Post-Traumatic Stress, Illness Perception, Concussion Symptoms, and Quality of Life Following Mild Traumatic Brain Injury.

This study examined demographic, military, and clinical characteristics associated with combat-related concussion and persistent postconcussive symptoms; and how combat-related concussion and persistent postconcussive symptoms and a novel 5-factor model of posttraumatic stress disorder (PTSD) symptoms are related to physical and mental health-related quality of life in veterans who served in Iraq and Afghanistan. 233 veterans recruited from the Veterans Affairs Hawaii Program Registry who served in Iraq and Afghanistan completed a survey in 2010 that assessed combat-related concussion and persistent postconcussive symptoms, PTSD (DSM-IV criteria), alcohol use problems, and physical and mental health-related quality of life. The primary measure was physical and mental health-related quality of life as assessed by the 12-item Short-Form Health Survey, version 2. Veterans who screened positive for combat-related concussion and persistent postconcussive symptoms were more likely than those who did not to report direct combat exposure (χ2 = 15.46, P < .001), living in a rural area (χ2 = 6.86, P < .01), and screening positive for PTSD (χ2 = 37.67, P < .001) and alcohol use problems (χ2 = 11.62, P < .01); 57.3% of veterans who screened positive for combat-related concussion and persistent postconcussive symptoms screened positive for PTSD. In bivariate analyses, combat-related concussion and persistent postconcussive symptoms were associated with lower scores on measures of physical and mental health-related quality of life (r = -0.27 to -0.45, P < .001). In multivariate analyses, combat-related concussion and persistent postconcussive symptoms were no longer related to these outcomes, with PTSD-related dysphoric arousal symptoms as the strongest predictor of physical health-related quality of life (β = -0.55, P < .001) and PTSD-related emotional numbing symptoms (β = -0.56, P < .001) as the strongest predictor of mental health-related quality of life. Results of this study suggest that a 5-factor model of PTSD symptoms may provide greater specificity in understanding the relation between combat-related concussion and persistent postconcussive symptoms, PTSD symptoms, and health-related physical and mental quality of life in Iraq/Afghanistan veterans. Psychiatric clinicians should consider this heterogeneity of PTSD symptoms when assessing and treating symptomatic veterans.

PTSD and Combat-Related Injuries: Functional Neuroanatomy

Some clinical trials report improvement in persistent post-concussive symptoms (PCS) with hyperbaric oxygen (HBO2) following mild traumatic brain injury (mTBI), but questions remain regarding the utility of HBO2 for PCS, the effects of HBO2 on post-traumatic stress disorder (PTSD), and the influences of sham control exposures. A systematic review and pooled analysis was conducted to summarize available evidence for HBO2 in mTBI-associated PCS ± PTSD. Data aggregated from four Department of Defense (DoD) studies with participant-level data (n=254) were grouped into pooled HBO2 and sham intervention groups. Changes from baseline to post-intervention on PCS, PTSD, and neuropsychological measures were assessed using linear mixed models to evaluate main intervention and intervention-by-baseline PTSD effects. Potential dose-response relationships to oxygen partial pressures were investigated. Intervention effects from three other published studies with summary-level participant data (n=135) were also summarized.. Pooled DoD data analyses indicated trends toward improvement favoring HBO2 for PCS (Rivermead Total Score: -2.3, 95% CI [-5.6, 1.0], p=0.18); PTSD (PTSD Checklist Total Score: -2.7, 95% CI [-5.8, 0.4], p=0.09); and significant improvement in verbal memory (CVLT-II Trial 1-5 Free Recall: 3.8; 95% CI [1.0, 6.7], p=0.01). A dose-response trend to increasing oxygen partial pressure was also found, with a greater HBO2 effect in mTBI-associated PTSD suggested. The direction of results was consistent with other published studies. A definitive clinical trial, with an appropriate control group, should be considered to identify the optimal HBO2 dosing regimen for individuals with mTBI-associated PTSD ± PCS.

160 Background: Patients’ perceptions of their illness are important for treatment decision-making and quality of life. Limited data exist describing associations of illness perceptions with other patient-centered outcomes, particularly in CCT participants. We sought to examine associations among illness perceptions and CCT patients’ financial toxicity, physical and psychological symptoms, and survival. Methods: From 7/2015-7/2017, we prospectively enrolled CCT participants who expressed interest in financial assistance programs (n = 157) and a group of patients matched by age, sex, cancer type, specific trial, and trial phase (n = 103). We assessed baseline illness perceptions (Brief Illness Perceptions Questionnaire [BIPQ] with scores &gt; 50 indicating negative perceptions), financial toxicity (degree costs of cancer care have been a burden, moderate to catastrophic indicating financial toxicity), physical (Edmonton Symptom Assessment Scale [ESAS]) and psychological (Patient Health Questionnaire-4 [PHQ-4]) symptoms. We used descriptive statistics to examine associations of BIPQ and sociodemographic/clinical factors, financial toxicity, ESAS, PHQ-4, and overall survival. We used the Kaplan-Meier method to estimate median survival times and Cox regression to assess the association of BIPQ and overall survival. Results: Among 260 patients, 189 (72.7%) completed BIPQ surveys (median age 69 [Range 26 to 83] years, 66.1% female). 68.8% had negative illness perceptions. We found no significant associations among negative illness perceptions and patients’ age, sex, race, education, marital status, performance status, insurance, cancer type, metastatic disease status, self-reported income, trial phase, trial year, or Charlson Comorbidity Index score. Patients with negative illness perceptions were more likely to report financial toxicity (69.8% vs 48.8%, p = 0.006), and had higher ESAS-total (Medians: 44 [Range 0-89] vs 21 [Range 0-78], p &lt; 0.001), PHQ-4 depression (Medians: 2 [Range 0-6] vs 0 [Range 0-6], p &lt; 0.001), and PHQ-4 anxiety (Medians: 3 [Range 0-6] vs 1 [Range 0-6], p &lt; 0.001) scores. Patients with negative illness perceptions had shorter overall survival (Medians: 22 [Range 10-29] vs 42 [Range 28-Not Reached] months, log-rank p = 0.004). Adjusting for receipt of financial assistance, patients with negative illness perceptions experienced higher risk of death (HR 1.65, 95% CI 1.10-2.48). Conclusions: In this prospective study of CCT participants, we found that patients with negative illness perceptions experienced greater financial toxicity, more symptom burden, and worse survival than those with more positive perceptions, despite comparable sociodemographic/clinical factors. These findings highlight the need to assess and address patients’ illness perceptions and financial burden when seeking to enhance patient-centered outcomes in oncology.

Introduction: The illness perception of mild Traumatic Brain Injury (mTBI) patients before discharge from the hospital tends to be inappropriate. Apart from that, post-injury symptoms such as post-traumatic stress disorder (PTSD) are often experienced by patients, which can affect their quality of life. However, research linking patient perceptions with post-traumatic stress and quality of life remains scarce. This study aimed to examine patient’s illness perceptions and their relationship with PTSD and HRQOL. Methods: This study employed a prospective survey. Illness perceptions were measured before hospital discharge, and a follow-up of post-traumatic stress and health-related quality of life using an online survey was conducted one month later. The survey was administered from July to October 2023 at two hospitals, with a sample size of 72 mTBI patients. Results: mTBI patients with older age (p=.001), negative emotional perceptions (p=&lt;.001), more consequence (p=.045), more concern about their injury (p=&lt;.001) are significantly related to more symptoms of post-traumatic stress. Patients with mTBI who felt more identity symptoms of IR (p=.001), worsened personal control (p=.041), and worsened treatment control (p=.011) are significantly related to deteriorated quality of life one month after injury. Conclusions: This study produces evidence that mTBI patients' perceptions before leaving the hospital tend to be inappropriate and are related to post-traumatic stress and quality of life one month later. Based on these results, it is crucial for trauma nurses to identify patients' illness perceptions and initiate appropriate interventions to reduce PTSD symptoms and improve patients’ quality of life.

Persistent postconcussive symptoms (PPCS) are a set of physical, cognitive, emotional, and behavioral symptoms that often follow mild traumatic brain injury (mTBI). Some of these symptoms also occur in posttraumatic stress disorder (PTSD). The current study examined the unique contribution of mTBI and PTSD to PPCS. The roles of neurocognitive and motivational factors were also addressed. Sixty one children and adolescents (ages 6-18), at least 3 months post motor vehicle accident (MVA), participated in the study. All participants were diagnosed with PTSD symptoms. Thirty three participants met mTBI criteria, and 28 did not. Standard instruments for assessment included a semistructured clinical interview, self-report questionnaires, and a neuropsychological evaluation. No differences were found between the mTBI and non-TBI groups on any of the emotional or neurocognitive measures, including PPCS symptoms. Multiple regression analyses revealed that emotional status, such as state anxiety and depression, were the best predictors of PPCS. Furthermore, hierarchical regression analyses revealed a double mediation model, in which suboptimal effort mediated the relationship between neurocognitive performance and PPCS, and emotional status mediated the relationship between suboptimal effort and PPCS. These findings underscore the importance of emotional status in the diagnosis of PPCS among children who suffer from PTSD. It is possible that PPCS reflect a more general expression of accident-related emotional distress, rather than being a direct result of the injury. (PsycINFO Database Record

Involvement in litigation in children with PTSD following motor vehicle accident: Associations with emotional distress and treatment outcomes

Section one presents a systematic literature review examining the relationship between injury perceptions and persistent post-concussion symptoms (PPCS), quality of life (QoL) and psychological distress outcomes in individuals following traumatic brain injury (TBI). Four databases were systematically searched using key words and thesaurus terms related to the concepts noted above. 12 papers were included in the final review. Findings suggest that the attribution of m re symptoms to the TBI, a perception that symptoms will last a long time, have more negative consequences and a stronger emotional reaction to the TBI, are more likely to be associated with increased PPCS. The identity, timeline, consequences, concern, emotional representations and personal control subscales were significantly associated with QoL outcomes following TBI. Longitudinal studies emphasise the predictive ability of injury perceptions following TBI which gives attention to the role of clinical psychology in acute management and follow-up of those who have suffered a TBI. Clinical implications and limitations of the review are discussed. Section two reports on an empirical investigation into the relationship between selfcriticism and both symptomatic (PPCS) and post-TBI depression in a sample of 41 adults who sustained a mild to moderate TBI between 3 and 12 months previous. Significant moderate effect size correlations between both self-criticism and self-reassurance with each of the outcomes assessed (early onset PPCS, late-enduring PPCS and post-TBI depression) were found. A series of multiple regression analyses evidenced that self-criticism demonstrated significant predictive ability above previously known predictors for enduring PPCS and also post-TBI depression. Self-reassurance did not demonstrate predictive ability. Limitations and clinical implications are discussed and include the relevance of self-criticism to both preventative and therapeutic intervention for individuals following TBI. Section three includes a critical appraisal of the thesis and processes involved in undertaking the above two research papers.

In prior military randomized trials, participants with persistent symptoms after mild traumatic brain injury (TBI) reported improvement regardless of receiving hyperbaric oxygen (HBO₂) or sham intervention. This study's objectives were to identify outcomes for future efficacy trials and describe changes by intervention. This Phase II, randomized, double-blind, sham-controlled trial enrolled military personnel with mild TBI and persistent post-concussive symptoms. Participants were randomized to receive 40 HBO₂ (1.5 atmospheres absolute (ATA), ⟩99% oxygen, 60 minutes) or sham chamber sessions (1.2 ATA, room air, 60 minutes) over 12 weeks. Participants and evaluators were blinded to allocation. Outcomes assessed at baseline, 13 weeks and six months included symptoms, quality of life, neuropsychological, neurological, electroencephalography, sleep, auditory, vestibular, autonomic, visual, neuroimaging, and laboratory testing. Participants completed 12-month questionnaires. Intention-to-treat results are reported. From 9/11/2012 to 5/19/2014, 71 randomized participants received HBO₂ (n=36) or sham (n=35). At baseline, 35 participants (49%) met post-traumatic stress disorder (PTSD) criteria. By the Neurobehavioral Symptom Inventory, the HBO₂ group had improved 13-week scores (mean change -3.6 points, P=0.03) compared to sham (+3.9 points). In participants with PTSD, change with HBO₂ was more pronounced (-8.6 vs. +4.8 points with sham, P=0.02). PTSD symptoms also improved in the HBO₂ group, and more so in the subgroup with PTSD. Improvements regressed at six and 12 months. Hyperbaric oxygen improved some cognitive processing speed and sleep measures. Participants with PTSD receiving HBO₂ had improved functional balance and reduced vestibular complaints at 13 weeks. By 13 weeks, HBO₂ improved post-concussive and PTSD symptoms, cognitive processing speed, sleep quality, and balance function, most dramatically in those with PTSD. Changes did not persist beyond six months. Several outcomes appeared sensitive to change; additional studies are warranted.

According to the Common Sense Model of self-regulation, cancer survivors construct perceptions of their illness as a (mal)adaptive mechanism. These perceptions might impact on health care use. We aimed to explore the association between illness perceptions and health care use in stage I-II endometrial cancer (EC) survivors, and whether these associations differed by time since diagnosis. A survey was conducted in 2008 by the population-based PROFILES registry among EC survivors diagnosed between 1999 and 2007. Survivors (n = 742, 77% response) completed the Brief Illness Perception Questionnaire (BIPQ) and questions on health care use in the past 12months. Clinical data were accessed from the Netherlands Cancer Registry. Multiple logistic regression was used to evaluate the relationship between illness perceptions and health care use. Between 15 and 22% of the survivors had negative illness perceptions. Survivors with more negative perceptions on consequences, timeline, treatment control, identity, cognitive representation, concern, emotion, and emotional representation were more likely to make ≥ 1 visit to their family physician/general practitioner in relation to their cancer when compared with survivors with more positive illness perceptions. More negative perceptions on consequences, timeline, identity, and concern were associated with ≥ 2 general or cancer-related visits to the medical specialists. The association between negative illness perceptions and health care use was more prominent among long-term (>5 years post-diagnosis) EC survivors. Negative illness perceptions among EC survivors were associated with higher health care use. For individuals with maladaptive illness perceptions, visits to their health care provider may reduce worry about their illness. Future research might address the effects of intervening in maladaptive illness perceptions on use of health care in this category of survivors.

To determine if systematic variation of diagnostic terminology (ie, concussion, minor head injury [MHI], mild traumatic brain injury [mTBI]) following a standardized injury description produced different expected symptoms and illness perceptions. We hypothesized that worse outcomes would be expected of mTBI, compared with other diagnoses, and that MHI would be perceived as worse than concussion. 108 volunteers were randomly allocated to conditions in which they read a vignette describing a motor vehicle accident-related mTBI followed by a diagnosis of mTBI (n = 27), MHI (n = 24), concussion (n = 31), or, no diagnosis (n = 26). All groups rated (a) event "undesirability," (b) illness perception, and (c) expected postconcussion syndrome (PCS) and posttraumatic stress disorder (PTSD) symptoms 6 months after injury. There was a statistically significant group effect on undesirability (mTBI > concussion and MHI), PTSD symptomatology (mTBI and no diagnosis > concussion), and negative illness perception (mTBI and no diagnosis > concussion). In general, diagnostic terminology did not affect anticipated PCS symptoms 6 months after injury, but other outcomes were affected. Given that these diagnostic terms are used interchangeably, this study suggests that changing terminology can influence known contributors to poor mTBI outcome.

To determine the factor structure of persistent postconcussive syndrome symptoms in a blast-exposed military sample and validate factors against objective and symptom measures. Veterans Affairs medical center and military bases. One hundred eighty-one service members and veterans with at least 1 significant exposure to blast during deployment within the 2 years prior to study enrollment. Confirmatory and exploratory factor analyses of the Rivermead Postconcussion Questionnaire. Rivermead Postconcussion Questionnaire, PTSD (posttraumatic stress disorder) Symptom Checklist-Civilian, Center for Epidemiological Studies Depression scale, Sensory Organization Test, Paced Auditory Serial Addition Test, California Verbal Learning Test, and Delis-Kaplan Executive Function System subtests. The 3-factor structure of persistent postconcussive syndrome was not confirmed. A 4-factor structure was extracted, and factors were interpreted as reflecting emotional, cognitive, visual, and vestibular functions. All factors were associated with scores on psychological symptom inventories; visual and vestibular factors were also associated with balance performance. There was no significant association between the cognitive factor and neuropsychological performance or between a history of mild traumatic brain injury and factor scores. Persistent postconcussive symptoms observed months after blast exposure seem to be related to 4 distinct forms of distress, but not to mild traumatic brain injury per se, with vestibular and visual factors possibly related to injury of sensory organs by blast.

Postinjury symptoms and decreased quality of life are common after mild traumatic brain injury. However, few studies have examined how soon, after injury, these changes dissipate. This study aimed to compare changes in postconcussion symptoms, posttraumatic stress, and illness representations and identify predictors of health-related quality of life before and 1 month after hospital discharge for mild traumatic brain injury. A prospective, multicenter, correlational design was used to measure postconcussion symptoms, posttraumatic stress, illness representations, and health-related quality of life. The survey was administered to 136 patients with mild traumatic brain injury between June 2020 and July 2021 at three hospitals in Indonesia. Data were collected at discharge and 1 month later. Compared with before hospital discharge, data collected 1 month after discharge showed that patients experienced reduced postconcussion symptoms, posttraumatic stress, better illness perceptions, and quality of life. Those with postconcussion symptoms (β =-.35, p < .001), more posttraumatic stress symptoms (β =-.12, p = .044), more identity symptoms (β = .11, p = .008), worsened personal control (β =-.18, p = .002), worsened treatment control (β =-.16, p = .001), and negative emotional representations (β =-.17, p = .007) were significantly related to worsened health-related quality of life. This study shows that within 1 month of hospital discharge, patients with mild traumatic brain injury had decreased postconcussion symptoms, posttraumatic stress, and improved illness perceptions. Efforts to impact mild brain injury quality of life should focus on inhospital care to optimize the transition to discharge.

A cross-sectional study of military personnel following deployment to conflicts in Iraq or Afghanistan ascertained histories of combat theater injury mechanisms and mild traumatic brain injury (TBI) and current prevalence of posttraumatic stress disorder (PTSD) and postconcussive symptoms. Associations among injuries, PTSD, and postconcussive symptoms were explored. In February 2005, a postal survey was sent to Iraq/Afghanistan veterans who had left combat theaters by September 2004 and lived in Maryland; Washington, DC; northern Virginia; and eastern West Virginia. Immediate neurologic symptoms postinjury were used to identify mild TBI. Adjusted prevalence ratios and 95% confidence intervals were computed by using Poisson regression. About 12% of 2,235 respondents reported a history consistent with mild TBI, and 11% screened positive for PTSD. Mild TBI history was common among veterans injured by bullets/shrapnel, blasts, motor vehicle crashes, air/water transport, and falls. Factors associated with PTSD included reporting multiple injury mechanisms (prevalence ratio = 3.71 for three or more mechanisms, 95% confidence interval: 2.23, 6.19) and combat mild TBI (prevalence ratio = 2.37, 95% confidence interval: 1.72, 3.28). The strongest factor associated with postconcussive symptoms was PTSD, even after overlapping symptoms were removed from the PTSD score (prevalence ratio = 3.79, 95% confidence interval: 2.57, 5.59).

Quality of life, psychological resilience, personality traits and illness perception in grown-up congenital heart patients in Hong Kong