Posttraumatic stress disorder following traumatic brain injury in civilians

Ondertitel:prevalence, assessment and neurocognitive functioning

The topic of posttraumatic stress disorder (PTSD) following a traumatic brain injury (TBI) has been extensively investigated in military conflict situations. A particular need exists for research in civilian settings. The main aim of this thesis was to investigate the occurrence of PTSD following civilian TBI and explore its relation with cognitive functioning. We performed a systematic review and meta-analysis and found that 15.6% of patients with TBI develop PTSD, regardless of injury severity. Neither did we find a clear effect of measure of PTSD used, and timing of assessment as the rates of PTSD remain high up to years after the event causing TBI. Further, a Dutch translation of the PTSD Checklist for DSM-5 (PCL-5) was validated in a civilian population of Dutch-speaking patients with TBI. The validation of the Dutch version of the PCL-5 was proven to be psychometrically sound and can now be used for clinical and academic purposes. The prospective part of this thesis was part of a larger study: the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI, www.center-tbi.eu) project. The project included a multicenter, longitudinal, observational study aiming to better characterize TBI as a disease and to identify the most effective clinical interventions for managing TBI. To explore the neurocognitive correlates of PTSD following TBI, a sample of 1,134 patients with TBI was evaluated in a cross-sectional design. Those with probable PTSD (13.5%), performed significantly worse on cognitive tests assessing cognitive flexibility and verbal, long-term memory, compared to patients with TBI only. Cognitive flexibility and reaction speed was associated to PTSD symptom severity. The impact of neurocognitive functioning on the course of PTSD symptoms following TBI, was investigated in a sample of 671 patients with assessment of PTSD symptoms at 6 and 12 months post injury, and neurocognitive assessment at 6 months. Results showed that better sustained attention was associated with improving PTSD symptoms. To conclude, health care professionals should be aware of the high risk of PTSD in patients with TBI, even in civilian populations. All patients with a TBI should be screened for PTSD, regardless of the injury severity. The use of a simple screening tool should be considered as a first approach to identify those at risk for PTSD and facilitate prompt intervention. Additionally, cognitive functioning can help to differentiate for PTSD in patients with TBI and to target risk patients for increasing PTSD symptoms.

Jaar van publicatie:2022

Trefwoorden:Doctoral thesis

Toegankelijkheid:Open