Trajectories of life satisfaction after Traumatic Brain Injury: Influence of life roles, age, cognitive disability, and depressive symptoms

Trajectories of life satisfaction after Traumatic Brain Injury: Influence of life roles, age, cognitive disability, and depressive symptoms 

Juengst, S.B., Adams, L.M., Bogner, J.A., Arenth, P.M., O’Neil-Pirozzi, T.M., Dreer, L.E., Hart, T., Bergquist, T.F., Bombardier, C.H., Dijkers, M.P., Wagner, A.K.

This study uses data from the TBI Model Systems National Database to explore factors which impact life satisfaction following traumatic brain injury (TBI). Life satisfaction is an important aspect of life for all people, but particularly for those who sustain a traumatic and potentially life-changing injury. Poor life satisfaction among individuals with TBI is associated with greater functional impact of injury. Individuals with acquired, long-term disabilities often experience fluctuating life satisfaction as they continue to recover and re-enter their previous roles and activities. Life satisfaction depends on an individual’s self-perception of their well-being, in particular, their perception of their participation in life roles (e.g. spouse, friend, worker, parent et cetera). There have been multiple past inquiries into life satisfaction post-TBI, however the current study attempts to determine if there are differing trajectories of life satisfaction across age cohorts, levels of engagement, and disability.

Study participants were individuals who were enrolled in the TBI Model Systems (TBI-MS) National Database and who sustained a moderate or severe TBI and were 16 years of age or older. Additionally, from among this group, individuals included in the analysis were required to have no missing life satisfaction data (which had been collected prospectively at 1-, 2-, and 5- years post-injury). With these inclusion parameters, 3,022 individuals had complete data and were used for the current study. This retrospective study examined data regarding depressive symptoms (PHQ-9), disability (FIM-MOT and FIM-COG), life roles (PART-O), and life satisfaction (SWLS).

Results of this study identified four different trajectories of life satisfaction among the cohort examined. The four trajectories include:

• Stable satisfaction: high life satisfaction across all three time points.
• Stable dissatisfaction: dissatisfaction with life across all three time points.
• Initial dissatisfaction improving: initial dissatisfaction with life but improving satisfaction over time.
• Initial satisfaction declining: initial satisfaction with life but declining satisfaction over time.

Overall, individuals with stable satisfaction trajectory had the highest percentage of young people (16-30 years of age) and the largest proportion of people reporting high levels of participation across relevant life roles at all time points. This group also reported the lowest cognitive disability and depressive symptoms at all time points.

The stable dissatisfaction cohort had the lowest percentage of people reporting high levels of participation across roles and also had the highest report of depressive symptoms and cognitive disability at all time points. The modal age for the stable dissatisfaction group was 31-59 years of age (otherwise defined as middle age).

The group comprised of individuals with initial satisfaction declining over time reported lower participation in work roles and leisure activities and a smaller proportion of this group was older than 60 years of age.

The group comprised of individuals with initial dissatisfaction improving over time began (year 1) with the second lowest life satisfaction and second highest report of depressive symptoms (second only to the stable dissatisfaction group) but, by year 5 reported higher satisfaction and lower depressive symptoms than the initial satisfaction declining group. The initial dissatisfaction group also had the second highest participation reports across time points.

Participation in activities, particularly in work, leisure, and religious activities significantly predicted life satisfaction in this study. Lower participation in these life roles was generally associated with decreased life satisfaction. Individuals reporting higher participation as workers were more likely to demonstrate high stable satisfaction. Those whose satisfaction decreased across time reported less participation in leisure roles than those whose satisfaction remained high. Additionally, the current study found that cognitive disability rather than physical disability was most predictive of life satisfaction trajectory; increased cognitive disability was associated with stable dissatisfaction trajectory and decreased cognitive disability associated with stable satisfaction.

This information tells us that it is critically important for individuals to return to previous activities or develop new meaningful life roles after TBI. Therefore, it is important to encourage and promote engagement in vocational rehabilitation services, early community re-entry (as appropriate), leisure activities, and community involvement as recovery continues. Even for those who are unable to return to work due to disability post-TBI, engagement with family, friends, and community are critical to well-beingand life satisfaction. Additionally, for this sample depressive symptoms were potent indicators and predictors of life satisfaction (and dissatisfaction). The authors recommend depression monitoring and intervention for individuals who have sustained TBI so that appropriate services and treatments might be applied to prevent decline. Behavioral activation interventions may serve a dual function in this case: treating depressive symptoms while also increasing activity and role engagement.

The construct of life role participation may capture an aspect of disability not identified by the FIM rating system and, may be more important to life satisfaction post-TBI than motor or cognitive disability.

Who may be affected by these findings?

Individuals who have sustained a TBI, their loved ones, and health care practitioners working with individuals who have sustained TBI.

Caveats

This sample includes individuals with complete data, which is a relatively small subset of the entire database sample. Therefore, while these results are meaningful, generalizations across the TBI population should be made with caution. Since life satisfaction is measured by self-report, individuals who are not able to answer the questions are not represented. Finally, some pre-morbid characteristics of individuals in the sample were not known; these factors may have important bearing on life-satisfaction post-injury but they were unable to be examined in this group.

Bottom Line

Individuals who sustain TBI have different life satisfaction trajectories which are influenced by level of life role engagement, depressive symptomology, age, and disability. It is critical that health care providers and family members of those with TBI work to promote re-integration into community living and activities to enhance life satisfaction throughout recovery.

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