Abstract
OBJECTIVE: To evaluate the associations between resilience and emotional symptoms among service members (SMs) with mild traumatic brain injury (mTBI) and determine whether these relationships vary by the number of lifetime mTBI. DESIGN: Cross-sectional. SETTING: Southwestern US military interdisciplinary traumatic brain injury (TBI) facility. PARTICIPANTS: N=230 SMs being treated for mTBI (92.2% of men, with a mean age of 33.8 years [SD, 8.8] and 13.5 years in active duty [SD, 8.3], and a median of 64.9 months from injury to intake). INTERVENTIONS: Not applicable; however, overall resilience (categorized as low, moderate, and high) and 5 themes (meaning-making and restoration, active coping, cognitive flexibility, spirituality, and self-efficacy) were measured using the Response to Stressful Experiences Scale. MAIN OUTCOME MEASURES: Clinically elevated posttraumatic stress (PTS) and depressive symptoms were measured using the Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Ediction (score≥33) and the 8-item Patient Health Questionnaire (score≥15), respectively. The number of lifetime mTBI (single vs multiple) was ascertained using the Ohio State University TBI Identification Method and evaluated as an interaction term. RESULTS: SMs with higher (vs lower) overall resilience levels were significantly less likely to have clinically elevated PTS and depressive symptoms at pretreatment. These associations did not vary by the number of lifetime mTBIs. By resilience themes, higher levels were associated with a lower likelihood of clinically elevated PTS and depressive symptoms at pretreatment, but for active coping and cognitive flexibility, the relationship with depressive symptoms was only significant among those with a single mTBI. No significant results were found at posttreatment. CONCLUSIONS: The findings may be helpful to inform expectations of recovery and optimal management of symptoms. Future longitudinal studies are needed to evaluate the effect of resilience on mental health issues and why it may not be beneficial in the presence of multiple mTBIs.