Anxiety May Be an Issue for People with Moderate TBI

According to the Centers for Disease Control and Prevention, about 5.3 million Americans are living with the effects of traumatic brain injury (TBI). TBI refers to damage to the brain caused by an external force, such as a fall or a car accident. TBI can be classified as mild, moderate, or severe based on the degree or extent of brain tissue damage and severity of symptoms such as loss of consciousness and amnesia. People who have TBI may experience difficulties with thinking and processing information; speaking; walking or moving limbs; maintaining balance; seeing or hearing; or regulating emotions. People recovering from severe TBI may also experience anxiety and other mood disorders, and these disorders can have serious impacts on everyday life. One recent NIDILRR-funded study looked at how common anxiety may be for people with severe TBI in their first year after injury, what kinds of anxiety they may experience, and whether anxiety may be connected to other emotional issues or functional outcomes.

 

Researchers from six TBI Model System (TBIMS) centers in Pennsylvania, New York, Ohio, Washington, and Alabama looked at the data of 1,838 people who were treated for moderate to severe TBI through a TBIMS-affiliated trauma center. These data were collected when patients were first admitted to these hospitals to receive care for a TBI, and then at regular intervals thereafter, including at the 1-year anniversary of their injury. The data included demographics such as age, sex, race, education, and employment status; type and severity of injury; functional status; and history of mental health, substance use, and any previous brain injury. At their 1-year follow-up, participants were interviewed by phone or in person about their physical and mental health, cognitive changes, and participation in and satisfaction with life activities such as work and socializing. These interviews included questions about any anxiety or depression participants might have experienced within a few weeks of the interview.

 

According to the authors, more than 20 percent of the participants reported significant anxiety at 1-year post injury, and most of those participants said that their anxiety made it difficult to do their work, take care of things at home, or get along with other people. Among their findings:

 

• Participants who were middle-aged (31-45), African American, had one or more TBIs in the past, or who had been previously diagnosed with depression or other mental health issues were more likely to report experiencing anxiety. 

• The most common symptoms of anxiety the participants reported were worrying too much about different things and not being able to stop or control their worrying. Other symptoms included being easily annoyed or irritated, having trouble relaxing, and feeling nervous or on edge.

• Many of the participants who reported anxiety also reported experiencing significant depression or problems with substance use.

• Participants who reported anxiety also reported lower levels of satisfaction with life, participation in the community, and everyday cognitive functioning.

 

The authors noted that the participants who had shorter bouts of post-trauma amnesia were also more likely to report experiencing anxiety, possibly because they may have had stronger memories of the incident that caused their injury. The authors also suggested that the higher rates of anxiety among middle-aged persons with moderate to severe TBI may be due to a larger impact of TBI on their life roles due to many responsibilities associated with people in this age group, whereas younger and older persons may have fewer responsibilities to address. The authors found a strong correlation between anxiety and impaired cognitive function, but more research is needed to see whether anxiety is provoked by cognitive challenges or whether it contributes to them.

 

According to the authors, anxiety is a potentially important concern for people who have moderate to severe TBI. The authors suggested that researchers may want to focus on controlled trials of behavioral interventions which could be effective for both anxiety and depression in people with TBI, and help address any related loss of cognitive function. Routine screening by health care professionals may identify people with TBI who are at risk for anxiety and connect them to programs and supports to help them move forward. 

The Model Systems have a wealth of information about TBI and its effects including:

 

• An excellent collection of factsheets on everything from understanding TBI to handling emotional problems to getting back behind the wheel.

• Emotional Changes after a TBI – An InfoComic that illustrates how a TBI can affect a person’s ability to regulate their emotions, with recommendations for how family and friends can help. 

 

Brainline.org is a national multimedia project offering information and resources about preventing, treating, and living with TBI. Among the large collection of articles, videos, and multimedia is this collection on behavioral and emotional symptoms after TBI.

Hart, T., Fann, J. R., Chervoneva, I., Juengst, S. B., Rosenthal, J. A., Krellman, J. W., Dreer, L. E., and Kroenke, K. (2016) Prevalence, risk factors, and correlates of anxiety at 1 year after moderate to severe traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 97, 701-707. This article is available from the NARIC collection under accession number J73801.