Esther Bay

Changes in directed attention and short-term memory in depression

This study examined changes in directed attention and short-term memory in depression using a newly constructed battery of computerized measures. A repeated measures design was used with two sample groups; 25 individuals meeting DSM-IV criteria for Major Depression and a group-matched comparison sample of 27. Both groups were tested at three points in time over a 10-week period. Test-retest reliability of the measures was examined. Profile analysis demonstrated that there were differences between the depressed and comparison groups in both directed attention and short-term memory. Recommendations for specific improvements in the testing battery are discussed. The ability to detect changes in directed attention and short-term memory may have clinical utility in early detection of impending onset of depression or subtle residual symptoms of an acute episode that may impair functioning or signal a relapse.

Risk factors for depressive symptoms after mild-to-moderate traumatic brain injury

Primary objective: To determine the extent to which pre-injury psychosocial factors, injury-related variables and post-injury litigation, perceived stress, fatigue, pain and information processing speed contributed to depressive symptoms after traumatic brain injury (TBI). Research design: Cross-sectional outpatient follow-up at 1–36 months post-injury. Methods and procedures: Eighty-four adults recruited from outpatient clinics completed measures of depressive symptoms, measured with the Neurobehavioural Functioning Inventory, chronic stress and other symptoms. Hierarchial linear regression analysis was used to identify statistically significant covariates. Logistic regression analysis determined classification accuracy of these variables with regard to the presence or absence of borderline depression levels. Main outcomes: Perceived stress, pain and litigation status made independent contributions to the level of depressive symptoms, with perceived stress explaining the bulk of the variance and mediating the effect of milder injury severity. These variables had a classification accuracy of 77% with regard to post-injury depressive symptoms, with a sensitivity of 84% and a specificity of 69%. Conclusions: Perceived stress, one indicator of allostatic load, explains a considerable amount of the variance in depressive symptoms after mild–moderate TBI. The findings suggest a need for earlier identification of, as well as preventative education with, those who are stress-vulnerable.

Sex differences in depressive symptoms and their correlates after mild-to-moderate traumatic brain injury

The purpose of this secondary data analysis, guided by allostatic load theory, was to compare depressive symptoms and their correlates in men and women following mild or moderate traumatic brain injury (n = 159). Using general linear modeling procedures in the Statistical Analysis Software, women reported significantly higher Center for Epidemiological Studies-Depression scores compared with men. According to the Neurobehavioral Functioning Inventory subscales, women also reported higher somatic and motor symptoms and difficulties with memory and cognition. Further, women within the first 6 months of their injury reported higher levels of depressive and depressive-somatic symptoms, perceived chronic stress, pain, memory difficulties, and somatic symptoms. These findings were no longer present at the 6- to 12-month or >12-month cutoffs. Womens depressive symptoms during the early recovery period are explained by higher symptom loads and perceived stress, yet mechanisms responsible for these differences remain to be elucidated. Future research is needed to describe hormonal, perceptual, or brain structure differences that may account for these findings. Findings from such research will most likely to contribute to our understanding of postconcussion syndrome.

Chronic stress and fatigue-related quality of life after mild to moderate traumatic brain injury

Objective:To determine relationships among chronic stress, fatigue-related quality of life (QOL-F), and related covariates after mild to moderate traumatic brain injury (TBI). Design:Observational and cross-sectional. Participants:A total of 84 community-dwelling individuals with mild to moderate TBI recruited from multiple out patient rehabilitation clinics assessed on average 15 months after injury. Method:Self-report surveys and chart abstraction. Measures:Neurofunctional Behavioral Inventory, Perceived Stress Scale–14, Impact of Events Scale, McGill Pain Short-form Scale, and modified version of the Fatigue Impact Scale. Results:QOL-F was associated with somatic symptoms, perceived situational stress, but not with event-related stress (posttraumatic stress disorder symptoms) related to index TBI, preinjury demographic, or postinjury characteristics. Somatic symptoms and chronic situational stress accounted for 42% of the variance in QOL-F. Conclusions:QOL-F in community-dwelling individuals with mild to moderate TBI is associated with chronic situational stress and somatic symptoms. Symptom management strategies may need to include general stress management to reduce fatigue burden and improve quality of life.

Psychological and biological correlates of fatigue after mild-to-moderate traumatic brain injury.

Relationships between chronic perceived stress, cortisol response (area under the curve) and posttraumatic brain injury fatigue were examined with persons from outpatient settings. Seventy-five injured persons with traumatic brain injury and their relatives/significant others participated in this cross-sectional study. Using interviews and self-reported data from the Neurofunctional Behavioral Inventory, the Perceived Stress Scale, the Profile of Mood States-Fatigue subscale, the McGill Pain Scale, as well as self-collection of salivary cortisol over a 12-hour period ( N = 50), we found that perceived chronic stress explained 40% of the variance in fatigue until depressive symptoms and pain were in the model. Hypocortisolemia was evident. Somatic symptom frequency and perceived chronic stress represented 50% of the variability in post-TBI fatigue. Fatigue and stress management interventions, as suggested in the Centers for Disease Control Acute Concussion guidelines, may be beneficial in reducing this common symptom.

Symptom experience and emotional distress after traumatic brain injury

Traumatic brain injury (TBI) is unexpected and affects nearly 1.5 million Americans annually. Many with seemingly minor injuries incur long-lasting symptoms without clear explanation. This study examined the symptom experience and emotional response of persons with mild-to-moderate TBI and was guided by the University of California San Francisco (UCSF) symptom management model. Using a cross-sectional design with persons recruited from outpatient rehabilitation settings, we found a positive and significant relationship between postinjury symptom frequency and tension/anxiety, anger/hostility and perceived chronic stress, implying a need to understand these relationships over time in order to implement symptom management strategies.

Functional Status, Chronic Stress, and Cortisol Response After Mild-to-Moderate Traumatic Brain Injury

It is well known that individuals experience difficulties with depressive symptoms and functional status after traumatic brain injury. However, it is unclear what the relationship is between these 2 phenomena and whether there is a biological explanation for. In this secondary analysis, we examined whether depressive symptoms explained postinjury functional status and whether chronic stress and salivary cortisol influenced this relationship. Participants included 75 persons within 24 months of their injury dates who were evaluated or treated in specialty clinics. All participants and a family member or significant other completed survey data, and 50 of the participants provided cortisol data. Results indicated that chronic stress, measured using Cohens Perceived Stress Scale, completely mediated the relationship between depressive symptoms, measured using the Center for Epidemiological Studies Depression Scale, and psychological functioning, measured using the Patient Competency Rating Scale. Furthermore, those who provided cortisol data displayed hypocortisolemia in their 12-hr profile. Results from this analysis suggest that interventions focused on addressing the chronic stress experience may be important in limiting depressive symptoms and improving psychological functioning. Longitudinal study of this phenomenon is required to understand the progression of chronic stress after traumatic brain injury.

Are there gender differences in cognitive function, chronic stress, and neurobehavioral symptoms after mild-to-moderate traumatic brain injury?

ABSTRACT Research is inconclusive on whether gender differences exist in cognitive function in persons who sustain a mild-to-moderate traumatic brain injury (TBI). Furthermore, it is also unclear whether there is a relationship between chronic stress and cognitive function in these persons. The purpose of this integrative review is to determine whether gender differences exist in cognitive function, neurobehavioral symptoms, and chronic stress levels after a mild-to-moderate TBI. Participants (n = 72) were recruited from eight outpatient rehabilitation centers. Participants completed the demographic questions, the Immediate Postconcussion Assessment Cognitive Testing neurocognitive test battery, the Perceived Stress Scale-14, and the Neurobehavioral Functioning Inventory (NFI). Gender differences were present on verbal memory composite scores (p = .033), with women performing worse than men. There were no other between-gender differences on cognitive tasks, neurobehavioral symptoms, or chronic stress. Higher chronic stress levels result in a decrease in verbal memory (p = .015) and motor processing speed (p = .006) and slower reaction time (p = .007) for women. As male NFI cognition scores increased, motor processing speed scores decreased (p = .012) and reaction time got slower (p = .019), whereas women exhibited decreased verbal memory (p = .017) and slower reaction time (p = .034). As NFI motor symptoms increased, men exhibited decreased verbal memory (p = .005), visual memory (p = .002), and motor processing speed (p = .002) and slower reaction time (p = .002). Overall, this study only found gender differences on verbal memory composite scores, whereas the remaining cognitive tasks, neurobehavioral symptoms, and chronic stress did not indicate gender differences. Correlations between chronic stress, neurobehavioral symptoms, and cognitive function differed in both men and women with TBI. Persons in the chronic phase of recovery from a TBI may benefit from training in compensatory strategies for verbal memory deficits and stress management.

Mild Traumatic Brain Injury/Concussion: A Review for ED Nurses

Traumatic brain injury (TBI) affects 1.4 million Americans annually, and severity can range from mild to severe. Mild traumatic brain injury (MTBI) accounts for approximately 75% of those injured. Following evaluation, many patients with mild noncomplicated TBI can be safely treated and released from the emergency department. In addition to those that are treated for their injury, there is an estimated 25% to 42% of persons who experience MTBI and do not seek treatment; thus, the true prevalence of MTBI is unknown. Symptoms are common following MTBI/concussion. Among the most commonly reported symptoms following MTBI are headache, dizziness, anxiety, dizziness, and fatigue. Overall, these symptoms tend to occur immediately or within days after injury and resolve within 3 months after the injury. Although this symptom trajectory may seem short compared with symptoms of chronic illness, presence of the symptoms has been associated with decreased ability to return to pre-injury activities. This situation can be problematic for several reasons: (1) persons usually are not monitored by health care providers, so aside from ED instructions, no further professional help is provided for symptom management; (2) persons are expected to return to work or school, which may be especially difficult while experiencing cognitive symptoms or fatigue; and (3) persons who attempt to return to work or school may fail because of symptom load and lack of symptom relief. For those with mild injury who seek treatment in an emergency department, there is inconsistency in ED management and follow-up recommendations. Bazarian and colleagues found that approximately 38% of patients treated in the emergency department for MTBI were discharged with no recommendations for follow up. Discharge instruction sheets often do not completely address key areas of MTBI, including what symptoms may be experienced following the injury. In addition, the reading levels of the discharge forms are often too difficult to understand, and instructions often are not remembered. The American College of Emergency Physicians states, “a glaring omission from most MTBI discharge instruction sheets is the lack of any mention of the possibility of the patient developing postconcussive symptoms.” A close examination of discharge processes is important for emergency departments across the United States in order to standardize practices among centers and improve quality of care delivered. ED nurses play a key role in presenting the discharge instructions to patients and thus should be actively involved in improving the discharge process for patients with MTBI. The purpose of this article is to provide nurses in practice with expanded knowledge about the current state of the science on the expected trajectory of recovery and best practices in discharge teaching for persons with MTBI.

Mild traumatic brain injury: an update for advanced practice nurses.

&NA; Nearly 75% of persons with brain injury experience a mild injury. These people do not often enter the healthcare system by traditional means, nor do they always present with visible signs and symptoms of injury. In fact, people who experienced brain trauma are likely to seek help in primary care settings and from advanced practice nurses (APNs). Because the symptom experience can be complicated by impaired perception or mood, delays in seeking help, and faulty explanations for their symptoms, APNs need to rule out competing diagnoses, offer brief psychoeducational treatment, and refer the person to an appropriate specialist for therapy when needed.