Category: Brain Injury; Military and Veterans Affairs
Examine the effect of medical comorbidities on psychological health outcomes.
Design : Longitudinal Cohort Study
Setting : A VA Polytrauma Rehabilitation Center
Participants (or Animals, Specimens, Cadavers) : VA TBI Model System participants (N =266) were primarily male (93%), white (73%), with a median age of 31 [IQR 25-50] with predominately severe TBI (71%).
Interventions : Not applicable
Main Outcome Measure(s) :
Two-Year Post-Injury Outcomes: National Health/Nutrition Survey Medical Comorbidities, Satisfaction with Life Scale (SWLS), Patient Health Questionnaire-9 (PHQ-9)
Most participants had at least one medical comorbidity (77%). The most common were chronic pain (47%), fractures (29%), sleep apnea (26%), and hypertension (25%). Using generalized linear regression models and following adjustment for known predictors of outcome, higher comorbidity burden was associated with lower quality of life (SWLS, β = -0.66, p<.05) but not PHQ-9. To examine for the effect of individual comorbid conditions and known predictors of outcome, lasso regression was used for variable selection by shrinking the coefficients of unselected variables to 0. Pre-injury mental health treatment (β = 2.32, 95% CI: = 0.17, 4.26) and chronic pain (β =2.40, 95% CI: 0.23-4.36) were selected to be associated with higher depression scores. Non-significant relations were found such that lower SWLS was associated with older age, pre-injury mental health treatment, lower discharge FIM, and chronic pain.
Conclusions : Consistent with previous research, this study demonstrates the high prevalence of medical comorbidities following TBI while examining the impact these conditions have on psychological health. Given the impact of comorbidity on satisfaction with life post TBI and the unique effects of chronic pain, results point to the importance of proactive interventions for these conditions in this population.
Emily Noyes– Research Assistant, James A Haley VA Hospital, Tampa, Florida
Xinyu Tang– Biostatistics Contractor, Tampa VA Research and Education Foundation, Inc, Tampa, Florida
Marc Silva– Neuropsychologist, James A Haley VA Hospital, Tampa, Florida
Kristen Dams-O'Connor– Associate Professor of Rehabilitation Medicine and Neurology; Director of Brain Injury Research Center, Icahn School of Medicine at Mount Sinai, New York, New York
Jacob Finn– Clinician Investigator, Minneapolis VA Healthcare System, Minneapolis, Minnesota
Flora Hammond– Professor & Chair, Indiana University School of Medicine, Indianapolis, Indiana
Mary Jo Pugh– Professor, University of Utah/ VA Salt Lake City, Salt Lake City, Utah
Angelle Sander– Associate Professor, Baylor College of Medicine, Houston, Texas
Lillian Stevens– Research Psychologist, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
William Walker– Professor, Dept of PM&R, Virginia Commonwealth University, Richmond, Virginia
Risa Nakase-Richardson– Neuropsychologist, Associate Professor, James A. Haley Veterans' Hospital / University of South Florida, Tampa, Florida
Deveney Ching– Graduate Research Assistant/Ph.D. Student/WOC Research Assistant, University of South Florida / James A. Haley VA Hospital, Tampa, Florida