The role of self-discrepancy theory in understanding post-traumatic brain injury affective disorders: a pilot study.

This pilot study examined the utility of self-discrepancy theory (SDT) in explaining post-traumatic brain injury (TBI) depression and anxiety. The SDT model was expanded to include the discrepancy between the postinjury self and the preinjury self. Study participants were 21 individuals with mild to severe TBI residing in the community, who completed the Selves Interview, the Selves Adjective Checklist, the Beck Depression Inventory-II and the Beck Anxiety Inventory. Strong correlations were found between affective distress and self-discrepancies, as measured by the checklist. Scores on the interview were not related to affective distress. The findings suggest that further research is merited to examine the utility of the SDT in addressing issues of post-TBI depression and anxiety.

Participation objective, participation subjective: a measure of participation combining outsider and insider perspectives.

BACKGROUND: Participation now replaces community integration or handicap as concepts reflecting the social and interpersonal aspects of disability. If rehabilitation is to adequately measure participation, new measures of participation are needed. To represent the voice of the consumer, such measures should reflect not just "objective," normative aspects, but also subjective ones, tapping the consumer's view of participation. OBJECTIVES: To describe the development of and preliminary metrological information on a new measure of participation, Participation Objective, Participation Subjective (POPS). METHODS: A total of 454 community-living individuals with traumatic brain injury (TBI) completed the POPS, as well as measures of quality of life (Life 3), depressive mood (BDI), and TBI symptoms (BISQ). The POPS requires reporting of the share of household activities performed, or the frequency or hours of nonhousehold activities. For each, the subject indicates whether he or she wants to perform more, the same, or less of the activity, and the importance of the activity to well-being. Five subscales and a total scale are calculated, for an objective component (PO), and a subjective component (PS) that reflects importance-weighted satisfaction with activity level. RESULTS: Individuals with mild TBI scored minimally higher than those with moderate-severe TBI on PO subscores, but desired more change on the PS. Test-retest reliability for the PO and the PS and the subscales was from weak (intraclass correlation coefficient 0.28) to adequate (0.89), with PS components having better reliability. The PS component scores had the expected correlations with TBI symptoms, depressed mood, and life satisfaction, among both those with mild injury and those with moderate-severe injury. Injury severity and time since onset were not related to PO or PS scores. CONCLUSIONS: The POPS shows promise as a measure of participation. It fills a void in that it reflects both insider and outsider perspectives on participation after TBI.

Relationship between depression and psychosocial functioning after traumatic brain injury.

OBJECTIVE: To examine the relationship between depression and psychosocial functioning up to 5 years after traumatic brain injury (TBI). DESIGN: Longitudinal cohort study with 2 assessments completed. SETTING: Community. PARTICIPANTS: Individuals (N=188) with TBI living in the community. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Structured Clinical Interview for Depression, self-reports of depression severity, functional symptoms, quality of life (QOL), unmet important needs, and psychosocial functioning. RESULTS: Based on observed depression patterns at initial and repeat assessment, 4 subgroups were created: no depression, resolved depression, late-onset depression, and chronic depression. Groups were equivalent in terms of demographic and injury-related factors but differed significantly in perceived psychosocial functioning. The no-depression group reported fewer depressive symptoms and higher levels of psychosocial functioning, whereas the chronic-depression group reported the poorest psychosocial functioning, with a further decline in QOL at reassessment. Although the resolved-depression and late-onset-depression groups reported similar psychosocial functioning at initial assessment, psychosocial functioning had improved for the resolved-depression group and declined for the late-onset-depression group at reassessment. Pre- and postpsychiatric diagnoses were common in all groups, with pre-TBI diagnosis of depression not predictive of post-TBI depression. CONCLUSIONS: Findings highlight the need for broad-based assessments and timely interventions for both mood and psychosocial challenges after TBI.

Child and parent responses to a brain injury screening questionnaire.

OBJECTIVES: To determine, by using a Brain Injury Screening Questionnaire (BISQ), in a sample of urban public school students, what proportion of children are at risk for having sustained a brain injury, to measure the incidence of blows to the head and alterations in mental status, and to determine whether children and parents report differently on the BISQ. DESIGN: Survey. SETTING: Research facility and community. PARTICIPANTS: A total of 137 urban students (age range, 12-19y) of varied ethnicity, who were recruited in 2 public schools, and their parents. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: The BISQ as completed by children and parents. RESULTS: Fourteen children (10%) were at risk for having sustained a brain injury because they or their parents reported an alteration in mental status and 5 or more symptoms sensitive and specific to traumatic brain injury. Most children were reported to have experienced blows to the head, and 50% were reported to have experienced an alteration in mental status. In all areas, no significant differences were found between parent and child reports. CONCLUSIONS: There may be significant numbers of children with undetected brain injury in schools. The BISQ is a useful tool to identify children at risk for having sustained a brain injury. Histories should be obtained from parents and children who are older than 11 years when screening children for brain injury.

Peer support in the community: initial findings of a mentoring program for individuals with traumatic brain injury and their families.

OBJECTIVES: To evaluate the impact of a community-based peer support program for individuals and their family members following traumatic brain injury (TBI). SETTINGS: Community-based sample of family members and individuals with traumatic brain injury. PARTICIPANTS: Twenty individuals who had participated in the peer support program (11 individuals with TBI and 9 family members). MAIN OUTCOME MEASURES: Quantitative and qualitative approaches were used: a retrospective structured interview assessing self-reported impacts of peer support on empowerment, quality of life, mood, skills and knowledge, and social supports; an in-depth qualitative interview with a subgroup of family members focused on the specific benefits/limitations of the peer support program. RESULTS: Participants in the peer support program reported positive impacts of peer support on increasing their knowledge of TBI, enhancing their overall quality of life, improving their general outlook, and enhancing their ability to cope with depression post TBI. The peer support program was reported to have had a minimal impact on enhancing social support from families, friends, and the community, with varying impacts noted on levels of happiness, coping with anger and anxiety, communication with professionals, and control over one's life. Qualitative analysis suggests the merits of this type of community-based support and areas of improvement for the peer support program itself. CONCLUSIONS: Preliminary data suggest that peer support is a promising approach to enhancing coping for both individuals and their family members after TBI.

Cognitive impairment associated with toxigenic fungal exposure: a replication and extension of previous findings.

In this study, neuropsychological data and symptom reports from 31 individuals exposed to toxic mold were examined. Most participants were found to have reduced cognitive functioning in multiple domains, with memory and executive functions the most commonly affected areas. Rates of dysfunction were significantly greater than chance on more than half of the tests. Number of cognitive impairments was found to be related to depression, although few neuropsychological test scores were correlated with depression. Results also indicated that symptom report of the mold-exposed participants was not significantly different from that of matched groups of 65 persons with mild traumatic brain injury (TBI) and 26 individuals with moderate TBI. The mold-exposed participants reported significantly more symptoms than 47 people with no disability. This study adds to a growing body of literature (e.g., Baldo, Ahmad, & Ruff, 2002; Gordon, Johanning, & Haddad, 1999) relating exposure to mycotoxins to cognitive dysfunction.