Data-driven profiles of psychopathology following moderate-severe traumatic brain injury

Objective: To identify data-driven “prototypes” (distinct profiles) of psychopathology among adults with moderate-severe traumatic brain injury (TBI) using a transdiagnostic assessment battery, and to examine predictors of profile membership. Setting: Community survey.Participants: Participants (513 enrolled, 397 analyzed) were sampled from a larger cohort previously admitted consecutively for inpatient rehabilitation. They took part in the current study on average 12.63 years post-injury (range 0.40–35.42). Design: Observational, cross-sectional.Main Measures: A comprehensive battery of psychiatric questionnaires, including the Inventory of Depression and Anxiety Symptoms – Expanded Version (IDAS-II), Somatic Symptom Scale – 8 (SSS-8), Comprehensive Assessment of Traits Relevant to Personality Disorders (CAT-PD), and Externalizing Spectrum Inventory – Brief Form (ESI-BF). This battery was previously validated in the same sample to assess seven transdiagnostic dimensions of psychopathology: four internalizing (Detachment, Dysregulated Negative Emotionality, Somatic Symptoms, Compensatory and Phobic Reactions) and three externalizing (Self-Harm and Psychoticism, Rigid Constraint, Harmful Substance Use). Results: Latent profile analysis identified five profiles: Average Internalizing (29% of participants most resembled this profile), Lower Psychopathology (25%), Elevated Internalizing (21%), Substance Use (16%), and Elevated Psychopathology (10%). In multivariable analyses, younger age, greater self-reported functional disability, lower life satisfaction, and mental health treatment were associated with more severe psychopathology profiles. Male sex and unemployment were associated with the Substance Use profile. Those who were fewer years post-injury and in a relationship were more likely to show a Lower Psychopathology profile relative to Average Internalizing. Education, Glasgow Coma Scale scores, and comorbid orthopedic injuries showed no significant associations with psychopathology profiles. Conclusions: A data-driven categorical approach identified psychopathology profiles following moderate-severe TBI that differed primarily in overall severity. Profiles reflecting greater psychopathology were associated with poorer functioning and subjective well-being, providing some validation. However, clinically relevant variation in post-TBI psychopathology may not readily reduce to a small number of qualitatively discrete categories.