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Prediction of mental health complications following mild traumatic brain injury Shi, Shuyuan


People with mild traumatic brain injury (mTBI) are at elevated risk for developing mental health disorders, which in turn can lead to poorer recovery. This study aimed to identify risk factors and develop prognostic model(s) for mental health complications following mTBI. The study was a secondary data analysis of a randomized controlled trial, including 517 adults presenting to emergency departments/urgent care centers. Demographic, injury-related and health history information was collected during eligibility screening within a week of injury. At 2-weeks post-injury, participants completed online questionnaires assessing a range of social, psychological and behavioral factors. At 3- and 6-months post-mTBI, participants engaged in a structured psychodiagnostics interview to determine the presence/absence of new or worsened Major Depressive Disorder (MDD), anxiety-related disorders, and Post-Traumatic Stress Disorder (PTSD). The primary outcome in the current study was any vs. none of these mental health disorders. Logistic regression was used to assess the prognostic value of pre-, peri-, and early post-injury factors. Least Absolute Shrinkage Selection Operator (LASSO) was used for predictor selection. A comprehensive model (with LASSO selected predictors from all 22 predictors) and a basic (clinical) model were developed using logistic regression modelling, and compared. Being younger, identifying as a woman and a people of color, lower education level, having mTBI(s) history, maladaptive coping behaviors and illness perceptions, and greater PTSD symptom severity measured at 2-weeks post-injury were significant predictors for new/worsened mental health complications 3-6 months following mTBI. 14 predictors, including demographic, healthy history, injury-related, and early post-injury factors, were included in the comprehensive model. The comprehensive model showed strong discriminability for predicting mental health outcomes and significantly outperformed the basic model. The identified risk factors hold the potential to guide targeted screening and treatment in post-mTBI care. The basic model can identify at-risk patients as early as their emergency department visit, using data that is collected as part of usual clinical care. The comprehensive model, which incorporates self-report measures collected online at 2 weeks post-injury, can significantly improve prognostic accuracy. These models can serve as valuable tools for evidence-based screening and risk stratification, enabling selective referral and proactive management.

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