Exploratory Analysis of Changes in Patient-perceived Stress Throughout Traumatic Brain Injury Recovery
Maria Thereza Paulino1, Amanda Fang1, Stephania Tovar-Vargas2, Maral Sakayan1, Danh Nguyen3, Mark Mapstone4, Sigrid Burruss5, Areg Grigorian5, Jeffry Nahmias5, Michael Lopez1, Bernadette Boden-Albala2, Patrick Chen1
1Neurology Traumatic Brain Injury & Concussion (NTBIC) Program, Department of Neurology, 2Joe C. Wen School of Population & Public Health, 3Department of Medicine, 4Department of Neurology, 5Department of Surgery, University of California, Irvine
Objective:
To explore longitudinal changes in patient-perceived stress following traumatic brain injury (TBI).
Background:
With growing recognition of TBI as a chronic condition, there is an increasing need to better characterize patterns in patient-perceived stress and identify factors contributing to prolonged stress.
Design/Methods:
A single-center longitudinal cohort study was performed including all TBI patients evaluated within 3 weeks of injury in our TBI clinic (4/2024-9/2025). Primary outcome: Perceived Stress Scale (0-16) at initial clinic visit (PSS1), 6-month follow-up (PSS2), and change from PSS1 to PSS2. Descriptive and univariate statistics were performed.
Results:
There were 31 patients who completed both PSS1 and PSS2 (mean age 48 ±17; 54.8% female; 35.5% white; 80.6% mild TBI). Median PSS1 was 8 (IQR, 2.5-10) and median PSS2 was 5 (IQR, 2-9). From PSS1 to PSS2, 0 patients reported an increase in stress level, 26 (83.9%) reported no change in stress level, while 5 (16.1%) reported a decrease in stress. Among these 5 patients, the median decrease in PSS was 6 points (IQR, 5-7) or 54.5% decrease in score. There were no significant differences in demographics, TBI-severity, premorbid psychiatric conditions, or Glasgow Outcome Scale-Extended (GOSE) score between the improved vs. non-improved cohort. There was higher initial PSS (11 vs 5.5, p=0.024) and a higher proportion with private insurance (80% vs 23.1%, p=0.027) in those with improved versus static stress.
Conclusions:
Stress is chronic and persistent following TBI, with 83.9% of patients with static PSS 6 months post-TBI. Patients with higher levels of initial stress more often demonstrated improvements in stress longitudinally. Private insurance was associated with improvement in stress in this exploratory analysis, likely pointing to an outcome disparity driven by determinants of health.
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