Correlates of self-rated resilience following traumatic brain injury

Resilience reflects the capacity of persons to continue to function in a positive way in the context of adverse conditions. Prior research has suggested that resilience may affect emotional adjustment and quality of life after traumatic brain injury (TBI). The purpose of this investigation was to determine to what extent self-rated resilience influences cognitive test performance after TBI.

We conducted a retrospective analysis of data collected during routine clinical care over a period of about 3 years at a regional rehabilitation facility. Participants included 100 adult persons with TBI (46% uncomplicated mild injury, 32% complicated mild injury and 22% severe injury). They had been clinically referred and seen for an outpatient neuropsychological evaluation within 1-36 months post injury. Main measures included the Connor-Davidson Resilience Scale-10 (CD - RISC-10), Patient Health Questionnaire-9 (PHQ-9), General Anxiety Disorder-7 (GAD-7), and Trail MakingTest (TMT).

Self-rated resilience, as reflected in CD - RISC-10 ratings, had strong negative correlations with symptoms of depression (PHQ-9) and anxiety (GAD-7). As expected, worse injury severity, older age and lower education level were associated with worse performance on both parts of the TMT (all p's< .03). Importantly, beyond those influences, self-rated resilience was also positively associated with TMT performance. However, this was the case only in those who had threshold levels of normal resilience.

Across the range of TBI severity, resilience as self-rated on the CD - RISC-10 is strongly related to subjective symptoms of anxiety and depression. It does not have a linear relationship with objective cognitive test performance. Instead, a minimum level of normal resilience is needed in order for it to support cognition after TBI. Findings of sub-threshold levels of resilience would support interventions to boost it and thereby potentially improve outcomes.