Objective: The objective of this observational cohort study was to compare coping strategies and personality traits among individuals with acquired brain injury (ABI), based on their level of depression symptoms.
Methods: Participants were recruited from an ABI outpatient clinic in Ontario, Canada. Participants were selected using the following inclusion criteria: 1) diagnosed with an ABI, 2) 18 years of age, and 3) able to read and write in English. Individuals completed the Patient Health Questionnaire 9-item (PHQ-9), Acceptance and Action Questionnaire, Anxiety Sensitivity Index, Adult Dispositional Hope Scale, Big Five Inventory, Brief Coping Orientation of Problems Experienced, and Rosenberg Self-Esteem Scale. A descriptive analysis was performed for the overall sample, as well as for each subclassification of depression: none (PHQ-9 = 0-4), mild (PHQ-9 = 5-9), moderate (PHQ-9 = 10-14), and severe (PHQ-9 = 15-27). A one-way multivariate analysis of variance, with post hoc Bonferroni-corrected tests, was conducted to assess the impact of depression symptoms on coping strategies and personality traits.
Results: A total of 89 individuals (56.2% females) were included with a mean age of 46.6±15.1 years and a mean Glasgow Coma Scale score of 13.2±3.4. Overall, individuals were 3.5±4.3 years post injury. There was a statistically significant interaction effect between depression groups and the combined coping strategy and personality trait variables (F(36,128)=2.959, p < .001; Wilks' Λ= .167). Individuals with mild (p = .045), moderate (p = .004) and severe (p < .001) depression symptoms had greater experiential avoidance (EA) than those without depression. Those with severe depression symptoms had significantly greater anxiety sensitivity than those with no (p < 0.001), mild, (p = .004) or moderate (p = .025) depression symptoms. Overall, individuals in the no, mild, and moderate depression groups used emotion-focused strategies primarily, followed by dysfunctional strategies for coping. Conversely, those with severe depression symptoms primarily used dysfunctional strategies, followed by emotion-focused strategies to cope. All depression groups applied problem-based coping strategies infrequently.
Conclusions: The use of passive coping strategies combined with increased EA behaviours among severely depressed individuals with ABI may lead to long-term negative outcomes. Programs that promote problem-based coping and reduce EA behaviours may be beneficial in reducing disability and impaired quality of life associated with depression symptoms in individuals with ABI.
Keywords: Brain injury; anxiety sensitivity; coping; depression; dispositional hope; experiential avoidance; self-esteem.