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Coping strategies and personality traits among individuals with brain injury and depressive symptoms.

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.