Identifying the Bridges Between Post Concussion Symptoms and Psychological Distress in Mild Traumatic Brain Injury Using Network Analysis.

Objective: Psychological distress in mild traumatic brain injury (mTBI) can exacerbate post-concussion symptoms (PCS) and prolong recovery. However, little is known about the symptom-to-symptom relationships between psychological distress and PCS. Understanding the connection between these constructs can inform patient education and identify areas for treatment. This study used network analysis to explore item-level relationships between PCS and psychological distress in individuals with mTBI.

Setting: Participants were recruited from outpatient mTBI clinics throughout New Zealand.

Participants and setting: A total of 436 adults diagnosed with mTBI.

Design: A Cross-sectional network analysis design using the using the EBICglasso method. Bridge expected influence (BEI) was calculated to quantify the extent to which each node connects PCS and psychological distress within the network.

Measures: PCS were assessed using the Rivermead Post Concussion Questionnaire and psychological distress using the Depression, Anxiety, Stress Scale 21 (DASS-21).

Results: Two significant bridging connections were identified. The first connection had the highest BEI and was between the symptom of sleep disturbance and the hyperarousal (difficulties winding down and relaxing) component of psychological distress. The second connection was between the symptoms of concentration difficulties and lack of initiation within psychological distress.

Conclusion: This study highlights which specific symptoms between PCS and psychological distress may be important in connecting these 2 constructs. These findings provide novel insights into what symptoms may be worth prioritising when treating individuals experiencing psychological distress whilst recovering from mTBI.