Emotional Distress, Neurobehavioral Symptoms, and Social Functioning among Treatment Seeking Service Members with TBI and PTSD Symptoms

Abstract

This study examined the combined effects of traumatic brain injury (TBI) history and posttraumatic stress disorder (PTSD) symptoms on social functioning in treatment-seeking active duty service members. We sought to determine whether objective cognitive performance, self-reported neurobehavioral symptoms, and emotional distress would be associated with more social functioning difficulties. Additionally, we hypothesized self-reported neurobehavioral symptoms would mediate both the relationships between emotional distress and social functioning, and between cognitive performance and social functioning. The study was part of a larger clinical project conducted at two military hospitals. We analyzed smaller datasets of baseline data from two groups: service members with history of TBI and/or PTSD (n = 71) and those with responses considered “valid” (n = 39). A significant predictive relationship among cognitive performance, neurobehavioral symptoms, and emotional distress on social functioning was found in the full sample. Further, neurobehavioral symptoms completely mediated the relationship between emotional distress and social functioning, but not between cognitive performance and social functioning. In the subsample, the overall regression was significant, but individual independent predictors were not. Findings suggest emotional distress and self-reported neurobehavioral symptoms are key considerations in treatment as a means of improving functioning in social domains and prioritizing treatment goals.

Keywords:

• Traumatic brain injury
• TBI
• posttraumatic stress disorder
• PTSD
• emotional distress
• neurobehavioral symptoms
• social functioning
• treatment seeking
• active duty
• service members
• military

Disclosure statement

The opinions expressed in this manuscript are those of the authors and do not necessarily represent the opinions of the Uniformed Services University of the Health Sciences, the Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., the Department of Defense, or the United States Government. Additionally, the authors have no conflicts of interests to report. The authors have also not submitted this article simultaneously to any other journals for publication and it has not yet been published elsewhere.

Notes

1 Given the possibility that the inclusion of individuals with moderate or severe TBI could impact the results, sensitivity analyses were conducted using only participants with mild TBI (mTBI). The pattern of results in the correlational, regression, and mediation analyses all remained the same as in the full sample.