Academic journal article Care Management Journals

Symptom Experience and Emotional Distress after Traumatic Brain Injury

Academic journal article Care Management Journals

Symptom Experience and Emotional Distress after Traumatic Brain Injury

Article excerpt

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.

Keywords: UCSF Model; traumatic brain injury; symptoms; emotional distress

Traumatic brain injury is an unexpected event affecting nearly 1.5 million Americans per year (Centers for Disease Control [CDC] and Prevention, 1999). Many with seemingly minor injuries may have long-term symptoms without clear explanation. In fact, symptoms associated with milder injuries are expected to subside within the first year (Dikmen, Machamer, & Temkin, 2001). Because the lack of symptom abatement can be distressful, particularly when persons are informed that their brain injury was minor, we examined the relationship between the symptom experience and emotional response of persons with mild-tomoderate traumatic brain injury (TBI). The University of California San Francisco (UCSF) symptom management model guided this study (UCSF, 1994).

Traumatic brain injury (TBI) is associated with diffuse axonal injury within a rigid skull and can result in lifelong consequences affecting mood, behavior, cognition, and physical health. While 75% of those with brain injury are classified as mild, TBI rehabilitation is expensive. Estimates of the costs associated with milder injuries are projected to be $17 billion while the estimated economic burden for all injury levels of TBI approaches $49 billion annually with $32 billion expended on hospitalization expenses (CDC, 2003; Thurman & Guerrero, 1999; Thurman, 2001). Annually, about 75,000 Americans will encounter a moderate-level brain injury and two-thirds of these will have moderate disability. Disability after mild-to-moderate brain injury is associated with difficulties in activities of daily living, interpersonal relationships, and return to preinjury work status. These difficulties are associated with emotional changes and brain injury symptoms, such as pain, dizziness, cognitive impairment, hearing and visual disturbances.

It is expected that resolution of brain injury symptoms will occur within 3-12 months of mild injury. Yet between 20%-80% of those with mild injuries do not experience symptom abatement and have difficulties with information processing speed, memory, mood and physical function (CDC, 2003; de Kruijk et al., 2002; Dikmen, Machamer, & Temkin, 2001). Factors implicated in worse outcome from mild TBI include older age, female gender, psychosocial stress, duration of posttraumatic amnesia, a prior history of TBI, and headache within 24 hours of the injury (de Kruijk et al., 2002; McCauley, Boake, Levin, Contant, & Song, 2001).

Complicating recovery from a brain injury is the presence of emotional disorders. Emotional disorders, such as anxiety, depression, irritability, aggression, and posttraumatic stress disorder (PTSD) are prevalent after injury. These emotions most likely impact cognition, perception of illness, social functioning, family burden, and return to productive social roles in the community (CDC, 1999; Jorge et al., 2004).

Whether emotional disorders after TBI are the result of a pathogenic mechanism or reactive to the situation or symptom experience remains unclear. We propose that the frequency of neurobehavioral symptoms following TBI is related to increased emotional distress, defined as a strong perception of feelings in response to physical, cognitive or behavioral difficulties resulting from the brain injury. …

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