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BACKGROUND: Almost one-third of the U.S. military population is comprised of service members and veterans (SMVs) of color. Research suggests poorer functional and psychosocial outcomes among Black and Hispanic/Latine vs. White civilians following traumatic brain injury (TBI). OBJECTIVE: This study examined racial/ethnic differences in 5-year functional independence and life satisfaction trajectories among SMVs who had undergone acute rehabilitation at one of five Veterans Affairs (VA) TBI Model Systems (TBIMS) Polytrauma Rehabilitation Centers (PRCs). METHODS: Differences in demographic and injury-related factors were assessed during acute rehabilitation among White (n = 663), Black (n = 89), and Hispanic/Latine (n = 124) groups. Functional Independence Measure (FIM) Motor, FIM Cognitive, and Satisfaction with Life Scale (SWLS) scores were collected at 1, 2, and 5 years after injury. Racial/ethnic comparisons in these outcome trajectories were made using hierarchical linear modeling. RESULTS: Black SMVs were less likely than White and Hispanic/Latine SMVs to have been deployed to a combat zone; there were no other racial/ethnic differences in any demographic or injury-related variable assessed. In terms of outcomes, no racial/ethnic differences emerged in FIM Motor, FIM cognitive, or SWLS trajectories. CONCLUSION: The absence of observable racial/ethnic differences in 5-year outcome trajectories after TBI among SMVs from VA TBIMS PRCs contrasts sharply with previous research identifying disparities in these same outcomes and throughout the larger VA health care system. Individuals enrolled in VA PRCs are likely homogenized on key social determinants of health that would otherwise contribute to racial/ethnic disparities in outcome trajectories.

Retrospective analysis of cross-sectional data. To verify the factor structure of the Injustice Experience Questionnaire (IEQ) using a sample of individuals with spinal cord injury (SCI) and to assess IEQ scale reliability and construct validity using the same population. Two SCI rehabilitation sites in the United States. Three datasets were combined to conduct this validation study. The sample consisted of 341 adults with SCI who completed the IEQ, measures of psychological distress and pain, and provided sociodemographic and injury-related information. A series of confirmatory factor analyses (CFA) and exploratory factor analyses (EFA) were conducted to verify the two-factor structure of the IEQ, Cronbach’s alpha was used to demonstrate scale reliability, and correlations between the IEQ and measures of pain and psychological distress were examined to assess construct validity. Poor model fit was observed for the two-factor structure of the IEQ as well as for the subsequent factor-structures that were explored. The IEQ demonstrated strong scale reliability (α = 0.89) and correlations between the IEQ and measures of pain and psychological distress were in the expected direction, indicating good construct validity. In this preliminary validation study, we failed to confirm the two-factor structure of the IEQ in a population of individuals with SCI. Though good scale reliability and construct validity were observed, further study is needed to refine the IEQ for use in this population.

Objective To evaluate a neurocognitive eye tracking task, the Bethesda Eye & Attention Measure (BEAM), for use in cognitive screening of patients with a history of mild traumatic brain injury (TBI). Setting US military TBI rehabilitation clinic. Design/participants Cross-sectional study of 191 military personnel receiving outpatient services related to history of mild TBI. Main measures: BEAM; neuropsychological screening measures of attention, processing speed, executive function, and memory. Results Medium effect sizes were found for partial correlations (controlling for age) between key BEAM metrics and neuropsychological screening tests. Linear regression analyses demonstrated that BEAM saccadic eye movements and manual (button press) metrics each provided complementary value in measurement of cognitive performance, above and beyond effects of demographic factors and clinical characteristics. Conclusion This study provides initial support for the use of BEAM neurocognitive eye tracking in cognitive screening of adults with a history of mild TBI. BEAM saccadic metrics appear to be particularly well-suited for the assessment of visual attention. Study findings also highlight opportunities for greater cognitive sensitivity or testing efficiency that may be missed by tests measuring only one response modality at a time.

OBJECTIVE To identify risk factors for suicidal ideation (SI) following mild traumatic brain injury (mTBI). SETTING Eleven US level 1 trauma centers. PARTICIPANTS A total of 1158 emergency department patients with mTBI (Glasgow Coma Scale score = 13-15) enrolled in the Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study. DESIGN Prospective observational study; weights-adjusted multivariable logistic regression models (n's = 727-883) estimated associations of baseline factors and post-TBI symptoms with SI at 2 weeks and 3, 6, and 12 months postinjury. MAIN MEASURES Patient Health Questionnaire, Rivermead Post-Concussion Symptoms Questionnaire. RESULTS Preinjury psychiatric history predicted SI at all follow-ups (adjusted odds ratios [AORs] = 2.26-6.33, P values

Traumatic brain injury (TBI) is often experienced under stressful circumstances that can lead to symptoms of post-traumatic stress disorder (PTSD) and neurobehavioral symptoms of brain injury. There is considerable symptom overlap in the behavioral expression of these conditions. Psychometric network analysis is a useful approach to investigate the role of specific symptoms in connecting these two disorders and is well suited to explore their interrelatedness. This study applied network analysis to examine the associations among PTSD and TBI symptoms in a sample of Service Members and Veterans (SM/Vs) with a history of TBI one year after injury. Responses to the Neurobehavioral Symptom Inventory (NSI) and PTSD Checklist-Civilian version (PCL-C) were obtained from participants who completed comprehensive inpatient rehabilitation services across five Veterans Affairs polytrauma rehabilitation centers. Participants (N = 612) were 93.1% male with an average age of 36.98 years at injury. The analysis produced a stable network. Within the NSI symptom groups, the frustration symptom was an important bridge between the affective and cognitive TBI symptoms. The PCL-C nodes formed their own small cluster with hyperarousal yielding connections with the affective, cognitive, and somatic symptom groups. Consistent with this observation, the hyperarousal node had the second strongest bridge centrality in the network. Hyperarousal appears to play a key role in holding together this network of distress and thus represents a prime target for intervention among individuals with elevated symptoms of PTSD and a history of TBI. Network analysis offers an empirical approach to visualizing and quantifying the associations among symptoms. The identification of symptoms that are central to connecting multiple conditions can inform diagnostic precision and treatment selection.

Objective To estimate associations of lifetime traumatic brain injury (TBI) characteristics with prospective suicide attempt among US Army soldiers. Method The Army STARRS (Study to Assess Risk and Resilience in Servicemembers) Pre/Post Deployment Study surveyed 3 Brigade Combat Teams that were deployed to Afghanistan in 2012. Lifetime TBI and past-month postconcussive/post-TBI symptoms were evaluated at predeployment baseline. Recency and number of TBIs were quantified, and TBI severity was classified on the basis of reports of alteration/loss of consciousness and memory lapse. Suicide attempt data came from administrative records and surveys administered after return from deployment. Logistic regression models estimated associations of TBI characteristics with prospective suicide attempt among baseline respondents who were deployed (n = 7677), adjusting for other risk factors including lifetime mental disorder. Results One hundred three soldiers made a suicide attempt over a median follow-up period of 30 months (weighted prevalence = 1.31% [0.14%]). In the final model estimating joint associations of TBI severity/recency and past-month postconcussive/post-TBI symptoms, only postconcussive/post-TBI symptoms were associated with a higher risk of suicide attempt (per standard score increase: AOR [adjusted odds ratio] = 1.31; 95% CI, 1.05-1.63; P = .012). Conclusions Among the lifetime TBI characteristics evaluated at predeployment baseline, only past-month postconcussive/post-TBI symptoms were prospectively associated with an increased risk of suicide attempt following deployment. Detection of postconcussive/post-TBI symptoms could facilitate targeting of Army suicide prevention programs.

Purpose/Objective: The purpose of this study was to (a) assess the relationship between stigma and psychosocial outcomes and (b) examine the potential mediating influence of stigma on the relationship between sociodemographic and injury-related characteristics and psychosocial outcomes after spinal cord injury (SCI). Research Method/Design: This cross-sectional, observational study included participants enrolled in the Rocky Mountain Regional Spinal Cord Injury Model System. Questionnaires were administered via telephone. Stigma was assessed using the Spinal Cord Injury Quality of Life Stigma Short Form. Results: Questionnaires were completed by 225 participants (78% male; 22% female). Stigma was significantly, positively associated with depression symptoms, perceived disability, injustice appraisals, and participation (physical independence and mobility). Stigma was significantly, negatively associated with quality of life and self-efficacy. Stigma partially mediated several relationships between sociodemographic or injury-related characteristics and psychosocial outcomes. Stigma fully mediated the relationships between each time since injury and self-efficacy, length of rehabilitation stay and injustice appraisals, wheelchair use and self-efficacy, and wheelchair type and quality of life. Conclusions/Implication: Stigma is an important psychological factor associated with several person- and injury-related characteristics and psychosocial outcomes. Furthermore, stigma mediates particular relationships between sociodemographic or injury-related characteristics and outcomes. These findings will inform the development of interventions designed to mitigate stigma's negative impact on outcomes such as mood, quality of life, and participation after SCI. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Identifying the principal determinants of life satisfaction following mild TBI (mTBI) may inform efforts to improve subjective well-being in this population. We examined life satisfaction among participants in the Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study who presented with mTBI (Glasgow Coma Scale [GCS] score = 13–15; n = 1152). An L1-regularization path algorithm was used to select optimal sets of baseline and concurrent symptom measures for prediction of scores on the Satisfaction with Life Scale (SWLS) at 2 weeks and 3, 6, and 12 months post-injury. Multi-variable linear regression models (all n = 744–894) were then fit to evaluate associations between the empirically selected predictors and SWLS scores at each follow-up visit. Results indicated that emotional post-TBI symptoms (all b = −1.27 to −0.77, all p

Participants first completed a state affect checklist that included a fatigue (energy-tiredness) index and a measure of mental sharpness. They then were presented a simple memory challenge. In the first minute of the two-minute work period, heart rate responses (1) rose with values on the fatigue index, and (2) fell with values on the measure of mental sharpness. In the second minute of the work period, the responses were unrelated to fatigue index and mental sharpness values. Follow-up analysis indicated mental sharpness mediation of fatigue influence on heart rate in Minute 1. First minute findings add substantively to the body of evidence supporting recent suggestions that fatigue can lead people to try harder and experience stronger cardiovascular responses when confronted with simple challenges. They also support the suggestion that fatigue might exert its influence on cardiovascular responses to a mental challenge by diminishing cognitive clarity, that is, by obscuring thought. Second minute findings are contrary to the fatigue suggestions, but could indicate that memorization was accomplished in the first minute. A practical implication of the first minute results is that real-world fatigue could elevate health risk by enhancing CV responses to mundane daily tasks.

Prior studies raise questions about whether persistent postconcussive symptoms (PCS) are differentiable from mental health sequelae of traumatic brain injury (TBI). To investigate whether PCS represented a distinct symptom domain, we evaluated the structure of post-concussive and psychological symptoms using data from The Army STARRS Pre/Post Deployment Study, a panel survey of three U.S. Army Brigade Combat Teams that deployed to Afghanistan. Data from 1229 participants who sustained probable TBI during deployment completed ratings of past-30-day post-concussive, posttraumatic stress, and depressive symptoms three months after their return. Exploratory factor analysis (EFA; n = 300) and confirmatory factor analysis (CFA; n = 929) of symptom ratings were performed in independent subsamples. EFA suggested a model with 3 correlated factors resembling PCS, posttraumatic stress, and depression. CFA confirmed adequate fit of the 3-factor model (CFI = .964, RMSEA = .073 [.070, .075]), contingent upon allowing theoretically defensible cross-loadings. Bifactor CFA indicated that variance in all symptoms was explained by a general factor (λ = .36-.93), but also provided evidence of domain factors defined by (a) reexperiencing/hyperarousal, (b) cognitive/somatic symptoms, and (c) depressed mood/anhedonia. Soldiers with more severe TBI had higher cognitive/somatic scores, whereas soldiers with more deployment stress had higher general and reexperiencing/hyperarousal scores. Thus, variance in PCS is attributable to both a specific cognitive/somatic symptom factor and a general factor that also explains variance in posttraumatic stress and depression. Measurement of specific domains representing cognitive/somatic symptoms, reexperiencing/hyperarousal, and depressed mood/anhedonia may help clarify the relative severity of PCS, posttraumatic stress, and depression among individuals with recent TBI. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Background Depression is a common mental health outcome after traumatic injury, negatively impacting physical outcomes and increasing the cost of care. Research shows that the presence and quality of support is a leading protective factor against depression post-injury; however, research is vague on the directional effects of both factors over the course of recovery. Methods 130 patients admitted to a Level I Trauma Center were recruited to a prospective study examining overall outcomes one-year after injury. Effects of social support and depression at baseline and 12-months post-injury were examined using correlational and cross-lagged path model analyses. Additional follow-up analyses were conducted for depression on specific types of social support. Results Findings replicated previous research suggesting depression and social support were inversely related. Initial depression at time of traumatic injury was predictive of social support 12-months after their injury, but initial social support levels did not significantly predict depression at 12-months. Additionally, initial depression significantly predicted attachment, social integration, reassurance of worth, and guidance 12-months later. Limitations Findings of the analyses are limited by lack of experimentation and inability to control for other related variables. Conclusions Findings of the present study support the notion that initial depression predicts poorer social support in recovery, in lieu of prevailing theory (i.e., initial support buffers against later depression) in a sample of trauma patients. These findings highlight the need for medical staff to target specific factors during inpatient stay, such as addressing depressive symptoms and preparing family members and caregivers prior to discharge.

OBJECTIVE Hospital readmission rates have become a quality metric-particularly in trauma and acute care, where up to one third of individuals with traumatic injury return to the hospital. Thus, identifying predictors of readmission is a priority in an effort to reduce readmissions. Based on previous theoretical work, this study tests the utility of social support and depression in predicting readmissions up to one year after initial injury. METHOD Data from 180 injured individuals admitted to a large, urban Level 1 trauma center were matched to a regional readmissions database. Logistic regression was used to assess whether social support levels or positive depression screens during initial trauma visit predicted unplanned (a) readmissions or (b) emergency/urgent outpatient visits. RESULTS Within the sample, there were 32 total readmissions and 50 total emergency outpatient encounters following initial injury. Depression continued to be a risk factor for emergency outpatient visits only (OR = 2.75). Patients with greater social integration (OR = 0.78), more guidance (advice or information; OR = 0.72) and more reliable alliance (OR = 0.72) as forms of social support were less likely to readmit. CONCLUSIONS This study demonstrates the utility of screening for depression and social support in predicting readmission within one year after traumatic injury. Future efforts should continue emphasizing the impact of initial depression and the need for patients to have trusted individuals in their lives to whom they can turn during recovery; doing so may lower the probability that patients return to hospital. (PsycINFO Database Record

Objective: Caregivers of patients with spinal cord injury (SCI) have increased risk of depression, anxiety, and diminished quality of life. Unmet expectations for recovery may contribute to poorer outcomes. Design: Prospective, longitudinal observation study. Settings: Trauma/Critical care ICU at baseline, telephone for follow-ups. Participants: Caregivers of patients with SCI (n = 13). Interventions: None. Outcome Measures: Expectations for recovery were assessed across four primary domains identified in a review of the literature including: pain severity, level of engagement in social/recreational activities, sleep quality, and ability to return to work/school. Caregivers’ forecasts of future recovery were compared to later perceived actual recovery. Results: At three months, 75% of caregivers had unmet expectations for social engagement recovery, 50% had unmet expectations for pain decrease, and 42% had unmet expectations for sleep improvement and resuming work. Rates of unmet expectations were similar at six months, with 70% of caregivers reporting unmet expectations for social engagement recovery, 50% with unmet expectations for pain decrease, and 40% with unmet expectations for sleep improvement. Conclusion: Unmet caregiver expectations for recovery could pose a risk for caregiver recovery and adjustment. Our results show that caregiver expectations merit further investigation for their link with caregiver mental health.

Abstract. As originally formulated, Brehm’s theory of psychological reactance posited two manifestations of reactance, (1) an increased desire to exercise the threaten freedom, and (2) an increased tendency to exercise that freedom. The theory included no statement about what determines the intensity of reactant striving, although many have assumed that striving intensity should be proportional to the magnitude of reactance, that is, the strength of the reactance motive. Conceptual links between Brehm’s reactance theory and his later theory of motivation intensity have rarely been made. However, the motivation intensity theory in fact has important implications for how reactance motives should convert into effortful goal pursuit. This article identifies central motivation intensity theory implications and discusses in summary a body of evidence that bears them out, albeit indirectly. The broad indication is that reactance should increase the willingness to deploy effort in the interest of restoring or confirming freedoms, with the conversion of willingness into action depending on what can, will, and must be done to achieve these ends.

To identify (1) changes in psychosocial factors, (2) relationships between psychosocial factors, and (3) significant predictors of resilience in adults with spinal cord injury (SCI) during inpatient rehabilitation and at 3-month post-discharge.Cross sectional with convenience sample based on inclusion/exclusion criteria.Inpatient rehabilitation hospital and community-based follow-up.Individuals with a SCI.Not applicable.Demographic, resilience, self-efficacy for managing a chronic health issue, depression, social roles/activity limitations, and pain.The final sample consisted of 44 respondents (16 women and 28 men). Results of repeated measure analyses of variance indicated no significant changes in variables between inpatient and 3-month follow-up. Bivariate correlations revealed associations between resilience and self-efficacy at inpatient (r = 0.54, P0.001), and resilience and depression (r = -0.69, P0.001) and self-efficacy (r = 0.67, P0.001) at 3-month follow-up. Hierarchical regression analyses a significant model predicting resilience at inpatient stay (R = 0.61; adjusted R(2) = 0.24, P = 0.023), and at 3-month follow-up (R = 0.83; adjusted R(2) = 0.49, P = 0.022). Self-efficacy was the strongest predictor at inpatient stay (β = 0.46, P = 0.006) and depression was strongest at 3-month follow-up (β = -0.80, P = 0.007).Results suggest that although resilience appears to be stable from inpatient to 3-month follow-up, different factors are stronger predictors of resilience across time. Based on current results, an assessment of self-efficacy during inpatient rehabilitation and an identification of depression at 3-month follow-up may be important factors to help identify those at risk of health issues overtime.

Psychological resilience is the process of adapting well to adverse situations, including medical illness, disability, traumatic events, or extreme stressors. Research and theory in this area has been explicit that resilience is not simply the absence of psychopathology, but instead maintaining one’s ability to return to stable psychological and physical function and even have the capacity for positive emotions in the wake of a difficult life event (Am Psychol, 59(1):20–8, 2004). While past conceptualizations of resilience assumed that it was an inherent and stable construct, more recent theories and research suggest that psychological resilience is malleable and thus can be bolstered to help an individual recovery following an adverse event.

Purpose/objective A recent study by Trost et al. (2015) investigated the influence of perceived injustice-reflecting appraisals of the severity and irreparability of loss following injury, blame, and unfairness-on physical and psychological outcomes in a sample of patients 12 months after sustaining a traumatic injury. This brief report examines the psychometric properties of the Injustice Experiences Questionnaire (IEQ) using the previous sample from Trost et al. (2015) with added trauma patients (total N = 206). Research method/design Primary analyses included confirmatory and exploratory factor analyses to validate the measurement model of the IEQ in patients 12 months after traumatic injury. Reliability analyses were conducted and construct validity was assessed by examining associations between the IEQ and other pain-related, psychological, and health-related outcome variables of interest. Results Results replicated both one- and two-factor structures from past research, with a high factor correlation in confirmatory factor analyses and cross-loadings in exploratory factor analysis. Item characteristics analysis demonstrated overall strong internal consistency (α = .95). In addition, significant associations with psychosocial variables provide additional construct validity in regards to related outcomes. Conclusion/implications The IEQ shows strong psychometric properties and is suitable for use in a sample of diverse traumatic injury. However, results suggest the use of a one-factor model for the IEQ in this sample. Future trauma and rehabilitation research can use the IEQ to explore how injustice perceptions related to traumatic injury can prospectively influence physical and psychological outcomes. (PsycINFO Database Record

Event centrality, the extent to which one perceives a stressful or traumatic event as central to one's identity, has been shown to be one of the predictors of PTSD symptoms. Boals and Murrell (in press) found that an Acceptance and Commitment Therapy (ACT)-based, therapist-led treatment resulted in significant decreases in event centrality, which in turn led to decreases in PTSD symptoms. In the current study, a version of this treatment was administered using a modified expressive writing intervention. Participants were randomly assigned to learn core components about either ACT, cognitive-behavioral therapy (CBT), or baseball (control) via audio analogs. The ACT and CBT groups then attempted to apply what they learned in two subsequent expressive writing sessions, while the baseball group wrote about a neutral topic. The results revealed that participants in the ACT and CBT conditions evidenced significant decreases in event centrality, if they followed the writing instructions correctly, in comparison to the control group. However, there were no group differences in changes in PTSD symptoms. These results suggest that principles of ACT and traditional CBT expressed using a modified expressive writing intervention hold great promise to help individuals recover from stressful experiences.

We sketch here an understanding of self-regulatory restraint and cardiovascular responses that may accompany it. The understanding represents an application of an integrative analysis that has long guided research in our laboratory and has distinctive implications relative to traditional self-regulation perspectives. One core idea is that restraint intensity varies proximally with the magnitude of the urge resisted—first rising and then falling, with the fall occurring where regulatory success appears impossible or excessively difficult given its importance. Another is that regulatory ability factors, including fatigue, have different influences on restraint intensity depending on the magnitude of an urge and the importance of resisting it. Cardiovascular responses accompanying self-regulatory restraint may be those associated with beta-adrenergic sympathetic nervous system activation. Direct evidence for this understanding is limited, but indirect evidence—from nonregulatory tests of the integrative analysis and its application—is abundant.

Background Increasingly, studies have examined the psychological impact on individuals who survive a traumatic physical injury. The primary aim of this study was to determine the stability of resilience and its association with depressive symptoms. Methods This study included 110 adults admitted to a Level I trauma center. Resilience and depression were measured at baseline and 12 months. Injury-related variables included Glasgow Coma Scale, Injury Severity Score, etiology of injury, and type of injury. Results Analysis revealed that resilience remained stable over 12 months regardless of injury severity, etiology, or type. Negative correlations were found between baseline resilience and 12-month depression ( P P = .001). Conclusions Injured individuals with low resilience are more likely to be depressed at 12 months. Assessing resilience at the time of injury may be useful in identifying those at risk for depression 1 year later.