(Research Hub Theater) Does Exposure to Adverse Childhood Experiences Predict Increased Neurobehavioral Symptom Reporting in Adults with Mild Traumatic Brain Injury?

Background and/or Objectives: The Neurobehavioral Symptom Inventory (NSI-22) is a validated, self-reported assessment measure for neurobehavioral symptoms after mild traumatic brain injury (mTBI). Pre-injury psychological factors have been associated with worse outcomes after mTBI. Adverse Childhood Experiences (ACEs) have been associated with psychiatric morbidity in the general population. Although studies have demonstrated association between increased incidence of mTBI with a history of ACEs, the impact of ACEs on outcomes after mTBI is unknown.

Objectives: Examine whether ACEs prior to age 18 are associated with increased neurobehavioral symptoms (NSI-22 scores) in an adult treatment-seeking population with mTBI.

Design: Retrospective cohort study.

Setting: Outpatient multidisciplinary rehabilitation clinic in academic tertiary medical center.

Participants: 78 treatment-seeking participants with a mTBI diagnosis in an outpatient multidisciplinary rehabilitation facility.

Interventions: Not applicable.

Main Outcome Measures: NSI-22 score on admission to rehabilitation clinic.

Results: Of the 78 participants, 51 experienced at least one ACE prior to age 18. Patients who reported at least one ACE prior to age 18 had significantly increased NSI-22 scores on admission compared to patients without history of ACEs (mean difference 10.1, p = 0.011), adjusted for age and gender. Patients with ACEs were more likely to have diagnosis of PTSD (24% versus 4%, p=0.025), mood disorder (96% versus 56%, p< 0.001), substance abuse history (41% versus 11%, p=0.006), sleep disorder (55% versus 22%, p=0.006), and divorce (41% versus 15%, p = 0.018) prior to the mTBI. A LASSO model suggested that domestic violence and household mental illness were key drivers for observed differences in NSI-22 scores.

Conclusions: For patients presenting for treatment after mTBI, a history of ACEs prior to age 18 was associated with increased neurobehavioral symptoms. Further studies are needed to understand the clinical implications of this association in preventing increased neurobehavioral symptoms after mTBI.