Predictors of Anxiety Symptoms Over the 10 Years After TBI in Asian Americans/Pacific Islanders: A Model System Study

Abstract

Background

Anxiety symptoms are common after traumatic brain injury (TBI), and its impact over time may be influenced by demographic and injury-related factors. Specifically, there is a need to characterize post-injury anxiety symptom trajectories after TBI in understudied racial/ethnic groups.

Objective

To examine demographic and injury-related predictors of anxiety trajectories over the first 10 years following TBI in an Asian American and Pacific Islander (AAPI) sample.

Methods

Participants were 272 individuals enrolled in the U.S. TBI Model System study. Participants self-identified as AAPI and completed the Generalized Anxiety Disorder-7 scale (GAD-7) at 1, 2, 5, and/or 10-year post-injury follow ups. Over the 10-year period, unconditional growth models assessed curvature of GAD-7 score trajectories, and hierarchical linear modeling (HLM) identified baseline predictors of those trajectories. Secondary HLMs assessed changes in anxiety trajectory slopes over time as a function of significant baseline predictors.

Results

Clinically significant anxiety symptoms affected 10.9–13.4% of the participants across the four time points. Over 10 years, anxiety was characterized by a linear, flat/stable, low-level trajectory. A higher overall anxiety trajectory was predicted by lower educational attainment and pre-injury history (vs. no such history) of mental health treatment, with no significant interactions between these predictors over time.

Conclusions

Educational background and pre-injury mental health history are risk factors in the development and maintenance of anxiety symptoms in AAPIs with TBI and should be considered in culturally responsive screening and intervention. The disaggregation of AAPI subgroups may be help reframe and target treatment efforts in this heterogeneous population.