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Purpose: To identify life satisfaction trajectories at 1-10 years post-traumatic brain injury (TBI) and examine which demographic and injury characteristics at the time of injury are associated with those trajectories., Methods: Participants included 1,051 Hispanic individuals from the multi-site, longitudinal TBI Model Systems (TBIMS) database. Individuals were enrolled after sustaining a TBI and while undergoing inpatient rehabilitation at a TBIMS site; they were included if they completed the Satisfaction with Life Scale during one or more follow-up data collections at 1, 2, 5, or 10 years after TBI., Results: A linear (straight-line) movement of life satisfaction trajectories was the best fit to the data. Across the overall sample, life satisfaction increased over time, with higher trajectories for Hispanic individuals who had been partnered at baseline, born outside the US and experienced a nonviolent injury cause. There were no significant interactions between time and any of these main effect predictors, suggesting no differential change over time in life satisfaction trajectories as a function of these characteristics., Conclusions: Results revealed increases in life satisfaction over time among Hispanic individuals with TBI and shed light on critical risks and protective factors that may inform targeted rehabilitation services with this underserved group.

Objective: To describe associations of demographic, military, and health comorbidity variables between mild traumatic brain injury (mTBI) history and posttraumatic stress disorder (PTSD) status in a sample of Former and current military personnel., Setting: Participants recruited and tested at seven VA sites and one military training facility in the LIMBIC-CENC prospective longitudinal study (PLS), which examines the long-term mental health, neurologic, and cognitive outcomes among previously combat-deployed U.S. Service Members and Veterans (SM/Vs)., Participants: A total of 1,540 SM/Vs with a history of combat exposure. Data were collected between 1/1/2015 through 3/31/2019., Design: Cross-sectional analysis using data collected at enrollment into the longitudinal study cohort examining demographic, military, and health comorbidity variables across PTSD and mTBI subgroups., Main Measures: PTSD Checklist for DSM-5 (PCL-5), mTBI diagnostic status, Patient Health Questionnaire 9-item (PHQ-9), Pittsburgh Sleep Quality Index (PSQI), AUDIT-C, and other self-reported demographic, military, and health comorbidity variables., Results: Ten years following an index date of mTBI exposure or mid-point of military deployment, combat-exposed SM/Vs with both mTBI history and PTSD had the highest rates of depression symptoms, pain, and sleep apnea risk relative to SM/Vs without both of these conditions. SM/Vs with PTSD, irrespective of mTBI history, had high rates of obesity, sleep problems, and pain., Conclusion: The long-term symptom reporting and health comorbidities among SM/Vs with mTBI history and PTSD suggest that ongoing monitoring and intervention is critical for addressing symptoms and improving quality of life.

Objective: To evaluate the factor structure of the Modified Mini Mental State (3MS) Exam and its suitability as a cognitive screening tool among individuals admitted to an inpatient rehabilitation unit for new-onset neurological injury/illness., Method: A retrospective chart review was conducted. Of the 187 individuals meeting the inclusion criteria, 116 had a diffuse pattern of neurological injury/illness; 71 had a focal injury/illness. Confirmatory and exploratory factor analyses (CFA; EFA) were conducted for the whole sample and separately by group., Results: The CFA suggested poor fit indices. The EFA of the total sample suggested a three-factor solution (Orientation/Awareness; Learning/Recall and Executive Functioning; Psychomotor Ability). The EFA of the diffuse subsample suggested a three-factor solution (Attention and Learning/Recall; Psychomotor Ability; Expressive Language). The Orientation/Awareness, Learning/Recall, Executive Functioning, Psychomotor Ability, and Expressive Language four-factor solution observed among the focal subsample was considered invalid., Conclusion: The 3MS provides information about the pattern of cognitive performance among individuals in neurorehabilitation; clinicians are advised to interpret total scores with caution. Among individuals with focal injuries/illnesses, clinicians might use the 3MS to compare the pattern of cognitive ability to expectations for performance and to support strengths-based approaches to participation in rehabilitation therapies.

Background : Traumatic brain injury (TBI) rates and outcomes are worse in Latin American countries relative to high-income countries. This study examined whether cognitive dysfunction, depressive mood, and poor social and emotional self-regulation in individuals with an acute TBI in Latin America predict longitudinal trajectories of caregiver burden during the first 4 months post-discharge. Method : A sample of 109 caregivers of individuals with a new TBI from Colombia and Mexico completed the observer European Brain Injury Questionnaire before hospital discharge and the Zarit Burden Inventory at the same time and again at 2 and 4 months after discharge. A hierarchical linear model (HLM) was used to assess whether cognitive dysfunction, depressive mood, and poor social and emotional self-regulation at hospital discharge predicted longitudinal trajectories of caregiver burden. Results : Results suggested that burden trajectories decreased over time and men reported higher burden than women. Additionally, results showed that poor patient social and emotional self-regulation predicted higher burden trajectories. Conclusions : Men and caregivers providing care for those experiencing poor social and emotional self-regulation may be at risk for burden. Culturally sensitive interventions focusing on social functioning of individuals with TBI and gender-informed caregiver interventions aimed at burden should be implemented in Latin America.

Primary Objective : Survey TBI literature to identify evidence of risk for post-injury suicide. Literature Selection : Search terms ((traumatic brain injury OR TBI) AND (suicidality OR suicidal behaviour OR suicidal ideation)) entered in PubMed, OVID Medline, PsychInfo, and Web of Science for papers published in print 01/01/1997 to 06/30/2019. Analysis of Literature : Authors screened abstracts, excluding duplicates and articles not meeting inclusion/exclusion criteria. Full papers were reviewed to make final exclusions. Data were extracted from 40 papers included co- and premorbid disorders, demographics, injury-related and psychological factors. Results : Persons with TBI have a higher risk for suicide than the general population. Reviewed articles reported comorbid depression and/or PTSD as risk factors for post-TBI suicide. Co- or premorbid substance misuse, sex, and sleep disturbance moderate risk. Quality of the literature was limited by sample size, the predominance of male participants, and inconsistency in reporting of findings. Conclusions : Comorbid depression and PTSD are significant post-TBI risk factors for suicide. Several variables combine to moderate or mediate TBI's connection with suicide. Civilian and military clinician cross-talk and consistent reporting of results from reproducible studies of post-TBI suicide risk factors could improve prevention and treatment efforts in veterans and civilians.

Objectives : To describe trajectories of self-reported functional competency up to 10 years following traumatic brain injury (TBI) and identify their predictors from baseline socio-demographic and injury severity characteristics. Design and methods : Data from 94 participants from a longitudinal cohort of patients with moderate-to-severe TBI were analyzed. Socio-demographic and injury severity data were recorded at baseline. Participants completed the Patient Competency Rating Scale (PCRS) at 1, 2, 5, and 10 years. Hierarchical linear modeling was used to examine PCRS trajectories over time and assess baseline predictors. Results : There was no significant change in average PCRS scores across the follow-up time points in the full sample. Emotional and cognitive competencies had the lowest mean scores. Gender, employment, and the interaction term between gender and time were significant predictors of PCRS trajectories. Females and those who were unemployed at the time of injury showed lower trajectories of self-reported competency. Conclusion : Self-reported competency remained stable from one-year post-injury for men only. Lower mean scores in the domains of emotional and cognitive competencies suggest a need for continued rehabilitation focus in the chronic phase after TBI. Special attention to women and individuals who are unemployed at the time of injury may be warranted.

Primary Objectives: To assess longitudinal trajectories of overall disability after moderate-to-severe traumatic brain injury (TBI) and to examine whether those trajectories could be predicted by socio-demographic and injury characteristics., Methods: Demographics and injury characteristics of 105 individuals with moderate-to-severe TBI were extracted from medical records. At the 1-, 2-, and 5-year follow-ups, TBI-related disability was assessed by the GOSE. A hierarchical linear model (HLM) was used to examine functional outcomes up to 5 years following injury and whether those outcomes could be predicted by: time, gender, age, relationship, education, employment pre-injury, occupation, GCS, cause of injury, length of post-traumatic amnesia (PTA), CT findings and injury severity score, as well as the interactions between each of these predictors and time., Results: Higher GOSE trajectories (lower disability) were predicted by younger age at injury and shorter PTA, as well as by the interaction terms of time*PTA and time*employment. Those who had been employed at injury decreased in disability over time, while those who had been unemployed increased in disability., Conclusion: The study results support the view that individual factors generally outweigh injury-related factors as predictors of disability after TBI, except for PTA.

Objective: To examine the effect of primary language on admission and discharge FIM™ communication ratings in a sample of individuals with moderate-to-severe traumatic brain injury (TBI)., Design and Methods: Secondary data analysis of rehabilitation admission and discharge FIM™ communication ratings of 2795 individuals hospitalized at a Traumatic Brain Injury Model Systems (TBIMS) centre between 2007-2012., Results: Individuals who spoke no English were rated worse on functional communication outcomes at inpatient rehabilitation discharge relative to individuals whose primary language was English., Conclusions: These findings may reflect systematic bias in FIM™ communication ratings of non-English-speaking individuals with TBI and/or TBI-induced communication difficulties in non-English-speaking individuals. Clinical and research implications are discussed.

Primary Objectives: To examine trajectories of employment probability and stability over the first 5 years after traumatic brain injury (TBI) by using multi-level modelling and multinomial logistic regressions., Research Design: A longitudinal cohort study., Methods and Procedures: One hundred and five individuals with moderate-to-severe TBI who had been admitted to the Trauma Referral Centre for the Southeast region of Norway were followed up at 1, 2 and 5 years after the injury., Main Outcomes and Results: Employment status was dichotomized into employed and unemployed, while employment stability was categorized into stably employed, unstably employed and unemployed at 1, 2 and 5 years after injury. Being single, unemployment prior to injury, blue collar occupation, lower Glasgow Coma Scale (GCS) score at hospital admission and greater length of post-traumatic amnesia (PTA) were significantly associated with being unemployed at 1, 2 and 5 years post-injury. Further, younger patients, those with a lower GCS, greater length of PTA and greater length of hospital stay were negatively associated with employment stability., Conclusions: It could be wise to target patient population with these demographic and injury characteristics for more extensive follow-ups and vocational rehabilitation to help improve employment outcomes following injury.

Purpose: This study examined relationships between caregiver mental health and the extent to which needs were met in families of individuals with traumatic brain injury (TBI) in Mexico City, Mexico., Method: Sixty-eight TBI caregivers completed Spanish versions of instruments assessing their own mental health and whether specific family needs were met., Results: Twenty-seven per cent of caregivers reported clinically significant depression levels, 40% reported below-average life satisfaction and 49% reported mild-to-severe burden. Several of the most frequently met family needs were in the emotional support domain, whereas the majority of unmet needs were in the health information domain. Family needs and caregiver mental health were significantly and highly related. When family needs were met, caregiver mental health was better. The strongest pattern of connections in multivariate analyses was between family instrumental support (assistance in the completion of daily life tasks) and caregiver burden, such that caregivers with less instrumental support had greater burden. Additional results suggested that instrumental support uniquely predicted caregiver satisfaction with life, burden and depression., Conclusions: Interventions for TBI caregivers, especially in Latin America, should help family members determine how best to meet their health information and instrumental needs, with the former being likely to improve caregiver mental health.

Purpose: This study examined the influence of five types of impairments in individuals with traumatic brain injury (TBI)-and caregiver stress due to these impairments-on the mental health of family caregivers in Guadalajara, Mexico., Method: Ninety caregivers completed measures of TBI impairments and of their own mental health. The majority were female (92.20%) with a mean age of 47.12 years (SD = 12.67). Caregivers dedicated a median of 50 hours weekly to caregiving and had spent a median of 11 months providing care., Results: Two canonical correlation analyses suggested that these two sets of variables were broadly related, such that more severe impairments in individuals with TBI and more caregiver stress due to those impairments were associated with lower caregiver mental health. Across both analyses, social impairments were most associated with increased caregiver burden. Follow-up analyses also uncovered that caregiver stress due to cognitive impairments was uniquely associated with caregiver burden and anxiety., Conclusions: These results are the first to provide evidence that social and cognitive impairments in individuals with TBI from Latin America are the impairments most associated with caregiver mental health and highlight the need for interventions that target social and cognitive functioning.