Emotional and behavioral adjustment after traumatic brain injury

Objectives: To examine emotional and behavioral adjustment and recovery ove r 1 year after traumatic brain injury (TBI), and to determine whether the d ifficulties, if present, are due to neurologic insult. Design: Longitudinal evaluation of adjustment from 1 month to 1 year after injury. Setting: Level I trauma center at a university hospital. Patients: One hundred fifty-seven consecutively hospitalized adults with TB I and 125 trauma controls with other system injuries evaluated at 1 and 12 months after injury. Main Outcome Measures: Katz Adjustment Scale (KAS). Results: The TBI group at 1 year follow-up demonstrated significant emotion al and behavioral maladjustment, but such difficulties did not appear to be mediated by the brain injury, since the KAS scores for the TBI and trauma control groups were not significantly different. Those with moderate TBI re ported greater difficulties than those with mild or severe injuries. Change s in adjustment over 1 year were common for both groups. Within the TBI gro up there was differential recovery: improvement in cognitive clarity, dysph oric mood, and emotional stability, but increased difficulties with anger m anagement, antisocial behaviors, and self-monitoring, Conclusions: These results raise questions about commonly held beliefs that those with mild TBI report greater distress, and clarify some misconceptio ns regarding change in emotional and behavioral functioning over time. (C) 1999 by the American Congress of Rehabilitation Medicine and the American A cademy of Physical Medicine and Rehabilitation.