Browsing by Author "Neumann, Dawn"

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    Anxiety Trajectories the First 10 Years After a Traumatic Brain Injury (TBI): A TBI Model Systems Study
    (Elsevier, 2022-11) Neumann, Dawn; Juengst, Shannon B.; Bombardier, Charles H.; Finn, Jacob A.; Miles, Shannon R.; Zhang, Yue; Kennedy, Richard; Rabinowitz, Amanda R.; Thomas, Amber; Dreer, Laura E.; Physical Medicine and Rehabilitation, School of Medicine
    Objective Determine anxiety trajectories and predictors up to 10 years posttraumatic brain injury (TBI). Design Prospective longitudinal, observational study. Setting Inpatient rehabilitation centers. Participants 2836 participants with moderate to severe TBI enrolled in the TBI Model Systems National Database who had ≥2 anxiety data collection points (N=2836). Main Outcome Measure Generalized Anxiety Disorder-7 (GAD-7) at 1, 2, 5, and 10-year follow-ups. Results Linear mixed models showed higher GAD-7 scores were associated with Black race (P<.001), public insurance (P<.001), pre-injury mental health treatment (P<.001), 2 additional TBIs with loss of consciousness (P=.003), violent injury (P=.047), and more years post-TBI (P=.023). An interaction between follow-up year and age was also related to GAD-7 scores (P=.006). A latent class mixed model identified 3 anxiety trajectories: low-stable (n=2195), high-increasing (n=289), and high-decreasing (n=352). The high-increasing and high-decreasing groups had mild or higher GAD-7 scores up to 10 years. Compared to the low-stable group, the high-decreasing group was more likely to be Black (OR=2.25), have public insurance (OR=2.13), have had pre-injury mental health treatment (OR=1.77), and have had 2 prior TBIs (OR=3.16). Conclusions A substantial minority of participants had anxiety symptoms that either increased (10%) or decreased (13%) over 10 years but never decreased below mild anxiety. Risk factors of anxiety included indicators of socioeconomic disadvantage (public insurance) and racial inequities (Black race) as well as having had pre-injury mental health treatment and 2 prior TBIs. Awareness of these risk factors may lead to identifying and proactively referring susceptible individuals to mental health services.
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    Assessing Negative Attributions After Brain Injury With the Ambiguous Intentions Hostility Questionnaire
    (Wolters Kluwer, 2020-09) Neumann, Dawn; Sander, Angelle M.; Perkins, Susan M.; Bhamidipalli, Surya Sruthi; Witwer, Noelle; Combs, Dennis; Hammond, Flora M.; Physical Medicine and Rehabilitation, School of Medicine
    OBJECTIVES: (1) To explore the construct validity of the Ambiguous Intentions Hostility Questionnaire (AIHQ) in participants with traumatic brain injury (TBI) (ie, confirm negative attributions are associated with anger and aggression); and (2) use the AIHQ to examine negative attribution differences between participants with and without TBI. SETTING: Two rehabilitation hospitals. PARTICIPANTS: Eighty-five adults with TBI and 86 healthy controls (HCs). DESIGN: Cross-sectional survey. MAIN MEASURES: The AIHQ, a measure of negative attributions (intent, hostility, and blame), anger, and aggressive responses to hypothetical scenarios. RESULTS: Attributions were significantly correlated with anticipated anger and aggressive responses to AIHQ scenarios. Compared with HCs, participants with TBI reported stronger negative attributions (P ≤ .001), anger (P = .021), and aggressive responses (P = .002) to the scenarios. CONCLUSION: Negative attributions were associated with anger and aggression responses, demonstrating construct validity of the AIHQ in the TBI population. Participants with TBI judged others' behaviors more severely than HCs, similar to prior research using a different attribution measure. The AIHQ has promise as a practical instrument for assessing negative attributions after TBI.
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    Assessment of Boys' Responses to Interpersonal Conflict in Virtual Reality
    (Mary Ann Liebert, 2023) Hummer, Tom A.; Wood, Zebulun M.; Miller, Kevin; McCarthy, Rachel L.; Brickman, Jocelyn E.; Neumann, Dawn; Psychiatry, School of Medicine
    Background: Continuous advances in virtual reality (VR) technology have increased its potential for clinical use in the research, assessment, and treatment of mental health difficulties. One potential target for VR use is childhood behavior problems, which are often associated with social-cognitive deficits that can be difficult to measure or modify. Materials and Methods: We enrolled 36 boys between the ages of 8–13 to assess the usability of a VR device and its feasibility as a psychiatric tool for youth. Each participant experienced three virtual school cafeteria scenes that varied in antisocial content and the intentions of a virtual counterpart (VC) (control, ambiguous, or hostile). Following each scene, participants completed questions about ease and comfort in using the headset as well as an assessment of hostile attribution bias (HAB). HAB is the tendency to attribute hostile motivations to others' behaviors, which contributes to antisocial thoughts and behaviors. Following this VR use, participants completed a standard text assessment of HAB. Results: In general, participants reported the VR headset to be enjoyable and easy to use, and scenes worked as intended, with VCs in the hostile scene rated the meanest. In addition, boys with more conduct problems reported that virtual characters were meaner to them, despite no difference in text vignette measures of HAB. Conclusion: This study provides preliminary evidence supporting the further development of VR programs to assess and treat childhood behavior problems.
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    Demographic and Mental Health Predictors of Arrests Up to 10 Years Post-Traumatic Brain Injury: A Veterans Affairs TBI Model Systems Study
    (Wolters Kluwer, 2021-07) Miles, Shannon R.; Silva, Marc A.; Neumann, Dawn; Dillahunt-Aspillaga, Christina; Corrigan, John D.; Tang, Xinyu; Eapen, Blessen C.; Nakase-Richardson, Risa; Physical Medicine and Rehabilitation, School of Medicine
    OBJECTIVE: Examine rates and predictors of arrests in Veterans and Service Members (V/SM) who received inpatient rehabilitation for traumatic brain injury (TBI). SETTING: Veterans Administration (VA) Polytrauma Rehabilitation Centers. PARTICIPANTS: A total of 948 V/SM drawn from the VA TBI Model Systems cohort with arrest data up to 10 years post-TBI. DESIGN: Longitudinal cohort study; secondary analysis of pre-TBI characteristics predicting post-TBI arrests. MAIN MEASURES: Disclosure of arrests pre-TBI and up to10 years post-TBI. RESULTS: Thirty-six percent of the sample had been arrested prior to their TBI; 7% were arrested post-TBI. When considering all variables simultaneously in a multivariate model, pre-TBI mental health treatment (adjusted odds ratio [aOR] = 4.30; 95% confidence interval [CI]: 2.03-9.14), pre-TBI heavy alcohol use (aOR = 3.04; CI: 1.08-8.55), and number of follow-up interviews (aOR = 2.05; CI: 1.39-4.50) were significant predictors of post-TBI arrest. CONCLUSION: Arrest rates of V/SM prior to TBI were consistent with rates of arrest for people of similar ages in the United States. Post-TBI rates were lower for V/SM than published rates of post-TBI arrests in civilians with TBI. As part of rehabilitation planning for V/SM with TBI, providers should assess for preinjury mental health services and alcohol misuse to (1) identify those who may be at risk for postinjury arrests and (2) provide relevant resources and/or supports.
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    Empathic Responses to Affective Film Clips Following Brain Injury and the Association with Emotion Recognition Accuracy
    (Elsevier, 2018) Neumann, Dawn; Zupan, Barbra; Physical Medicine and Rehabilitation, School of Medicine
    Objective To compare empathic responses to affective film clips in participants with traumatic brain injury (TBI) and Healthy controls (HCs), and examine associations with affect recognition. Design Cross sectional study using a quasi-experimental design. Setting Multi-site study conducted at a post-acute rehabilitation facility in the USA and a University in Canada. Participants A convenience sample of 60 adults with moderate to severe TBI and 60 HCs, frequency matched for age and sex. Average time post-injury was 14 years (range: .5-37) Main Outcome Measures Participants were shown affective film clips and asked to report how the main character in the clip felt and how they personally felt in response to the clip. Empathic responses were operationalized as participants feeling the same emotion they identified the character to be feeling. Results Participants with TBI had lower emotion recognition scores (p=.007) and fewer empathic responses than HCs (67% vs. 79%; p<.001). Participants with TBI accurately identified and empathically responded to characters’ emotions less frequently (65%) than HCs (78%). Participants with TBI had poorer recognition scores and fewer empathic responses to sad and fearful clips compared to HCs. Affect recognition was associated with empathic responses in both groups (p<.001). When participants with TBI accurately recognized characters’ emotions, they had an empathic response 71% of the time, which was more than double their empathic responses for incorrectly identified emotions. Conclusions Participants with TBI were less likely to recognize and respond empathically to others’ expressions of sadness and fear, which has implications for interpersonal interactions and relationships. This is the first study in the TBI population to demonstrate a direct association between an affect stimulus and an empathic response.
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    Evaluating Negative Attributions in Persons With Brain Injury: A Comparison of 2 Measures
    (Wolters Kluwer, 2021-05) Neumann, Dawn; Sander, Angelle M.; Witwer, Noelle; Jang, Jeong Hoon; Bhamidipalli, Surya Sruthi; Hammond, Flora M.; Physical Medicine and Rehabilitation, School of Medicine
    Objectives: To compare construct and predictive validity, readability, and time-to-administer of 2 negative attribution measures in participants with traumatic brain injury (TBI). Setting: Two TBI rehabilitation hospitals. Participants: Eighty-five adults with complicated mild to severe TBI. Main Measures: Negative attributions (intent, hostility, and blame) and anger responses to hypothetical scenarios were measured with the Epps scenarios and the Ambiguous Intention Hostility Questionnaire (AIHQ). Trait aggression was measured with the Buss-Perry Aggression Questionnaire (BPAQ). Results: Associations between attributions and anger responses (ie, construct validity) within each measure were significant (Epps: r = 0.61-0.74; AIHQ: r = 0.39-0.71); however, associations were stronger for Epps (Ps < .001). Receiver operating characteristics (ROC) revealed attributions from both measures predicted BPAQ scores (area under the ROC curves = 0.6-0.8); predictive validity did not statistically differ between the 2 measures. Both had comparable readability (fifth- to sixth-grade levels), but Epps required longer administration times. Conclusion: Negative attributions affect anger and aggression after TBI, making it important to identify suitable assessments for the TBI population. While psychometric properties of the AIHQ and Epps scenarios should be further explored, this study offers early support for the use of either instrument in persons with TBI. Advantages and disadvantages of the AIHQ and Epps scenarios are highlighted.
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    Evolution of Irritability, Anger, and Aggression after Traumatic Brain Injury: Identifying and Predicting Subgroups
    (Liebert, 2021) Miles, Shannon R.; Hammond, Flora M.; Neumann, Dawn; Silva, Marc A.; Tang, Xinyu; Kajankova, Maria; Dillahunt-Aspillaga, Christina; Nakase-Richardson, Risa; Physical Medicine and Rehabilitation, School of Medicine
    The current prospective, multi-center, longitudinal cohort study examined how veterans/service members (V/SM) changed in their irritability, anger, and aggression (IAA) scores from admission to discharge in post-acute rehabilitation settings. The goals were to identify trajectory subgroups, and explore if there were different predictors of the subgroups. V/SM (n = 346) from five Veterans Affairs TBI Model Systems Polytrauma Rehabilitation Centers participated. The sample was mostly men (92%) and identified as white (69%), black (13%), and other races (18%). Median age was 28 years, and 78% had sustained a severe TBI. Staff rated IAA at admission and discharge using the Mayo-Portland Adaptability Inventory-4 item#15. Four IAA trajectory subgroups were identified: (1) no IAA at admission or discharge (n = 89, 25.72%), (2) resolved IAA (n = 61, 17.63%), (3) delayed onset IAA (n = 31, 8.96%), and (4) persistent IAA (n = 165, 47.69%). Greater post-traumatic stress disorder (PTSD) symptoms were the only consistent predictor of belonging to all the subgroups who had IAA compared with the no IAA subgroup. We conclude that IAA had different trajectories after a TBI. The majority of V/SM had persistent impairment from IAA, a quarter of the sample had no impairment from IAA, and fewer participants had resolving or worsening IAA. Findings emphasize the importance of educating providers and family of the different ways and times that IAA can manifest after TBI. Timely diagnosis and treatment of PTSD symptoms during and after rehabilitation are critical treatment targets.
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    Evolution of Irritability, Anger, and Aggression after Traumatic Brain Injury: Identifying and Predicting Subgroups
    (Mary Ann Liebert, 2021) Miles, Shannon R.; Hammond, Flora M.; Neumann, Dawn; Silva, Marc A.; Tang, Xinyu; Kajankova, Maria; Dillahunt-Aspillaga, Christina; Nakase-Richardson, Risa; Physical Medicine and Rehabilitation, School of Medicine
    The current prospective, multi-center, longitudinal cohort study examined how veterans/service members (V/SM) changed in their irritability, anger, and aggression (IAA) scores from admission to discharge in post-acute rehabilitation settings. The goals were to identify trajectory subgroups, and explore if there were different predictors of the subgroups. V/SM (n = 346) from five Veterans Affairs TBI Model Systems Polytrauma Rehabilitation Centers participated. The sample was mostly men (92%) and identified as white (69%), black (13%), and other races (18%). Median age was 28 years, and 78% had sustained a severe TBI. Staff rated IAA at admission and discharge using the Mayo-Portland Adaptability Inventory-4 item#15. Four IAA trajectory subgroups were identified: (1) no IAA at admission or discharge (n = 89, 25.72%), (2) resolved IAA (n = 61, 17.63%), (3) delayed onset IAA (n = 31, 8.96%), and (4) persistent IAA (n = 165, 47.69%). Greater post-traumatic stress disorder (PTSD) symptoms were the only consistent predictor of belonging to all the subgroups who had IAA compared with the no IAA subgroup. We conclude that IAA had different trajectories after a TBI. The majority of V/SM had persistent impairment from IAA, a quarter of the sample had no impairment from IAA, and fewer participants had resolving or worsening IAA. Findings emphasize the importance of educating providers and family of the different ways and times that IAA can manifest after TBI. Timely diagnosis and treatment of PTSD symptoms during and after rehabilitation are critical treatment targets.
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    Examination of Social Inferencing Skills in Men and Women After Traumatic Brain Injury
    (Elsevier, 2022-05) Neumann, Dawn; Mayfield, Ryan; Sander, Angelle M.; Jang, Jeong Hoon; Bhamidipalli, Surya Sruthi; Hammond, Flora M.; Physical Medicine and Rehabilitation, School of Medicine
    Objective To examine sex differences in social inferencing deficits after traumatic brain injury (TBI) and to examine the odds of men and women being impaired while controlling for potential confounders. Design Cross-sectional survey. Setting Two TBI rehabilitation hospitals. Participants One hundred five participants with TBI (60 men, 45 women) and 105 controls without TBI (57 men, 48 women) (N=210). Interventions Not applicable. Main Outcome Measures The Awareness of Social Inference Test (TASIT), which includes (1) Emotion Evaluation Test (EET), (2) Social Inference-Minimal (SI-M) test, and (3) Social Inference-Enriched (SI-E) test. Results Within the control sample, men and women performed similarly on all 3 TASIT subtests. Within the group with TBI, men had significantly lower scores than women on EET (P=.03), SI-M (P=.01), and SI-E (P=.04). Using impairment cutoffs derived from the sample without TBI, we found significantly more men with TBI (30%) were impaired on the EET than women (16.7%); impairment was similar between men and women on SI-M and SI-E. When adjusting for executive functioning and education, the odds of being impaired on the EET did not significantly differ for men and women (odds ratio, 0.47; 95% CI, 0.16-1.40; P=.18). Conclusions Although more men with TBI have emotion perception deficits than women, the difference appears to be driven by education and executive functioning. Research is needed in larger samples with more definitive norms to better understand social inferencing impairments in men and women with TBI as well as translation to interpersonal behaviors.
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    Exploration of a new tool for assessing emotional inferencing after traumatic brain injury
    (Taylor and Francis, 2015-05) Zupan, Barbra; Neumann, Dawn; Babbage, Duncan R.; Willer, Barry; Department of Physical Medicine and Rehabilitation, IU School of Medicine
    bjective: To explore validity of an assessment tool under development—the Emotional Inferencing from Stories Test (EIST). This measure is being designed to assess the ability of people with traumatic brain injury (TBI) to make inferences about the emotional state of others solely from contextual cues. Methods and procedures: Study 1: 25 stories were presented to 40 healthy young adults. From this data, two versions of the EIST (EIST-1; EIST-2) were created. Study 2: Each version was administered to a group of participants with moderate-to-severe TBI—EIST 1 group: 77 participants; EIST-2 group: 126 participants. Participants also completed a facial affect recognition (DANVA2-AF) test. Participants with facial affect recognition impairment returned 2 weeks later and were re-administered both tests. Main outcomes: Participants with TBI scored significantly lower than the healthy group mean for EIST-1, F(1,114) = 68.49, p < 0.001, and EIST-2, F(1,163) = 177.39, p < 0.001. EIST scores in the EIST-2 group were significantly lower than the EIST-1 group, t = 4.47, p < 0.001. DANVA2-AF scores significantly correlated with EIST scores, EIST-1: r = 0.50, p < 0.001; EIST-2: r = 0.31, p < 0.001. Test–re-test reliability scores for the EIST were adequate. Conclusions: Both versions of the EIST were found to be sensitive to deficits in emotional inferencing. After further development, the EIST may provide clinicians valuable information for intervention planning.