, C. (2015). Physical disease and resilient outcomes: A systematic review of resilience definitions and study methods. Psychosomatics, 56, 168–180.CrossRefGoogle ScholarPubMed
Laliberté Durish, C., Persevereff, R.S., & Yeates, K.O. (2018). Depression and depressive symptoms in pediatric traumatic brain injury: A scoping review. Journal of Head Trauma Rehabilitation, 33(3), E18–E30.CrossRefGoogle ScholarPubMed
Laliberté Durish, C., Yeates, K.O., & Brooks, B.L. (2017). Convergent and divergent validity for a measure of psychological resilience in children with mild traumatic brain injury [abstract]. In: Final Program Forty Fifth Annual Meeting International Neuropsychological Society. Journal of the International Neuropsychological Society, 23(S1), 294.Google Scholar
Laliberté Durish, C., Yeates, K.O., & Brooks, B.L. (2018). Psychological resilience as a predictor of persistent post-concussive symptoms in children with single and multiple concussion. Journal of the International Neuropsychological Society, 24, 759–768.CrossRefGoogle ScholarPubMed
Losoi, H., Silverberg, N.D., Waljas, M., Turunen, S., Rosti-Otajarvi, E., Helminen, M., . . . Iverson, G.L. (2015). Reslience is associated with outcome from mild traumatic brain injury. Journal of Neurotrauma. 32, 942–949. doi:10.1089/neu.2014.43799CrossRefGoogle Scholar
Luis, C.A., & Mittenberg, W. (2002). Mood and anxiety disorders following pediatric traumatic brain injury: A prospective study. Journal of Clinical and Experimental Neuropsychology, 24(3), 270–279.CrossRefGoogle ScholarPubMed
McCauley, S.R., Wilde, E.A., Miller, E.R., Frisby, M.L., Garaza, H.M., Varghese, R., . . . McCarthy, J.J. (2013). Preinjury resilience and mood as predictors of early outcome following mild traumatic brain injury. Journal of Neurotrauma, 30, 642–652.CrossRefGoogle ScholarPubMed
McNally, K.A., Bangert, B., Dietrich, A., Nuss, K., Rusin, J., Wright, M., . . . Yeates, K.O. (2013). Injury versus non-injury factors as predictors of post-concussive symptoms following mild traumatic brain injury in children. Neuropsychology, 27(1), 1–12.CrossRefGoogle Scholar
Merritt, V.C., Lange, R.T., & French, L.M. (2015). Resilience and symptom reporting following mild traumatic brain injury in military service members. Brain Injury, 29(11), 1325–1336.CrossRefGoogle ScholarPubMed
Olsson, K.A., Lloyd, O.T., Lebrocque, R.M., McKinlay, L., Anderson, V.A., & Kenardy, J.A. (2013). Predictors of child post-concussion symptoms at 6 and 18 months following mild traumatic brain injury. Brain Injury, 27, 145–157.CrossRefGoogle ScholarPubMed
Pietrzak, R.J., Johnson, D.C., Goldstein, M.B., Malley, J.C., & Southwick, S.M. (2009). Psychological resilience and postdeployment social support protect against traumatic stress and depressive symptoms in soldiers returning from Operations Enduring Freedom and Iraqi Freedom. Depression and Anxiety, 26, 745–751.CrossRefGoogle ScholarPubMed
Ponsford, J., Willmont, C., Rothwell, A., Cameron, P., Ayton, G., Nelms, R., . . . Ng, K.T. (1999). Cognitive and behavioral outcome following mild traumatic head injury in children. Journal of Head Trauma and Rehabilitation, 14, 360–372.CrossRefGoogle ScholarPubMed
Poole, J.C., Dobson, K.S., & Pusch, D. (2017). Anxiety among adults with a history of childhood adversity: Psychological resilience moderates the indirect effect of emotion dysregulation. Journal of Affective Disorders, 217, 144–152.CrossRefGoogle ScholarPubMed
Preacher, K.J., & Kelley, K. (2011). Effect size measures for mediation models: Quantitative strategies for communicating indirect effects. Psychological Methods, 16(2), 93–115.CrossRefGoogle ScholarPubMed
Rainey, E.E., Petrey, L.B., Reynolds, M., Agtarap, S., & Warren, A.M. (2014). Psychological factors predicting outcome after traumatic injury: The role of resilience. The American Journal of Surgery, 208, 517–523.CrossRefGoogle ScholarPubMed
Reynolds, C.R., & Kamphaus, R.W. (2004). BASC-2: Behavior assessment system for children, second edition manual. Circle Pines, MN: American Guidance Service.Google Scholar
Rieger, B.P., Lewandowski, L.J., Callahan, J.M., Spenceley, L., Truckenmiller, A., Gathke, R., & Miller, L.A. (2013). A prospective study of symptoms and neurocognitive outcomes in youth with concussion vs orthopaedic injuries. Brain Injury, 27(2), 169–178.CrossRefGoogle ScholarPubMed
Sady, M.D., Vaughan, C.G., & Gioia, G.A. (2014). Psychometric characteristics of the postconcussion symptom inventory in children and adolescents. Archives of Clinical Neuropsychology, 29, 348–363.CrossRefGoogle ScholarPubMed
Schulz, A., Becker, M., Van der Auwera, S., Barnow, S., Appel, K., Mahler, J., . . . Grabe, H.J. (2014). The impact of childhood trauma on depression: Does resilience matter? Population-based results from the Study of Health in Pomerania. Journal of Psychosomatic Research, 77(2), 97–103.CrossRefGoogle ScholarPubMed
Stazyk, K., DeMatteo, C., Moll, S., & Missiuna, C. (2017). Depression in youth recovering from concussion: Correlates and predictors. Brain Injury, 31(5), 631–638.CrossRefGoogle ScholarPubMed
Stein, E., Howard, W., Rowhani-Rahbar, A., Rivara, F.P., Zatzick, D., & McCarty, C.A. (2017). Longitudinal trajectories of post-concussive and depressive symptoms in adolescents with prolonged recovery from concussion. Brain Injury, 31(13-14), 1736–1744.CrossRefGoogle ScholarPubMed
Steinhardt, M.A., & Dolbier, C. (2008). Evaluation of a resilience intervention to enhance coping strategies and protective factors and decrease symptomatology. Journal of American College Health, 56, 445–453.CrossRefGoogle ScholarPubMed
Sullivan, K.A., Edmed, S.L., Allan, A.C., Smith, S.S., & Karlsson, L. J. E. (2015). The role of psychological resilience and mTBI as predictors of postconcussional syndrome symptomatology. Rehabilitation Psychology, 60(2), 147–154.CrossRefGoogle ScholarPubMed
Taylor, H.G., Dietrich, A., Nuss, K., Wright, M., Rusin, J., Bangert, B., . . . Yeates, K.O. (2010). Post-concussive symptoms in children with mild traumatic brain injury. Neuropsychology, 24, 148–159.CrossRefGoogle ScholarPubMed
Wood, R.L., O’Hagan, C., Williams, C., McCabe, M., & Chadwick, N. (2014). Anxiety sensitivity and alexithymia as mediators of postconcussion syndrome following mild traumatic brain injury. Journal of Head Trauma Rehabilitation, 29(1), E9–E17.CrossRefGoogle ScholarPubMed
Woodrome, S.E., Yeates, K.O., Taylor, H.G., Rusin, J., Bangert, B., Dietrich, A., . . . Wright, M. (2011). Coping strategies as a predictor of post-concussive symptoms in children with mild traumatic brain injury versus mild orthopedic injury. Journal of the International Neuropsychological Society, 17(2), 317–326.CrossRefGoogle ScholarPubMed
World Health Organization. (1992). The ICD-10 classification of mental and behavioural disorders: Clinical descriptions and diagnostic guidelines. Geneva: World Health Organization.Google Scholar
Yeates, K.O., Kaizar, E., Rusin, J., Bangert, B., Dietrich, A., Nuss, K., . . . Taylor, H.G. (2012). Reliable change in post-concussive symptoms and its functional consequences among children with mild traumatic brain injury. Archives of Pediatrics & Adolescent Medicine, 166(7), 615–622.CrossRefGoogle Scholar
Zemek, R., Barrowman, N., Freedman, S.B., Gravel, J., Gagnon, I., McGahern, , . . . Pediatric Emergency Research Canada (PERC) Concussion Team. (2016). Clinical risk score for persistent postconcussion symptoms among children with acute concussion in the ED. Journal of the American Medical Association, 315(10), 1014–1025.CrossRefGoogle ScholarPubMed