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

OBJECTIVE

To examine whether ageing with a TBI was associated with a greater burden of health-related comorbidities compared to 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 centre or telephone.

PARTICIPANTS

The study included 559 participants (NTBI=291, NControls=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% CI [1.37, 5.35]). Cardiovascular and physical health comorbidities were not elevated in the TBI group compared to controls. Both cohorts had three 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 to controls.

CONCLUSION

TBI was associated with greater mental, but not physical, health comorbidities in the decades following injury. However, physical and mental health comorbidities significantly impacted 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.

The utility of the Cognitive Reserve Index questionnaire in chronic traumatic brain injury

Objective: This study examined the relationship between cognitive reserve measured with the Cognitive Reserve Index questionnaire (CRIq) and cognitive and functional outcomes in a chronic traumatic brain injury (TBI) cohort compared to a non-TBI cohort. The utility of the CRIq was compared to common proxies of cognitive reserve (premorbid IQ and years of education) in TBI and non-TBI cohorts. Method: Participants were 105 individuals with moderate-severe TBI (10-33 years post injury) and 91 participants without TBI. Cognitive outcome was examined across four cognitive factors; verbal memory, visual ability and memory, executive attention, and episodic memory. Functional outcome was measured using the Glasgow Outcome Scale Extended. The CRIq total score and three subscale scores (education, work, leisure) were examined. Results: In the TBI cohort, associations were identified between two CRIq subscales and cognitive factors (CRIq education and verbal memory; CRIq work and executive attention). There were no associations between CRIq leisure and cognitive outcomes, or between CRIq and functional outcome. Model selection statistics suggested premorbid IQ and years of education provided a better fit than the CRIq for the relationship between cognitive reserve with two cognitive factors and functional outcome, with neither model providing an improved fit for the remaining two cognitive factors. This finding was broadly consistent in the non-TBI cohort. Conclusion: Cognitive reserve contributes significantly to long-term clinical outcomes following moderate-severe TBI. The relationship between cognitive reserve and long-term cognitive and functional outcomes following TBI is best characterised with traditional proxies of cognitive reserve, mainly premorbid IQ, rather than the CRIq.

The prevalence and correlates of haematological abnormalities in adult inpatients with anorexia nervosa

Introduction

There is only limited literature concerning haematological abnormalities in anorexia nervosa (AN), with little past investigation into these abnormalities in adult AN patients admitted to inpatient eating disorder (ED) units.

Objectives

This study sought to determine the prevalence and severity of haematological abnormalities in admitted AN patients, and to examine correlates of these abnormalities.

Methods

All adult patients with a clinical diagnosis of AN admitted to the Cotswold House specialist ED inpatient unit between November 2013 and December 2014 were included in the study. Demographic, anthropometric and haematological parameters were systematically recorded for the duration of each admission. The proportions of patients affected by haematological abnormalities (anaemia, leucocytopaenia, neutropaenia, thrombocytopaenia and pancytopaenia) were selected as primary outcomes, and binary logistic regression was performed using SPSS 22.0.

Results

A total of 37 AN patients (91.9% female; mean age: 29.7 years) were included in this study, with a mean admission BMI of 13.7 kg/m2 (SD: 1.8) and a mean admission duration of 128 days; 54.1% of patients were anaemic, 64.9% of patients experienced leucocytopaenia, 56.8% of patients developed neutropaenia, 16.2% of patients suffered thrombocytopaenia, and 8.1% of patients were pancytopaenic. Logistic regression identified low admission BMI (P = 0.009) and low serum albumin level (P = 0.017) as significant correlates of anaemia, and isolated increased age (P = 0.034) as a significant associate of leucocytopaenia.

Conclusions

Haematological abnormalities occur frequently in AN inpatients. Given the frequency at which abnormalities occurred in this cohort, further large-scale and prospective studies examining haematological abnormalities in inpatient AN populations are warranted.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Empirical examination of the interpersonal maintenance model of anorexia nervosa

OBJECTIVE

A cognitive interpersonal maintenance model of anorexia nervosa (AN) was first proposed in 2006 and updated in 2013 (Schmidt and Treasure, J Br J Clin Psychol, 45, 343-366, 2006; Treasure and Schmidt, J Eat Disorders, in press.). The aim of this study was to test the interpersonal component of this model in people with AN requiring intensive hospital treatment (inpatient/day patient).

METHOD

On admission to hospital women with AN or eating disorder not otherwise specified (AN subtype; n = 152; P) and their primary carers (n = 152; C) completed questionnaires on eating symptoms (P), depression and anxiety (P, C), accommodation and enabling (C), and psychological control (C). Structural equation modeling was used to examine relationships among these components.

RESULTS

Carers' expressed emotion and level of psychological control were significantly related to carers' distress, which in turn, was related to patients' distress. This pathway significantly predicted eating symptoms in patients.

DISCUSSION

The cognitive interpersonal maintenance model of eating disorders (EDs) was confirmed in part and suggests that interventions targeting interpersonal maintaining factors such as carer distress might impact on patient outcomes.