Article

The research attempting to disentangle the directionality of
relationships between mental health and functional outcomes after traumatic brain
injury (TBI) is growing but has yielded equivocal findings or focused on isolated
predictors or isolated outcomes. The purpose of the current study was to use
cross-lagged panel and structural equation modeling (SEM) techniques to examine
causality between comprehensive indices of mental health (depression, anxiety,
and life satisfaction) and functional independence in a national sample of
individuals with TBI over the first 2 years after injury. DESIGN: Participants
were 4,674 individuals with TBI from the TBI Model Systems Database. RESULTS: The
SEM, which yielded good fit indices, suggested that individuals with TBI with
greater mental health problems at 1 and 2 years after injury had lower functional
independence at those same time points. The standardized path loadings for mental
health problems and for functional independence over time were large, suggesting
a high degree of consistency in mental health and functional independence across
1 and 2 years. In terms of cross-lag, mental health at Time 1 did not exert a
unique effect on functional independence at Time 2, but functional independence
at Time 1 exerted a statistically significant but quite small unique effect on
mental health at Time 2. CONCLUSIONS: This combination of results suggests that
functional independence is only slightly more causal than mental health in the
relationship between mental health and functional independence over the first 2
years post-TBI, and that instead, reciprocal causality is a more likely scenario.
TO CLAIM CME CREDITS: Complete the self-assessment activity and evaluation online
at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this
article, the reader should be able to: (1) understand the nature of the
relationship between mental health problems and functional independence after
traumatic brain injury; (2) learn about a novel methodological technique for
examining the connections between variables over time; and (3) understand when
ongoing support for individuals with traumatic brain injury is necessary. LEVEL:
Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by
the Accreditation Council for Continuing Medical Education to provide continuing
medical education for physicians.The Association of Academic Physiatrists
designates this activity for a maximum of 1.5 AMA PRA Category 1 Credit(s).
Physicians should only claim credit commensurate with the extent of their
participation in the activity.

Langue : ANGLAIS