Stressful life events are associated with self-reported fatigue and depressive symptoms in patients with mild traumatic brain injury

Authors

  • Kaisa Mäki Neuropsychology, Helsinki University and Helsinki University Hospital, Helsinki, Finland
  • Taina Nybo Neuropsychology, Helsinki University and Helsinki University Hospital, Helsinki, Finland
  • Marja Hietanen Neuropsychology, Helsinki University and Helsinki University Hospital, Helsinki, Finland
  • Antti Huovinen Neurology, Helsinki University and Helsinki University Hospital, Helsinki, Finland
  • Ivan Marinkovic Neurology, Helsinki University and Helsinki University Hospital, Helsinki, Finland
  • Harri Isokuortti Neurology, Helsinki University and Helsinki University Hospital, Helsinki, Finland
  • Susanna Melkas Neurology, Helsinki University and Helsinki University Hospital, Helsinki, Finland

DOI:

https://doi.org/10.2340/jrm.v56.13438

Keywords:

depressive symptoms, fatigue, mild traumatic brain injury, stressful life events

Abstract

Abstract

Objective: To examine the associations between recent stressful life events and self-reported fatigue and depressive symptoms in patients with mild traumatic brain injury.

Design: Observational cohort study.

Participants: Patients (aged 18–68 years) with mild traumatic brain injury (n = 99) or lower extremity orthopaedic injury (n = 34).

Methods: Data on stressful life events and self-reported symptoms were collected 3 months post-injury. Stressful life events in the last 12 months were assessed as part of a structured interview using a checklist of 11 common life events, self-reported fatigue with Barrow Neurological Institute Fatigue Scale, and depressive symptoms with Beck Depression Inventory – Fast Screen.

Results: Median number of stressful life events was 1 (range 0–7) in the mild traumatic brain injury group and 1.5 (range 0–6) in the orthopaedic injury group. The groups did not differ significantly in terms of fatigue or depressive symptoms. In the mild traumatic brain injury group, the total number of recent stressful life events correlated significantly with self-reported fatigue (rs = 0.270, p = 0.007) and depressive symptoms (rs = 0.271, p = 0.007).

Conclusion: Stressful life events are associated with self-reported fatigue and depressive symptoms in patients with mild traumatic brain injury. Clinicians should consider stressful life events when managing patients who experience these symptoms, as this may help identifying potential targets for intervention.

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References

Cassidy JD, Carroll LJ, Peloso PM, Borg J, von Holst H, Holm L, et al. Incidence, risk factors and prevention of mild traumatic brain injury: results of the WHO collaborating centre task force on mild traumatic brain injury. J Rehabil Med 2004; Suppl 43: 28–60.

https://doi.org/10.1080/16501960410023732 DOI: https://doi.org/10.1080/16501960410023732

Nguyen R, Fiest KM, McChesney J, Kwon C-S, Jette N, Frolkis AD, et al. The international incidence of traumatic brain injury: a systematic review and meta-analysis. Can J Neurol Sci 2016; 43: 774–785.

https://doi.org/10.1017/cjn.2016.290 DOI: https://doi.org/10.1017/cjn.2016.290

Ponsford J, Cameron P, Fitzgerald M, Grant M, Mikocka-Walus A, Schönberger M. Predictors of postconcussive symptoms 3 months after mild traumatic brain injury. Neuropsychology 2012; 26: 304–313.

https://doi.org/10.1037/a0027888 DOI: https://doi.org/10.1037/a0027888

Skandsen T, Stenberg J, Follestad T, Karaliute M, Saksvik SB, Einarsen CE, et al. Personal factors associated with postconcussion symptoms 3 months after mild traumatic brain injury. Arch Phys Med Rehabil 2021; 102: 1102–1112.

https://doi.org/10.1016/j.apmr.2020.10.106 DOI: https://doi.org/10.1016/j.apmr.2020.10.106

Norrie J, Heitger M, Leathem J, Anderson T, Jones R, Flett R. Mild traumatic brain injury and fatigue: a prospective longitudinal study. Brain Inj 2010; 24: 1528–1538.

https://doi.org/10.3109/02699052.2010.531687 DOI: https://doi.org/10.3109/02699052.2010.531687

Rakers SE, Timmerman ME, Scheenen ME, de Koning ME, van der Horn HJ, van der Naalt J, et al. Trajectories of fatigue, psycholog-ical distress, and coping styles after mild traumatic brain injury: a 6-month prospective cohort study. Arch Phys Med Rehabil 2021; 102: 1965–1971.

https://doi.org/10.1016/j.apmr.2021.06.004 DOI: https://doi.org/10.1016/j.apmr.2021.06.004

Åhman S, Saveman B-I, Styrke J, Björnstig U, Stålnacke B-M. Long-term follow-up of patients with mild traumatic brain injury: a mixed-methods study. J Rehabil Med 2013; 45: 758–764.

https://doi.org/10.2340/16501977-1182 DOI: https://doi.org/10.2340/16501977-1182

Aaronson LS, Teel CS, Cassmeyer V, Neuberger GB, Pallikkathayil L, Pierce J, et al. Defining and measuring fatigue. Image J Nurs Sch 1999; 31: 45–50.

https://doi.org/10.1111/j.1547-5069.1999.tb00420.x DOI: https://doi.org/10.1111/j.1547-5069.1999.tb00420.x

Stulemeijer M, van der Werf S, Bleijenberg G, Biert J, Brauer J, Vos PE. Recovery from mild traumatic brain injury. A focus on fa-tigue. J Neurol 2006; 253: 1041–1047.

https://doi.org/10.1007/s00415-006-0156-5 DOI: https://doi.org/10.1007/s00415-006-0156-5

Wäljäs M, Iverson GL, Lange RT, Liimatainen S, Hartikainen KM, Dastidar P, et al. Return to work following mild traumatic brain injury. J Head Trauma Rehabil 2014; 29: 443–450.

https://doi.org/10.1097/HTR.0000000000000002 DOI: https://doi.org/10.1097/HTR.0000000000000002

Schiehser DM, Delano-Wood L, Jak AJ, Hanson KL, Sorg SF, Orff H, et al. Predictors of cognitive and physical fatigue in post-acute mild-moderate traumatic brain injury. Neuropsychol Rehabil 2017; 27: 1031–1046.

https://doi.org/10.1080/09602011.2016.1215999 DOI: https://doi.org/10.1080/09602011.2016.1215999

Iverson GL, Lange RT, Wäljäs M, Liimatainen S, Dastidar P, Hartikainen KM, et al. Outcome from complicated versus uncomplicated mild traumatic brain Injury. Rehabil Res Pract 2012; 2012: 415740.

https://doi.org/10.1155/2012/415740 DOI: https://doi.org/10.1155/2012/415740

Ponsford JL, Sinclair KL. Sleep and fatigue following traumatic brain injury. Psychiatr Clin N Am 2014; 37: 77–89.

https://doi.org/10.1016/j.psc.2013.10.001 DOI: https://doi.org/10.1016/j.psc.2013.10.001

Holmes TH, Rahe RH. The social readjustment rating scale. J Psychosom Res 1967; 2: 213–218.

https://doi.org/10.1016/0022-3999(67)90010-4 DOI: https://doi.org/10.1016/0022-3999(67)90010-4

Hatch SL, Dohrenwend BP. Distribution of traumatic and other stressful life events by race/ethnicity, gender, SES and age: a review of the research. Am J Community Psychol 2007; 40: 313–332.

https://doi.org/10.1007/s10464-007-9134-z DOI: https://doi.org/10.1007/s10464-007-9134-z

Cohen S, Murphy MLM, Prather AA. Ten surprising facts about stressful life events and disease risk. Annu Rev Psychol 2019; 70: 577–597.

https://doi.org/10.1146/annurev-psych-010418-102857 DOI: https://doi.org/10.1146/annurev-psych-010418-102857

Tibubos AN, Burghardt J, Klein EM, Brähler E, Jünger C, Michal M, et al. Frequency of stressful life events and associations with mental health and general subjective health in the general population. J Public Health 2021; 29: 1071–1080.

https://doi.org/10.1007/s10389-020-01204-3 DOI: https://doi.org/10.1007/s10389-020-01204-3

Hatcher S, House A. Life events, difficulties and dilemmas in the onset of chronic fatigue syndrome: a case-control study. Psychol Med 2003; 33: 1185–1192.

https://doi.org/10.1017/s0033291703008274 DOI: https://doi.org/10.1017/S0033291703008274

Swanepoel I, van Staden W, Fletcher L. Psychological resilience and vulnerability as mediators between adverse life events and fatigue, motor dysfunction, and paresthesia in multiple sclerosis. Psychosom Med 2020; 82: 138–146.

https://doi.org/10.1097/PSY.0000000000000770 DOI: https://doi.org/10.1097/PSY.0000000000000770

Barroso J, Hammill BG, Leserman J, Salahuddin N, Harmon JL, Pence BW. Physiological and psychosocial factors that predict HIV-related fatigue. AIDS Behav 2010; 14: 1415–1427.

https://doi.org/10.1007/s10461-010-9691-2 DOI: https://doi.org/10.1007/s10461-010-9691-2

Tao C, Gu M, Xu P, Wang J, Xiao L, Gui W, et al. Stressful life events can predict post-stroke fatigue in patients with ischemic stroke. E J Neurol 2021; 28: 3080–3088.

https://doi.org/10.1111/ene.14977 DOI: https://doi.org/10.1111/ene.14977

Reid MW, Cooper DB, Lu LH, Iverson GL, Kennedy JE. Adversity and resilience are associated with outcome after mild traumatic brain injury in military service members. J Neurotrauma 2018; 35: 1146–1155.

https://doi.org/10.1089/neu.2017.5424 DOI: https://doi.org/10.1089/neu.2017.5424

van Veldhoven LM, Sander AM, Struchen MA, Sherer M, Clark AN, Evans Hudnall G, et al. Predictive ability of preinjury stressful life events and post-traumatic stress symptoms for outcomes following mild traumatic brain injury: analysis in a prospective emergency room sample. J Neurol Neurosurg Psychiatry 2011; 82: 782–787.

https://doi.org/10.1136/jnnp.2010.228254 DOI: https://doi.org/10.1136/jnnp.2010.228254

Mäki K, Nybo T, Hietanen M, Huovinen A, Marinkovic I, Isokuortti H, et al. Perceived injustice after mild traumatic brain injury. J Head Trauma Rehabil 2022; 37: E157–E164.

https://doi.org/10.1097/HTR.0000000000000698 DOI: https://doi.org/10.1097/HTR.0000000000000698

Carroll LJ, Cassidy JD, Holm L, Kraus J, Coronado VG. Methodological issues and research recommendations for mild traumatic brain injury: the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury. J Rehabil Med. 2004; Suppl. 43: 113–125.

https://doi.org/10.1080/16501960410023877 DOI: https://doi.org/10.1080/16501960410023877

Brugha TS, Cragg D. The List of Threatening Experiences: the reliability and validity of a brief life events questionnaire. Acta Psychiatr Scand 1990; 82: 77–81.

https://doi.org/10.1111/j.1600-0447.1990.tb01360.x DOI: https://doi.org/10.1111/j.1600-0447.1990.tb01360.x

Borgaro SR, Gierok S, Caples H, Kwasnica C. Fatigue after brain injury: initial reliability study of the BNI Fatigue Scale. Brain Inj. 2004; 18: 685–690.

https://doi.org/10.1080/02699050310001646080 DOI: https://doi.org/10.1080/02699050310001646080

Wäljas M, Iverson GL, Hartikainen KM, Liimatainen S, Dastidar P, Soimakallio S, et al. Reliability, validity and clinical usefulness of the BNI fatigue scale in mild traumatic brain injury. Brain Inj 2012; 26: 972–978.

https://doi.org/10.3109/02699052.2012.660511 DOI: https://doi.org/10.3109/02699052.2012.660511

Beck AT, Steer RA, Brown GK. Manual for the Beck Depression Inventory-II. San Antonio: The Psychological Corporation; 1996. DOI: https://doi.org/10.1037/t00742-000

Beck AT, Guth D, Steer A, Ball R. Screening for major depression disorders in medical inpatients with the Beck Depression Inventory for primary care. Behav Res Ther 1997; 35: 785–791.

https://doi.org/10.1016/s0005-7967(97)00025-9 DOI: https://doi.org/10.1016/S0005-7967(97)00025-9

Beck At, Steer RA, Brown GK. BDI – Fast Screen for Medical Patients: Manual. San Antonio: The Psychological Corporation; 2000. DOI: https://doi.org/10.1037/t14984-000

Jefferis BJ, Nazareth I, Marston L, Moreno-Kustner B, Bellón JÁ, Svab I, et al. Associations between unemployment and major depressive disorder: Evidence from an international, prospective study (the predict cohort). Soc Sci Med 2011; 73: 1627–1634.

https://doi.org/10.1016/j.socscimed.2011.09.029 DOI: https://doi.org/10.1016/j.socscimed.2011.09.029

Olesen SC, Butterworth P, Leach LS, Kelaher M, Pirkis J. Mental health affects future employment as job loss affects mental health: findings from a longitudinal population study. BMC Psychiatry 2013; 13: 144.

https://doi.org/10.1186/1471-244X-13-144 DOI: https://doi.org/10.1186/1471-244X-13-144

Cantor JB, Gordon W, Gumber S. What is post TBI fatigue? NeuroRehabilitation 2013; 32: 875–883.

https://doi.org/10.3233/NRE-130912 DOI: https://doi.org/10.3233/NRE-130912

Karr JE, Iverson GL, Williams MS, Huang S-J, Yang C-C. Complicated versus uncomplicated mild traumatic brain injuries: A compar-ison of psychological, cognitive, and post-concussion symptom outcomes. J Clin Exp Neuropsychol 2020; 42: 1049–1058.

https://doi.org/10.1080/13803395.2020.1841118 DOI: https://doi.org/10.1080/13803395.2020.1841118

Levin HS, McCauley SR, Pedroza Josic C, Boake C, Brown SA, Goodman HS, et al. Predicting depression following mild traumatic brain injury. Arch Gen Psychiatry 2005; 62: 523–528.

https://doi.org/10.1001/archpsyc.62.5.523 DOI: https://doi.org/10.1001/archpsyc.62.5.523

Panenka WJ, Lange RT, Bouix S, Shewchuk JR, Manraj K, Heran MKS, et al. Neuropsychological outcome and diffusion tensor imag-ing in complicated versus uncomplicated mild traumatic brain injury. PloS One 2015; 10: e0122746.

https://doi.org/10.1371/journal.pone.0122746 DOI: https://doi.org/10.1371/journal.pone.0122746

Rao V, Bertrand M, Rosenberg P, Makley M, Schertlen DJ, Brandt J, et al. Predictors of new-onset depression after mild traumatic brain injury. J Neuropsychiatry Clin Neurosci 2010; 22: 100–104. DOI: https://doi.org/10.1176/appi.neuropsych.22.1.100

https://doi.org/10.1176/jnp.2010.22.1.100 DOI: https://doi.org/10.1176/jnp.2010.22.1.100

Voormolen DC, Zeldovich M, Haagsma JA, Polinder S, Friedrich S, Maas AIR et al. Outcomes after complicated and uncomplicated mild traumatic brain injury at three- and six-months post-injury: results from the CENTER-TBI study. J Clin Med 2020; 9: 1525.

https://doi.org/10.3390/jcm9051525 DOI: https://doi.org/10.3390/jcm9051525

Hou R, Moss-Morris R, Peveler R, Mogg K, Bradley BP, Belli A. When a minor head injury results in enduring symptoms: a prospec-tive investigation of risk factors for postconcussional syndrome after mild traumatic brain injury. J Neurol Neurosurg Psychiatry 2012; 83: 217–223.

https://doi.org/10.1136/jnnp-2011-300767 DOI: https://doi.org/10.1136/jnnp-2011-300767

Rickards TA, Cranston CC, McWhorter J. Persistent post-concussive symptoms: A model of predisposing, precipitating, and perpetuating factors. Appl Neuropsychol Adult 2022; 29: 284–294.

https://doi.org/10.1080/23279095.2020.1748032 DOI: https://doi.org/10.1080/23279095.2020.1748032

Published

2024-03-04

How to Cite

Mäki, K., Nybo, T., Hietanen, M. ., Huovinen, A., Marinkovic, I. ., Isokuortti, H., & Melkas, S. (2024). Stressful life events are associated with self-reported fatigue and depressive symptoms in patients with mild traumatic brain injury. Journal of Rehabilitation Medicine, 56, jrm13438. https://doi.org/10.2340/jrm.v56.13438

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