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Personality Characteristics and Acute Symptom Response Predict Chronic Symptoms After Mild Traumatic Brain Injury

Published online by Cambridge University Press:  29 January 2021

Hillary A. Parker Open the ORCID record for Hillary A. Parker [Opens in a new window] ,
Jana Ranson Open the ORCID record for Jana Ranson [Opens in a new window] ,
Michael A. McCrea ,
James Hoelzle ,
Terri deRoon-Cassini  and
Lindsay D. Nelson Open the ORCID record for Lindsay D. Nelson [Opens in a new window]
Hillary A. Parker
Affiliation:
Department of Neurology, Mount Carmel Health System, Columbus, OH, USA Clement J. Zablocki VA Medical Center, Milwaukee, WI, USA
Jana Ranson
Affiliation:
Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
Michael A. McCrea
Affiliation:
Clement J. Zablocki VA Medical Center, Milwaukee, WI, USA Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
James Hoelzle
Affiliation:
Department of Psychology, Marquette University, Milwaukee, WI, USA
Terri deRoon-Cassini
Affiliation:
Department of Surgery, Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
Lindsay D. Nelson*
Affiliation:
Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
*
*Correspondence and reprint requests to: Lindsay Nelson, PhD, Medical College of Wisconsin, 8701 West Watertown Plank Road, Milwaukee, WI53226, USA. Email: [email protected].
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Abstract

Objective:

Despite consensus that personality influences mild traumatic brain injury (mTBI) recovery, it has been underexamined. We evaluated the extent to which diverse personality and psychiatric symptom dimensions predict mTBI recovery.

Methods:

This prospective cohort study involved psychological assessments of hospital patients with mTBI (n = 75; median = 2 days post-injury, range = 0–12 days) and orthopedic trauma controls (OTC; n = 79) who were used for comparison in mediation modeling. Chronic symptoms were evaluated at 3 months after mTBI (n = 50) using the Sport Concussion Assessment Tool (SCAT) symptom checklist. Linear regression analyses were used to identify the predominant predictors of chronic symptoms in mTBI. Modern mediation analyses tested the hypothesis that personality traits predict chronic symptoms through acute psychological response to injury.

Results:

In mTBI, trait psychoticism directly predicted chronic mTBI symptoms and was the strongest personality predictor overall. Furthermore, an internalizing personality dimension emphasizing negative affect/emotionality and detachment predicted chronic mTBI symptoms indirectly through enhancement of acute somatic complaints. In OTC, internalizing personality acted through the same mediator as in mTBI, whereas the effect of psychoticism was also mediated through acute somatic complaints. There was varying support for a moderated direct effect of personality traits at low levels of positive emotionality across models.

Conclusion:

These causal models provide novel insights about the role of personality in mTBI symptom recovery, highlighting the complexity of how psychological processes may interact to affect recovery and revealing that some of these processes may be non-specific to brain injury.

Keywords

Brain concussionPost-concussion syndromeHuman characteristicsPsychologyAffectRecovery of function
Type
Regular Research
Information
Journal of the International Neuropsychological Society , Volume 27 , Issue 10 , November 2021 , pp. 992 - 1003
Copyright
Copyright © INS. Published by Cambridge University Press, 2021

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References

American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders (4th ed.). American Psychiatric Association.Google Scholar
Baker, S.P., O’Neill, B., Haddon, W., & Long, W.B. (1974). The Injury Severity Score: a method for describing patients with multiple injuries and evaluation of emergency care. Journal of Trauma: Injury, Infection, and Critical Care, 14(3), 187–196.CrossRefGoogle Scholar
Bastiaens, T., Smits, D., De Hert, M., Thys, E., Bryon, H., Sweers, K., … Claes, L. (2019). The relationship between the personality disorder inventory for DSM-5 (PID-5) and the psychotic disorder in a clinical sample. Assessment, 26(2), 315–323.CrossRefGoogle Scholar
Benedict, R.H.B., Schretlen, D., Gronginger, L., & Brandt, J. (1998). Hopkins Verbal Learning Test – Revised: normative data and analysis of inter-form and test-retest reliability. The Clinical Neuropsychologist, 12, 43–55.10.1076/clin.12.1.43.1726CrossRefGoogle Scholar
Ben-Porath, Y.S. & Tellegen, A. (2008). Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF). University of Minnesota Press: Minneapolis.Google Scholar
Boake, C., McCauley, S.R., Levin, H.S., Pedroza, D., Contant, C.F., Song, J.X., … Diaz-Marchan, P.J. (2005). Diagnostic criteria for postconcussional syndrome after mild to moderate traumatic brain injury. Journal of Neuropsychiatry and Clinical Neuroscience, 17, 350–356.10.1176/jnp.17.3.350CrossRefGoogle ScholarPubMed
Broshek, D.K., De Marco, A.P., & Freeman, J.R. (2015). A review of post-concussion syndrome and psychological factors associated with concussion. Brain Injury, 29, 228–237.10.3109/02699052.2014.974674CrossRefGoogle ScholarPubMed
Chmielewski, M., Bagby, R.M., Markon, K., Ring, A.J., & Ryder, A.G. (2014). Openness to experience, intellect, schizotypal personality disorder, and psychoticism: resolving the controversy. Journal of Personality Disorders, 28(4), 483–99.10.1521/pedi_2014_28_128CrossRefGoogle Scholar
DeYong, C.G. & Gray, J.R. (2009). Personality neuroscience: explaining individual differences in affect, behavior, and cognition. In Corr, P.J. & Matthews, G. (Eds.), The Cambridge Handbook of Personality Psychology. Cambridge University Press.Google Scholar
Derogatis, L.R. (2001). Brief Symptom Inventory 18 (BSI-18): Administration, Scoring, and Procedures Manual. Bloomington, MN: Pearson.Google Scholar
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. Journal of Trauma, 66, 289–297.Google Scholar
Donnell, A.J., Kim, M.S., Silva, M.A., & Vanderploeg, R.D. (2012). Incidence of postconcussion symptoms in psychiatric diagnostic groups, mild traumatic brain injury, and comorbid conditions. The Clinical Neuropsychologist, 26, 1092–1101.CrossRefGoogle ScholarPubMed
Evered, L., Ruff, R., Baldo, J., & Isomura, A. (2003). Emotional risk factors and postconcussional disorder. Assessment, 10, 420–7.CrossRefGoogle ScholarPubMed
Garden, N. & Sullivan, K.A. (2010). An examination of the base rates of post-concussion symptoms: The influence of demographics and depression. Applied Neuropsychology, 17, 1–7.CrossRefGoogle Scholar
Garden, N., Sullivan, K.A., & Lange, R.T. (2010). The relationship between personality characteristics and postconcussion symptoms in a nonclinical sample. Neuropsychology, 24, 168–175.CrossRefGoogle Scholar
Gore, W.L. & Widiger, T.A. (2013). The DSM-5 dimensional trait model and five-factor models of general personality. Journal of Abnormal Psychology, 122, 816–821.10.1037/a0032822CrossRefGoogle ScholarPubMed
Guskiewicz, K.M., Register-Mihalik, J., McCrory, P., McCrea, M., Johnston, K., Makdissi, M., … Meeuwisse, W. (2013). Evidence-based approach to revising the SCAT2: Introducing the SCAT3. British Journal of Sports Medicine, 47, 289–293.10.1136/bjsports-2013-092225CrossRefGoogle ScholarPubMed
Hayes, A.F. (2018). Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-Based Approach. New York, New York: The Guilford Press.Google Scholar
Harkness, A.R., McNulty, J.L. & Ben-Porath, Y.S. (1995). The personality psychopathology five (PSY-5): Constructs and MMPI-2 scales. Psychological Assessment, 7, 104–114.10.1037/1040-3590.7.1.104CrossRefGoogle Scholar
Israel, S., Moffitt, T.E., Belsky, D.W., Hancox, R.J., Poulton, R., Roberts, B., … Caspi, A. (2014). Translating personality psychology to help personalize preventive medicine for young adult patients. Journal of Personality and Social Psychology, 106, 284–298.10.1037/a0035687CrossRefGoogle ScholarPubMed
Iverson, G.L. (2005). Outcome of mild traumatic brain injury. Current Opinion in Psychiatry, 18, 301–317.CrossRefGoogle ScholarPubMed
Julien, J., Tinawi, S., Anderson, K., Frenette, L.C., Audrit, H., Ferland, M.C., … De Guise, E. (2017). Highlighting the differences in post-traumatic symptoms between patients with complicated and uncomplicated mild traumatic brain injury and injured controls. Brain Injury, 31, 1846–1855.CrossRefGoogle ScholarPubMed
Kay, T., Harrington, D.E., Adams, R., Anderson, T., Berrol, S., Cicerone, K., … Malec, J. (1993). Definition of mild traumatic brain injury. Journal of Head Trauma Rehabilitation, 8(3), 86–87.CrossRefGoogle Scholar
Kay, T., Newman, B., Cavallo, M., Ezrachi, O, & Resnick, M. (1992). Toward a neuropsychological model of functional disability after mild traumatic brain injury. Neuropsychology, 64, 371–384.CrossRefGoogle Scholar
Kendall, M., Stuart, A., Ord, J.K., & Arnold, S. (1999). Kendall’s Advanced Theory of Statistics: 114 Vol. 2A: Classical Inference and Linear Model (6th ed.). Kendall’s Library of Statistics.Google Scholar
Kennedy, J.E., Cooper, D.B., Reid, M.W., Tate, D.F., & Lange, R.T. (2015). Profile analyses of the personality assessment inventory following military-related traumatic brain injury. Archives of Clinical Neuropsychology, 30, 236–247.10.1093/arclin/acv014CrossRefGoogle ScholarPubMed
Keyes, K.M., Eaton, N.R., Krueger, R.F., Skodol, A.E., Wall, M.M., Grant, B., … Hasin, D.S. (2013). Thought disorder in the meta-structure of psychopathology. Psychological Medicine, 43, 1673–1683.10.1017/S0033291712002292CrossRefGoogle ScholarPubMed
Kurtz, J.E., Shealy, S.E., & Putnam, S.H. (2007). Another look at paradoxical severity effects in head injury with the Personality Assessment Inventory. Journal of Personality Assessment, 88, 66–73.CrossRefGoogle Scholar
Kotov, R., Krueger, R.F., Watson, D., Achenbach, T.M., Althoff, R.R., Bagby, R.M., … Zimmerman, M. (2017). The Hierarchical Taxonomy of Psychopathology (HiTOP): A dimensional alternative to traditional nosologies. Journal of Abnormal Psychology, 126, 454–477.10.1037/abn0000258CrossRefGoogle ScholarPubMed
Krueger, R.F., Derringer, J., Markon, K.E., Watson, D., & Skodol, A.E. (2012). Initial construction of a maladaptive personality trait model and inventory for DSM-5. Psychological Medicine, 42, 1879–1890.CrossRefGoogle ScholarPubMed
Krueger, R.F., & Markon, M.E. (2014). The role of the DSM-5 personality trait model in moving toward a quantitative and empirically based approach to classifying personality and psychopathology. Annual Review of Clinical Psychology, 10, 477–501.10.1146/annurev-clinpsy-032813-153732CrossRefGoogle Scholar
Krueger, R.F., Markon, K.E., Patrick, C.J., Benning, S.D., and Kramer, M.D. (2007). Linking antisocial behavior, substance use, and personality: An integrative quantitative model of the adult externalizing spectrum. Journal of Abnormal Psychology, 116, 645–666.CrossRefGoogle ScholarPubMed
Lahey, B.B. (2009). Public health significance of neuroticism. American Psychologist, 64, 241–256.CrossRefGoogle ScholarPubMed
Lange, R.T., Brickell, T., French, L.M., Ivins, B., Bhagwat, A., Pancholi, S., & Iverson, G.L. (2014). Risk factors for postconcussion symptom reporting after traumatic brain injury in U.S. military service members. Journal of Neurotrauma, 30, 237–246.10.1089/neu.2012.2685CrossRefGoogle Scholar
Lange, R.T., Iverson, G.L., & Rose, A. (2011). Depression strongly influences postconcussion symptom reporting following mild traumatic brain injury. Journal of Head Trauma Rehabilitation, 26, 127–137.CrossRefGoogle Scholar
Losoi, H., Silverberg, N.D., Wäljas, M., Turunen, S., Rosti-Otajärvi, E., Helminen, M., … Iverson, G.L. (2015). Resilience is associated with outcome from mild traumatic brain injury. Journal of Neurotrauma, 32, 942–949.10.1089/neu.2014.3799CrossRefGoogle ScholarPubMed
McCrea, M.A. (2007). Mild Traumatic Brain Injury and Postconcussion Syndrome: The New Evidence Base for Diagnosis and Treatment (Oxford Workshop Series: American Academy of Clinical Neuropsychology). New York: Oxford University Press.Google Scholar
McCrea, R.R., Costa, P.T., del Pilar, G.H., Rolland, J.-P., & Parker, W.D. (1998). Cross-cultural assessment of the five-factor model the revised NEO personality inventory. Journal of Cross-Cultural Psychology, 29, 171–188.CrossRefGoogle Scholar
McCrory, P., Meeuwisse, W.H., Aubry, M., Cantu, B., Dvorak, J., Echemendia, R.J., … Turner, M. (2013). Consensus statement on concussion in sport: The 4th International Conference on Concussion in Sport held in Zurich, November 2012. British Journal of Sports Medicine, 47, 250–258.CrossRefGoogle Scholar
McNally, K.A., Bangert, B., Dietrich, A., Nuss, K., Rusin, J., Wright, M., … Yeates, K.O. (2013). Injury versus noninjury factors as predictors of postconcussive symptoms following mild traumatic brain injury in children. Neuropsychology 27, 1–12.10.1037/a0031370CrossRefGoogle ScholarPubMed
Meares, S., Shores, E.A., Taylor, A.J., Batchelor, J., Bryant, R.A., Baquley, I.J., … Marosszeky, J.E. (2008). Mild traumatic brain injury does not predict acute postconcussion syndrome. Journal of Neurology, Neurosurgery & Psychiatry, 79, 300–306.CrossRefGoogle Scholar
Meares, S., Shores, E.A., Taylor, A.J., Batchelor, J., Bryant, R.A., Baquley, I.J., … Marosszeky, J.E. (2011). The prospective course of postconcussion syndrome: The role of mild traumatic brain injury. Neuropsychology, 25, 454–465.CrossRefGoogle ScholarPubMed
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, 1325–1336.10.3109/02699052.2015.1043948CrossRefGoogle ScholarPubMed
MIDUS. (2018). Midlife in the United State: A National Longitudinal Study on Health & Wellbeing. Last accessed on October 31, 2020 from midus.wisc.edu Google Scholar
Moganti-Kossmann, M.C., Rancan, M., Stahel, P., & Kossmann, T. (2002). Inflammation response in acute traumatic brain injury: a double-edged sword. Current Opinion in Critical Care, 8, 101–105.10.1097/00075198-200204000-00002CrossRefGoogle Scholar
Neils-Strunjas, J., Paul, D., Clark, A.N., Mudar, R., Duff, M.C., Waldron-Perrine, B., & Bechtold, K.T. (2017) Role of resilience in the rehabilitation of adults with acquired brain injury. Brain Injury, 31, 131–139.10.1080/02699052.2016.1229032CrossRefGoogle Scholar
Nelson, L.D., Tarima, S., LaRoche, A.A., Hammeke, T.A., Barr, W.B., Guskiewicz, K., … McCrea, M.A. (2016). Preinjury somatization symptoms contribute to clinical recovery after sport-related concussion. Neurology, 86, 1856–1863.CrossRefGoogle Scholar
Patrick, C.J., Curtin, J.J., & Tellegen, A. (2002). Development and validation of a brief form of the Multidimensional Personality Questionnaire. Psychological Assessment, 14, 150–163.CrossRefGoogle ScholarPubMed
Perez-Rodriguez, M.M., Zaluda, L., & New, A.S. (2013). Biological advances in personality disorders. Focus, 11, 146–154.10.1176/appi.focus.11.2.146CrossRefGoogle Scholar
Pertab, J.L., Merkley, T.L., Cramond, A.J., Cramond, K., Paxton, H., & Wu, T. (2018). Concussion and the autonomic nervous system: An introduction to the field and the results of a systematic review. NeuroRehabilitation, 42, 397–427.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, 304–313.CrossRefGoogle ScholarPubMed
Rush, B., Malec, J.F., Brown, A.W., & Moessner, A.M. (2006). Personality and functional outcome following traumatic brain injury. Rehabilitation Psychology, 51, 257–264.CrossRefGoogle Scholar
Silverberg, N.D., Gardner, A.J., Brubacher, J.R., Panenka, W.J., Li, J.J., & Iverson, G.L. (2015). Systematic review of multivariable prognostic models for mild traumatic brain injury. Journal of Neurotrauma, 32, 517–526.CrossRefGoogle Scholar
Smith, A. (1982). Symbol Digit Modalities Test Manual. Los Angeles, CA: Western Psychological Services.Google Scholar
Smith, T.W. (2006). Personality as risk and resilience in physical health. Current Directions in Psychological Science, 15, 227–231.10.1111/j.1467-8721.2006.00441.xCrossRefGoogle Scholar
Suvisaari, J. & Mantere, O. (2013). Inflammation theories in psychotic disorders: A critical review. Infection Disorders – Drug Targets, 13, 59–70.10.2174/18715265112129990032CrossRefGoogle Scholar
Sullivan, K.A., Kempel, C.B., Edmed, S.L., & Bonanno, G.A. (2016). Resilience and other possible outcomes after mild traumatic brain injury: A systematic review. Neuropsychology Review, 26, 173–185.10.1007/s11065-016-9317-1CrossRefGoogle Scholar
Suzuki, T., Griffin, S.A., & Samuel, D.B. (2017). Capturing the DSM-5 alternative personality disorder model traits in the five-factor model’s nomological net. Journal of Personality, 85(2), 220–231.10.1111/jopy.12235CrossRefGoogle ScholarPubMed
Toichi, M et al (1999). The influence of psychotic states on the autonomic nervous system. International Journal of Psychophysiology, 31, 147–154.CrossRefGoogle Scholar
Wäljas, M., Iverson, G.L., Lange, R.T., Hakulinen, U., Dastidar, P., Huhtala, H., … Öhman, J. (2015). A prospective biopsychosocial study of the persistent post-concussion symptoms following mild traumatic brain injury. Journal of Neurotrauma, 8, 534–547.CrossRefGoogle Scholar
Watson, D., Clark, L.A. & Tellegen, A. (1988). Development and Validation of brief measures of positive and negative affect: the PANAS scales. Journal of Personality and Social Psychology, 54, 1063–70.10.1037/0022-3514.54.6.1063CrossRefGoogle Scholar
Wechsler, D. (1997) Wechsler Adult Intelligence Scale Third Edition (WAIS-III). New York: Psychological Corporation.Google Scholar
Wilkinson, G.S. & Robertson, G.J. (2006). Wide Range Achievement Test 4 (WRAT4). Torrance, CA: Western Psychological Services (WPS).Google Scholar
Wright, A.G.C., Thomas, K.M., Hopwood, C.J., Markon, K.E., Pincus, A.L., & Krueger, R.F. (2012). The hierarchical structure of DSM-5 pathological personality traits. Journal of Abnormal Psychology, 121, 951–957.CrossRefGoogle ScholarPubMed
Yamagata, S., Suzuki, A., Ando, J., Ono, Y., Kijima, N., Yoshimura, K., … Jang, K.L. (2006). Is the genetic structure of human personality universal? A cross-cultural twin study from North America, Europe, and Asia. Journal of Personality and Social Psychology, 90, 987–998.10.1037/0022-3514.90.6.987CrossRefGoogle ScholarPubMed