Griffiths, Jessica; (2022) Association between Marshall computed tomography grade and anxiety, depression and post-traumatic stress disorder one-year after moderate-severe traumatic brain injury. Doctoral thesis (D.Clin.Psy), UCL (University College London).

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Abstract

BACKGROUND: This systematic review and meta-analysis examines predictors of selfreported symptoms of post-traumatic stress disorder (PTSD) in civilians after traumatic brain injury (TBI), assessed using the PTSD Checklist for DSM-IV – Civilian Version (PCL-C) or the PTSD Checklist for DSM-5 (PCL-5). METHODS: A systematic literature search was conducted in MEDLINE, EMBASE, PsycInfo, Web of Science, Cochrane Library and Google Scholar up until August 2021. Studies were identified exploring univariable predictors or multivariable models of self-reported PTSD symptoms after TBI, measured using the PCL-C or PCL-5. Univariate effects were metaanalysed. The review was limited to studies recruiting civilians aged 16-80 with a TBI of any severity. Data were extracted using the Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies checklist. Risk of bias assessments were conducted using the Quality in Prognostic Studies tool. Random effects meta-analyses were performed on univariable predictors in RevMan (version 5.4.1). RESULTS: A total of 19 papers, from 10 different studies, published between 2006-2022 were included. The majority of the studies were prospective cohort studies (n = 6) and based in the US (n = 6). TBI severity ranged from mild to severe. Risk of bias ratings were generally acceptable, though most studies had a moderate risk of bias in the ‘study participation’ domain, and many in ‘statistical analysis and reporting’ domain. 12 papers reported multivariable models. 20 univariable predictors were meta-analysed. Pooled effects showed that higher scores on self-report PTSD measures after TBI were significantly associated with: non-Caucasian race (pOR = 1.78; 95% CI: 1.21, 2.62; I2 = 0%; 3 studies), assault mechanism of injury (pOR = 3.44; 95% CI: 2.37, 5.00; I2 = 7%; 5 studies), pre-TBI psychiatric history (pOR = 2.95; 95% CI: 2.25, 3.89; I2 = 0%; 4 studies) and positive toxicology screen on admission (pOR = 3.40; 95% CI: 1.45, 7.95; I2 = 0%; 2 studies). Years of education was significantly inversely associated with scores on self-report PTSD measures after TBI (pMD = -1.43; 95% CI: -1.93, -0.94; I2 = 0%; 2 studies). These findings were robust to sensitivity analyses in which studies with cross-sectional or retrospective designs were excluded. DISCUSSION: This review and meta-analysis adds to existing research by identifying a number of potential predictors of self-reported PTSD symptoms after TBI. More research in more geographically diverse locations and recruiting more demographically diverse samples is needed to confirm the relevance of these predictors. Future research could also explore moderators of these associations. This would help to develop multivariate models that could identify TBI survivors at risk of PTSD in clinical practice

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