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.

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.

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.