Development of Depressive Symptoms During Early Community Reintegration After Traumatic Brain Injury

Abstract

The early onset of depression following traumatic brain injury (TBI) is associated with poorer psychosocial outcomes; however, the direction of this relationship is unclear. This study investigated the relationship between progress in resuming preinjury lifestyle (transition events), change in perceived functioning and level of depressive symptoms at discharge and 3-months postdischarge. As part of a prospective longitudinal study of brain injury outcomes, 96 consecutively discharged patients with TBI completed measures of transition events (Sentinel Events Questionnaire) and perceived functioning (Mayo-Portland Adaptability Inventory-4 Ability and Adjustment indices) at discharge and 3-months follow-up. Level of depressive symptoms was assessed at discharge and 3-months follow-up using the Depression Anxiety Stress Scale 21. After controlling for age and discharge depressive symptoms, change in perceived functioning was found to mediate the relationship between total transition events and depressive symptoms at 3-months postdischarge (b reduced from .21 to .14), with a significant indirect effect observed. The present findings indicate that lack of progress in resuming preinjury lifestyle contributes to postdischarge depressive symptoms through an influence on perceived functioning, thus providing an improved conceptualization of reactive depression in the context of brain injury. (JINS, 2011, 17, 112-119)

The impact of self-awareness and depression on subjective reports of memory, quality-of-life and satisfaction with life following TBI

“…A significant implication of this study is that, during the process of recovery or incorporating the consequences of injury into one's life, a person may become more self-aware of the consequences of his/her injury, more depressed and also experience poor QoL and reduced satisfaction with life. This is consistent with previous research [12,38]. Therefore, levels of self-awareness and depressive symptoms must be taken into consideration when appraising the degree and quality of a recovery from TBI.…”

“…Impaired self-awareness has been shown to adversely impact the ability to accurately provide information about one's own behavioural and emotional functioning [7][8][9][10]. Further complicating the evaluation of recovery post-TBI is evidence documenting a relationship between self-assessments of impairment and depression [11,12]. Depression has also been shown to impact the accuracy self-reports.…”

“…If a person is aware of his/her abilities, then his/her self-reports would be more accurate and reflective of his/her actual abilities than if he or she were unaware of these abilities [7][8][9][10]. However, as previously stated, research has shown such awareness can also be associated with increased depression [11,12]. Further complicating the issue, research also suggests that a lack of self-awareness can negatively impact an individual's ability to function in daily activities [7,10], successfully return to work and negatively impact overall QoL [15][16][17][18][19].…”

“…Thus, a cycle begins during recovery, wherein a person becomes more aware of his/her abilities and limitations, he/she utilizes more compensatory strategies to achieve more functional gains, while simultaneously becoming more depressed. Specifically, Ownsworth et al [12] found that a more severe TBI increases an individual's vulnerability to developing depressive symptoms after discharge, especially when their perceptions about functioning are in flux [12]. In fact, individuals who are aware of their impairments tend to be more depressed than individuals who are not aware [11].…”

A narrative literature review of depression following traumatic brain injury: prevalence, impact, and management challenges

“…The appraisal of post-injury abilities compared to the appraisal of pre-injury abilities was another underlying factor related directly to the adjustment to disability that contributes significantly to the development of psychiatric disorders after TBI 87,98–101. Individuals with TBI often over-generalize the effects their injuries have on their abilities and daily lives 102,103.…”