Hostname: page-component-586b7cd67f-l7hp2 Total loading time: 0 Render date: 2024-11-24T03:59:01.193Z Has data issue: false hasContentIssue false

Predictors of Neurobehavioral Symptoms in a University Population: A Multivariate Approach Using a Postconcussive Symptom Questionnaire

Published online by Cambridge University Press:  25 July 2013

Mark L. Ettenhofer*
Affiliation:
Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
Lindsay E. Reinhardt
Affiliation:
Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
David M. Barry
Affiliation:
Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
*
Correspondence and reprint requests to: Mark Ettenhofer, Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814-4712. E-mail: [email protected]

Abstract

Several factors have been linked to severity of postconcussive-type (neurobehavioral) symptoms. In this study, predictors of neurobehavioral symptoms were examined using multivariate methods to determine the relative importance of each. Data regarding demographics, symptoms, current alcohol use, history of traumatic brain injury (TBI), orthopedic injuries, and psychiatric/developmental diagnoses were collected via questionnaire from 3027 university students. The most prominent predictors of symptoms were gender, history of depression or anxiety, history of attention-deficit/hyperactivity disorder or learning disability diagnosis, and frequency of alcohol use. Prior mild TBI was significantly related to overall symptoms, but this effect was small in comparison to other predictors. These results provide further evidence that neurobehavioral symptoms are multi-determined phenomena, and highlight the importance of psychiatric comorbidity, demographic factors, and health behaviors to neurobehavioral symptom presentation after mild TBI. (JINS, 2013, 19, 1–9)

Type
Research Articles
Copyright
Copyright © The International Neuropsychological Society 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bazarian, J.J., Blyth, B., Mookerjee, S., He, H., McDermott, M.P. (2010). Sex differences in outcome after mild traumatic brain injury. Journal of Neurotrauma, 27(3), 527539.CrossRefGoogle ScholarPubMed
Bazarian, J.J., Wong, T., Harris, M., Leahey, N., Mookerjee, S., Dombovy, M. (1999). Epidemiology and predictors of post-concussive syndrome after minor head injury in an emergency population. Brain Injury, 13(3), 173189.CrossRefGoogle Scholar
Belanger, H.G., Vanderploeg, R.D. (2005). The neuropsychological impact of sports-related concussion: A meta-analysis. Journal of the International Neuropsychological Society, 11(4), 345357.CrossRefGoogle ScholarPubMed
Binder, L.M., Rohling, M.L. (1996). Money matters: A meta-analytic review of the effects of financial incentives on recovery after closed-head injury. American Journal of Psychiatry, 153(1), 710.Google ScholarPubMed
Bogner, J.A., Corrigan, J.D., Mysiw, W.J., Clinchot, D., Fugate, L. (2001). A comparison of substance abuse and violence in the prediction of long-term rehabilitation outcomes after traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 82(5), 571577.CrossRefGoogle ScholarPubMed
Brenner, L.A., Terrio, H., Homaifar, B.Y., Gutierrez, P.M., Staves, P.J., Harwood, J.E., Warden, D. (2010). Neuropsychological test performance in soldiers with blast-related mild TBI. Neuropsychology, 24(2), 160167.CrossRefGoogle ScholarPubMed
Carroll, L.J., Cassidy, J.D., Peloso, P.M., Borg, J., von Holst, H., Holm, L., Pepin, M. (2004). Prognosis for mild traumatic brain injury: Results of the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury. Journal of Rehabilitation Medicine (43 Suppl), 84105.CrossRefGoogle ScholarPubMed
Cassidy, J.D., Carroll, L., Peloso, P., Borg, J., von Holst, H., Holm, L., Coronado, V. (2004). Incidence, risk factors and prevention of mild traumatic brain injury: Results of the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury. Journal of Rehabilitation Medicine, 43(Suppl.), 2860.CrossRefGoogle Scholar
Cicerone, K.D., Kalmar, K. (1995). Persistent postconcussion syndrome: The structure of subjective complaints after mild traumatic brain injury. The Journal of Head Trauma Rehabilitation, 10(3), 117. doi:http://dx.doi.org/10.1097/00001199-199510030-00002CrossRefGoogle Scholar
Coronado, V.G., McGuire, L.C., Sarmiento, K., Bell, J., Lionbarger, M.R., Jones, C.D., Xu, L. (2012). Trends in traumatic brain injury in the U.S. and the public health response: 1995-2009. Journal of Safety Research, 43(4), 299307. doi:10.1016/j.jsr.2012.08.011CrossRefGoogle ScholarPubMed
Corrigan, J.D. (1995). Substance abuse as a mediating factor in outcome from traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 76(4), 302309.CrossRefGoogle ScholarPubMed
de Oliveira Thais, M.E., Cavallazzi, G., Formolo, D.A., de Castro, L.D., Schmoeller, R., Guarnieri, R., Walz, R. (2012). Limited predictive power of hospitalization variables for long-term cognitive prognosis in adult patients with severe traumatic brain injury. Journal of Neuropsychology. doi:10.1111/jnp.12000 [Epub ahead of print].Google ScholarPubMed
Delis, D.C., Wetter, S.R. (2007). Cogniform disorder and cogniform condition: Proposed diagnoses for excessive cognitive symptoms. Archives of Clinical Neuropsychology, 22(5), 589604. doi:10.1016/j.acn.2007.04.001CrossRefGoogle ScholarPubMed
Dikmen, S., Machamer, J., Fann, J.R., Temkin, N.R. (2010). Rates of symptom reporting following traumatic brain injury. Journal of the International Neuropsychological Society, 16(3), 401411.CrossRefGoogle ScholarPubMed
Dischinger, P.C., Ryb, G.E., Kufera, J.A., Auman, K.M. (2009). Early predictors of postconcussive syndrome in a population of trauma patients with mild traumatic brain injury. The Journal of Trauma, 66(2), 289.Google Scholar
Ettenhofer, M.L., Barry, D.M. (2012). A comparison of long-term postconcussive symptoms between university students with and without a history of mild traumatic brain injury or orthopedic injury. Journal of the International Neuropsychological Society, 18(3), 451460.CrossRefGoogle ScholarPubMed
Fann, J.R., Katon, W.J., Uomoto, J.M., Esselman, P.C. (1995). Psychiatric disorders and functional disability in outpatients with traumatic brain injuries. American Journal of Psychiatry, 152(10), 14931499.Google ScholarPubMed
Faul, M., Xu, L., Wald, M.M., Coronado, V.G. (2010). Traumatic brain injury in the United States: Emergency department visits, hospitalizations, and deaths. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control.Google Scholar
Feinstein, A., Ouchterlony, D., Somerville, J., Jardine, A. (2001). The effects of litigation on symptom expression: A prospective study following mild traumatic brain injury. Medicine, Science, and the Law, 41(2), 116.CrossRefGoogle ScholarPubMed
Gayton, W.F., Bailey, C., Wagner, A., Hardesty, V.A. (1986). Relationship between childhood hyperactivity and accident proneness. Perceptual and Motor Skills, 63, 801802.CrossRefGoogle ScholarPubMed
Gouvier, W.D., Cubic, B., Jones, G., Brantley, P., Cutlip, Q. (1992). Postconcussion symptoms and daily stress in normal and head-injured college populations. Archives of Clinical Neuropsychology, 7(3), 193211.CrossRefGoogle ScholarPubMed
Iverson, G.L. (2005). Outcome from mild traumatic brain injury. Current Opinion in Psychiatry, 18(3), 301317.CrossRefGoogle ScholarPubMed
Iverson, G.L., Gaetz, M., Lovell, M.R., Collins, M.W. (2004). Cumulative effects of concussion in amateur athletes. Brain Injury, 18(5), 433443.CrossRefGoogle ScholarPubMed
Iverson, G.L., Lange, R.T. (2003). Examination of “postconcussion-like” symptoms in a healthy sample. Applied Neuropsychology, 10(3), 137144.CrossRefGoogle Scholar
Kashluba, S., Casey, J.E., Paniak, C. (2006). Evaluating the utility of ICD-10 diagnostic criteria for postconcussion syndrome following mild traumatic brain injury. Journal of the International Neuropsychological Society, 12(01), 111118.CrossRefGoogle ScholarPubMed
Kesler, S.R., Adams, H.F., Blasey, C.M., Bigler, E.D. (2003). Premorbid intellectual functioning, education, and brain size in traumatic brain injury: An investigation of the cognitive reserve hypothesis. Applied Neuropsychology, 10(3), 153162.CrossRefGoogle ScholarPubMed
Kit, K.A., Tuokko, H.A., Mateer, C.A. (2008). A review of the stereotype threat literature and its application in a neurological population. Neuropsychology Review, 18(2), 132148. doi:10.1007/s11065-008-9059-9CrossRefGoogle Scholar
Kreutzer, J.S., Witol, A.D., Sander, A.M., Cifu, D.X. (1996). A prospective longitudinal multicenter analysis of alcohol use patterns among persons with traumatic brain injury. The Journal of Head Trauma Rehabilitation, 11, 5869.CrossRefGoogle Scholar
Lees-Haley, P.R., Fox, D.D., Courtney, J.C. (2001). A comparison of complaints by mild brain injury claimants and other claimants describing subjective experiences immediately following their injury. Archives of Clinical Neuropsychology, 16(7), 689695.CrossRefGoogle ScholarPubMed
Luis, C.A., Vanderploeg, R.D., Curtiss, G. (2003). Predictors of postconcussion symptom complex in community dwelling male veterans. Journal of the International Neuropsychological Society, 9(7), 10011015.CrossRefGoogle ScholarPubMed
McCauley, S.R., Boake, C., Levin, H.S., Contant, C.F., Song, J.X. (2001). Postconcussional disorder following mild to moderate traumatic brain injury: Anxiety, depression, and social support as risk factors and comorbidities. Journal of Clinical and Experimental Neuropsychology, 23(6), 792808.CrossRefGoogle ScholarPubMed
McCrea, M. (2008). Mild traumatic brain injury and postconcussion syndrome: The new evidence base for diagnosis and treatment. New York: Oxford University Press.Google Scholar
McCullagh, S., Feinstein, A. (2003). Outcome after mild traumatic brain injury: An examination of recruitment bias. Journal of Neurology, Neurosurgery, & Psychiatry, 74(1), 39.CrossRefGoogle ScholarPubMed
Miller, C.J., Marks, D.J., Halperin, J.M. (2005). Comparison of measured and estimated cognitive ability in older adolescents with and without ADHD. Journal of Attention Disorders, 9(2), 444450.CrossRefGoogle ScholarPubMed
Mittenberg, W., DiGiulio, D.V., Perrin, S., Bass, A.E. (1992). Symptoms following mild head injury: Expectation as aetiology. Journal of Neurology, Neurosurgery, and Psychiatry, 55(3), 200204.CrossRefGoogle ScholarPubMed
Mooney, G., Speed, J. (2001). The association between mild traumatic brain injury and psychiatric conditions. Brain Injury, 15(10), 865877.CrossRefGoogle ScholarPubMed
Mooney, G., Speed, J., Sheppard, S. (2005). Factors related to recovery after mild traumatic brain injury. Brain Injury, 19(12), 975987.CrossRefGoogle ScholarPubMed
Nelson, V.S. (1992). Paediatric head injury. Physical Medicine & Rehabilitation Clinics of North America, 3(2), 461474.CrossRefGoogle Scholar
Paniak, C., Reynolds, S., Phillips, K., Toller-Lobe, G., Melnyk, A., Nagy, J. (2002). Patient complaints within 1 month of mild traumatic brain injury: A controlled study. Archives of Clinical Neuropsychology, 17(4), 319334.CrossRefGoogle ScholarPubMed
Paniak, C., Reynolds, S., Toller-Lobe, G., Melnyk, A., Nagy, J., Schmidt, D. (2002). A longitudinal study of the relationship between financial compensation and symptoms after treated mild traumatic brain injury. Journal of Clinical and Experimental Neuropsychology, 24(2), 187193.CrossRefGoogle ScholarPubMed
Ponsford, J., Cameron, P., Fitzgerald, M., Grant, M., Mikocka-Walus, A., Schonberger, M. (2012). Predictors of postconcussive symptoms 3 months after mild traumatic brain injury. Neuropsychology, 26(3), 304313.CrossRefGoogle ScholarPubMed
Ponsford, J., Willmott, C., Rothwell, A., Cameron, P., Kelly, A.M., Nelms, R., Ng, K. (2000). Factors influencing outcome following mild traumatic brain injury in adults. Journal of the International Neuropsychological Society, 6(5), 568579.CrossRefGoogle ScholarPubMed
Preiss-Farzanegan, S.J., Chapman, B., Wong, T.M., Wu, J., Bazarian, J.J. (2009). The relationship between gender and postconcussion symptoms after sport-related mild traumatic brain injury. PM&R, 1(3), 245253.Google ScholarPubMed
Putnam, S.H., Millis, S.R. (1994). Psychosocial factors in the development and maintenance of chronic somatic and functional symptoms following mild traumatic brain injury. Advances in Medical Psychotherapy, 7, 122.Google Scholar
Rohling, M.L., Binder, L.M., Demakis, G.J., Larrabee, G.J., Ploetz, D.M., Langhinrichsen-Rohling, J. (2011). A meta-analysis of neuropsychological outcome after mild traumatic brain injury: Re-analyses and reconsiderations of Binder et al. (1997), Frencham et al. (2005), and Pertab et al. (2009). The Clinical Neuropsychologist, 25(4), 608–623.Google Scholar
Sawchyn, J.M., Brulot, M.M., Strauss, E. (2000). Note on the use of the Postconcussion Syndrome Checklist. Archives of Clinical Neuropsychology, 15(1), 18.CrossRefGoogle ScholarPubMed
Spencer, R.J., Drag, L.L., Walker, S.J., Bieliauskas, L.A. (2010). Self-reported cognitive symptoms following mild traumatic brain injury are poorly associated with neuropsychological performance in OIF/OEF veterans. Journal of Rehabilitation Research & Development, 47(6), 521530.CrossRefGoogle ScholarPubMed
Suhr, J.A., Gunstad, J. (2002). Postconcussive symptom report: The relative influence of head injury and depression. Journal of Clinical and Experimental Neuropsychology, 24(8), 981993.CrossRefGoogle ScholarPubMed
Thurman, D.J., Alverson, C., Dunn, K.A., Guerrero, J., Sniezek, J.E. (1999). Traumatic brain injury in the United States: A public health perspective. The Journal of Head Trauma Rehabilitation, 14(6), 602615.CrossRefGoogle ScholarPubMed
Trahan, D.E., Ross, C.E., Trahan, S.L. (2001). Relationships among postconcussional-type symptoms, depression, and anxiety in neurologically normal young adults and victims of mild brain injury. Archives of Clinical Neuropsychology, 16(5), 435445.CrossRefGoogle ScholarPubMed
Tsanadis, J., Montoya, E., Hanks, R.A., Millis, S.R., Fichtenberg, N.L., Axelrod, B.N. (2008). Brain injury severity, litigation status, and self-report of postconcussive symptoms. The Clinical Neuropsychologist, 22(6), 10801092.CrossRefGoogle ScholarPubMed
Vanderploeg, R.D., Curtiss, G., Luis, C.A., Salazar, A.M. (2007). Long-term morbidities following self-reported mild traumatic brain injury. Journal of Clinical and Experimental Neuropsychology, 29(6), 585598.CrossRefGoogle ScholarPubMed
Vickery, C.D., Sherer, M., Nick, T.G., Nakase-Richardson, R., Corrigan, J.D., Hammond, F., Sander, A. (2008). Relationships among premorbid alcohol use, acute intoxication, and early functional status after traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 89(1), 4855.CrossRefGoogle ScholarPubMed