Discerning the Social Support Factors That Protect Against Psychological Complications in Traumatic Brain Injury Patients: A Cohort Study

Introduction: Patients with traumatic brain injury (TBI) are at risk of developing depression, anxiety, and post-traumatic stress disorder (PTSD). Social support has been associated with decreased incidence of these complications. This study aims to discern which aspects of TBI patients’ social support systems are most protective against psychological complications.

Methods: A cohort of patients with TBI were selected from the All of Us database (N = 6,780, Concept ID: 4132546). A total of 28 survey questions, addressing various aspects of social support, were analyzed. Survey responses reflected varying degrees of agreement from participants. The dependent variables were post-TBI psychological complications: depressive disorder (Concept ID: 440383), anxiety (Concept ID: 441542), and PTSD (Concept ID: 436676). Logistic regression was used to evaluate whether survey responses could predict these psychological outcomes. Statistical significance was set at an alpha level of 0.05.

Results: Of the 6689 survey respondents with TBI, 67.7% (N = 4528) exhibited psychological complications. Univariate linear regression revealed 18 out of 28 survey items correlate to complications (seven (7) positive correlations; 11 negative correlations). The strongest positive association (b = +0.78, p < 0.0001) was financial and food insecurity. The strongest negative association (b = -0.44, p < 0.0001) was the ability to find companionship. Likewise, a lack of companionship was a positive predictor (b = +0.34, p < 0.0001). Generally, agreement with items referencing personal connectedness (to "someone" or a spiritual being) were negatively correlated with complications; whereas endorsing items referencing emotional distance from others ("people" and power dynamics) positively correlated to complications.

Conclusion : While lack of resources is a positive predictor of anxiety, depression, and PTSD; emotional closeness is the most protective aspect of social support. These results underscore the importance of post-TBI interventions focused on relationship building and social engagement in preventing psychological complications in TBI patients.