The assessment of multidimensional psychopathological outcomes after traumatic brain injury
by Fabian Bockhop
Date of Examination:2024-12-09
Date of issue:2024-12-13
Advisor:Prof. Dr. Nicole von Steinbüchel-Rheinwall
Referee:Prof. Dr. York Hagmayer
Referee:Prof. Dr. Tim Beißbarth
Referee:Prof. Dr. Knut Brockmann
Persistent Address:
http://dx.doi.org/10.53846/goediss-10959
Files in this item
Name:BockhopFabian_Dissertation_MedPsych_final.pdf
Size:9.60Mb
Format:PDF
The following license files are associated with this item:
Abstract
English
Traumatic brain injury (TBI) is frequently associated with neuropsychiatric impairments such as symptoms of post-traumatic stress disorder (PTSD), which can be screened using self-report instruments such as the Post-Traumatic Stress Disorder Checklist for DSM-5 (PCL-5). The first study of this dissertation aimed to inspect the factorial validity and cross-linguistic equivalence of the PCL-5 in individuals after TBI with differential severity. Data for six language groups (n ≥ 200; Dutch, English, Finnish, Italian, Norwegian, Spanish) were extracted from the CENTER-TBI study database. Factorial validity of PTSD was evaluated using confirmatory factor analyses (CFA), and compared between four concurrent structural models. A multi-group CFA approach was utilized to investigate the measurement invariance (MI) of the PCL-5 across languages. All structural models showed satisfactory goodness-of-fit with small between-model variation. The original DSM-5 model for PTSD provided solid evidence of MI across the language groups. The first study of this thesis underlined the validity of the clinical DSM-5 conceptualization of PTSD and demonstrates the comparability of PCL-5 symptom scores between language versions in individuals after TBI. Future studies should apply MI methods to other sociodemographic (e.g., age, gender) and injury-related (e.g., TBI severity) characteristics to improve the monitoring and clinical care of individuals suffering from PTSD symptoms after TBI. The second study of this dissertation focused on psychopathological symptoms, which are common sequelae after TBI and may lead to increased personal and societal burden. Previous studies on factors influencing PTSD, Generalized Anxiety Disorder (GAD), and Major Depressive Disorder (MDD) after TBI have produced inconclusive results, partly due to methodological limitations. The second study of this dissertation investigated the influence of commonly proposed factors on the clinical impairment, occurrence, frequency, and intensity of symptoms of PTSD, GAD, and MDD after TBI. The study sample comprised 2069 individuals (65% males). Associations between psychopathological outcomes and sociodemographic, premorbid, and injury-related factors were analyzed using logistic regression, standard, and zero-inflated negative binomial models. Overall, individuals experienced moderate levels of PTSD, GAD, and MDD. Outcomes correlated with early psychiatric assessments across domains. The clinical impairment, occurrence, frequency, and intensity of all outcomes were associated with the educational level, premorbid psychiatric history, injury cause, and functional recovery. Distinct associations were found for injury severity, LOC, and clinical care pathways with PTSD; age and LOC:sex with GAD; and living situation with MDD, respectively. The use of suitable statistical models supported the identification of factors associated with the multifactorial etiology of psychopathology after TBI. Future research may apply these models to reduce personal and societal burden.
Keywords: Traumatic Brain Injury; Post-traumatic Stress Disorder; Confirmatory Factor Analysis; Measurement Invariance; Generalized Anxiety Disorder; Patient-Reported Outcome Measures; Negative Binomial Regression; Zero-Inflated Negative Binomial Regression; Major Depression
