A Longitudinal Investigation of Alexithymia as a Predictor of Empathy, Emotional Functioning, Resilience, and Life Satisfaction Two Years after Brain Injury

Objective: To examine the unique contribution of alexithymia at 1 year after traumatic brain injury (TBI) to the prospective prediction of emotional and social health outcomes at 2 years post-injury.

Design: Multicenter, longitudinal cohort study.

Setting: Data were collected during Year 1 and Year 2 post-injury follow-up interviews across four TBI Model System (TBIMS) centers.

Participants: Persons with TBI (N = 175; 134 men and 41 women) who had English fluency and were capable of providing self-report data.

Main outcome measure: Primary independent variable was the Toronto Alexithymia Scale-20. Outcome measures included the Interpersonal Reactivity Index, National Institute of Health Toolbox Emotion Battery Anger, Difficulty with Emotion Regulation Scale, Connor-Davidson Resilience Scale, Posttraumatic Stress Disorder Checklist-Civilian, Satisfaction With Life Scale, General Anxiety Disorder-7, Patient Health Questionnaire-9, suicidal ideation, and problematic substance use.

Results: Simple adjusted models demonstrated that after controlling for the specific outcome at Year 1, TAS-20 scores significantly predicted Year 2 scores for perspective taking, physical aggression, emotion dysregulation, resilience, anxiety, depression, and suicidal ideation. All of these predictive findings except for physical aggression were maintained in the fully adjusted models that also controlled for age, sex, education level, number of prior TBIs, and motor and cognitive functioning.

Conclusions: Compared to those with lower alexithymia scores, persons with TBI who had higher alexithymia scores at 1-year post-injury reported poorer emotional health at 2 years after TBI, even after controlling for Year 1 outcome scores, sociodemographics, and injury-related factors. These results support the need to assess for elevated alexithymia and to provide interventions targeting alexithymia early in the TBI recovery process.