Initiation and awareness as concepts in depression and traumatic brain injury: word generation and figural fluency

The relationship of word generation (WG) and figural fluency (FF) to symptoms of depression was examined in traumatic brain injury (TBI). A higher severity score on the Beck Depression Inventory (BDI-II) was related to lower WG scores in examinees with suspected or uncomplicated mTBI (n = 75, FAS: r = -.23, p =.04; Animals: r = -.22, p = .06), and the size of correlations increased when a stricter validity inclusion criterion was utilized (n = 50, FAS: r = -.45, p = .001; Animals: r =-.37, p = .0076). Similar-sized negative correlations between WG and BDI-II scores were identified in a smaller sample comprised of complicated mTBI and moderate to severe TBI (n = 36), yet lower depression severity scores were associated with lower output scores on FF (r =.46, p = .002) and lower Glasgow Coma Scale (GCS) scores (r = .35, p = .04), suggesting reduced emotional awareness in some severely injured examinees. Age, FAS, and FF accounted for 31 percent of the variance in the full sample of examinees. The association between cognitive tests of initiation and depressive symptoms appears to depend on test sensitivity to dysfunction in specific brain regions, as moderated by TBI severity.