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    Network analysis applied to post-concussion symptoms in two mild traumatic brain injury samples.
    (Frontiers Media S.A., 2023-07-20) Faulkner JW; Theadom A; Snell DL; Williams MN; Andelic N
    OBJECTIVE: A latent disease explanation cannot exclusively explain post-concussion symptoms after mild traumatic brain injury (mTBI). Network analysis offers an alternative form of explanation for relationships between symptoms. The study aimed to apply network analysis to post-concussion symptoms in two different mTBI cohorts; an acute treatment-seeking sample and a sample 10 years post-mTBI. METHOD: The treatment-seeking sample (n = 258) were on average 6 weeks post-injury; the 10 year post mTBI sample (n = 193) was derived from a population-based incidence and outcomes study (BIONIC). Network analysis was completed on post-concussion symptoms measured using the Rivermead Post-Concussion Questionnaire. RESULTS: In the treatment-seeking sample, frustration, blurred vision, and concentration difficulties were central to the network. These symptoms remained central in the 10 year post mTBI sample. A Network Comparison Test revealed evidence of a difference in network structure across the two samples (p = 0.045). However, the only symptoms that showed significant differences in strength centrality across samples were irritability and restlessness. CONCLUSION: The current findings suggest that frustration, blurred vision and concentration difficulties may have an influential role in the experience and maintenance of post-concussion symptoms. The impact of these symptoms may remain stable over time. Targeting and prioritising the management of these symptoms may be beneficial for mTBI rehabilitation.
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    Patterns of post-traumatic stress symptoms in mild traumatic brain injury and their relationship with outcomes: a latent profile analysis.
    (Taylor and Francis Group, 2023-06-23) Faulkner JW; Snell DL; Theadom A; de Terte I; Low R
    INTRODUCTION: Post-traumatic stress symptoms (PTSS) are known to contribute to postconcussion symptoms and functional status following mild traumatic brain injury (mTBI). Identifying symptom cluster profiles provide an opportunity to better understand PTSS and their influence on these outcomes. In this study, latent profiles of PTSS following mTBI were identified, and their association with mTBI outcomes was examined. The predictive role of demographic and injury related variables on profile membership was also explored. METHOD: Adults (N = 252) completed self report measures of PTSS and mTBI outcomes (post-concussion symptoms and functional status) within three months of mTBI. These measures were re-administered six months later (N = 187). Latent profile analysis (LPA) was used to ascertain the latent class structure of PTSS, and regression analysis to examine predictors of profiles. ANCOVA, with general psychological distress as a covariate, revealed the relationship between profiles and mTBI outcomes. RESULTS: LPA identified a four-profile model to best describe PTSS at baseline. This included a resilient (49.6%), moderate (30.6%), moderate with high intrusion/avoidance (14.3%) and a highly symptomatic profile (5.6%). A secondary school education or less and/or unemployment before mTBI was significantly more likely in the highly symptomatic profile, as well as sustaining an mTBI due to an assault or motor vehicle accident. PTSS latent class membership was significantly associated with mTBI outcomes even when controlling for general psychological distress. The resilient group had significantly better outcomes at baseline and six-month follow-up. However, no significant differences in mTBI outcomes emerged between the moderate, moderate with high intrusion/avoidance and the highly symptomatic profiles. CONCLUSION: The current study provides novel information on the symptom profiles of PTSS in mTBI, predictors of profile membership and their relationship with mTBI outcomes. Although future research using this approach is needed, the current study offers a more in-depth understanding of PTSS in mTBI to inform clinical care.
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    Exploring psychological mechanisms that contribute to the development of post-traumatic stress disorder in mild traumatic brain injury : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University, Wellington, New Zealand
    (Massey University, 2021) Szembrener, Caroline-Nicolett
    Mild traumatic brain injuries (mTBI) are prevalent. Contrary to previous beliefs, a significant portion of individuals experience persistent post-concussion symptoms. Psychological mechanisms have been found to increase pathologies such as post-traumatic stress disorder (PTSD) and affect functional status within a large spectrum of health disorders. Alas, they have not been vastly explored within an mTBI population. This study examined the role of psychological flexibility and fear avoidance in the development of PTSD post-mTBI. Method: 169 participants were recruited from a specialist concussion service and completed a range of self-report measures within one month of entry. The psychological mechanisms were ascertained. This included psychological flexibility (Acceptance and Action Questionnaire in Acquired Brain Injury (AAQ-ABI(RA)) and fear avoidance (Fear Avoidance Behaviour after Traumatic Brain Injury Questionnaire (FAB-TBI)). In addition, measures of, psychological distress (Depression Anxiety and Stress Scale, DASS-21), post-traumatic stress disorder symptoms (PTSS) (Impact of Events Scale-Revised (IES-R)), post-concussion symptoms (PCS) (Rivermead Post-Concussion Questionnaire, (RPQ)), and functional disability (Word Health Organisation Disability Assessment Schedule 2.0 WHODAS 2.0) were gathered. Results: A large positive correlation was found between PTSS, PCS and functional disability. Linear regression analysis revealed that psychological flexibility and fear avoidance made a unique and significant contribution to PTSS in mTBI, even when controlling for confounding variables. Mediation analysis revealed an indirect effect of PTSS on PCS and functional status through both psychological mechanisms. Multiple mediation indicated that psychological flexibility was significantly associated with PCS, but fear avoidance was not. Whereas both were associated with functional status. Conclusion: PTSS significantly contribute to mTBI outcomes (i.e., PCS, functional status). Psychological flexibility and fear avoidance contribute to the development of PTSS following mTBI and affect recovery. These findings suggest that psychological flexibility and fear avoidance should be targeted in treatment interventions for mTBI.