Mental and Physical Health Comorbidities in Traumatic Brain Injury: A Non-TBI Controls Comparison

Amber Ayton; Gershon Spitz; Amelia J Hicks; Jennie Ponsford

doi:10.1016/j.apmr.2024.03.005

Mental and Physical Health Comorbidities in Traumatic Brain Injury: A Non-TBI Controls Comparison

Arch Phys Med Rehabil. 2024 Mar 22:S0003-9993(24)00886-4. doi: 10.1016/j.apmr.2024.03.005. Online ahead of print.

Authors

Amber Ayton¹, Gershon Spitz², Amelia J Hicks², Jennie Ponsford²

Affiliations

¹ Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia; School of Psychological Sciences, Monash University, Melbourne, Australia. Electronic address: amber.ayton@monash.edu.
² Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia; School of Psychological Sciences, Monash University, Melbourne, Australia.

PMID: 38521496
DOI: 10.1016/j.apmr.2024.03.005

Abstract

Objective: To examine whether aging with a TBI was associated with a greater burden of health-related comorbidities compared with a non-TBI control cohort and examine the associations between comorbidity burden, emotional outcomes, and health-related quality of life (HRQoL) after TBI across ages.

Design: Cross-sectional.

Setting: Research center or telephone.

Participants: The study included 559 participants (N_TBI=291, N_Controls=268). Participants with TBI were recruited during inpatient rehabilitation and had sustained a moderate-severe TBI 1-33 years previously. Non-TBI controls were a convenience sample recruited through advertisements in the community.

Interventions: Not applicable.

Main outcome measures: The number of cardiovascular, general physical health, and mental health comorbidities was compared between cohorts and age strata using Poisson regression. The relationships between comorbidities, age, emotional outcomes (Generalized Anxiety Disorder Scale-7, Patient Health Questionnaire-9), and HRQoL (PROMIS Global Health Measure) were examined with linear regression. Distinct subgroups of comorbidities were identified using latent class analysis. Associations between comorbidity classes with demographic and outcome variables were evaluated using multinomial logistic and linear regressions, respectively.

Results: TBI participants had a significantly higher comorbidity burden than controls, primarily driven by elevated rates of mental health disorders (RR=2.71, 95% confidence interval [1.37, 5.35]). Cardiovascular and physical health comorbidities were not elevated in the TBI group compared with controls. Both cohorts had 3 similar comorbidity subgroups, suggesting consistent patterns of co-occurring health conditions regardless of TBI exposure. Physical and mental health comorbidities were associated with elevated depression and anxiety symptoms and diminished HRQoL after TBI compared with controls.

Conclusion: TBI was associated with greater mental, but not physical, health comorbidities in the decades after injury. However, physical and mental health comorbidities significantly affected emotional and HRQoL status after TBI, underscoring a greater need for long-term support for individuals with TBI coping with both physical and mental health comorbidities.

Keywords: Age; Aging; Comorbidities; Health conditions; Mental health; Older adults; Outcomes; Physical health; Quality of life; Rehabilitation; Traumatic brain injury.