Skip to main content
SpringerLink
Log in

Resilience and Other Possible Outcomes After Mild Traumatic Brain Injury: a Systematic Review

  • Review
  • Published:
Neuropsychology Review Aims and scope Submit manuscript

Abstract

The relation between resilience and mild traumatic brain injury (TBI) outcome has been theorized but empirical studies have been scarce. This systematic review aimed to describe the research in this area. Electronic databases (Medline, CINAHL, PsychINFO, SPORTdiscus, and PILOTS) were searched from inception to August 2015 for studies in which resilience was measured following TBI. The search terms included ‘TBI’ ‘concussion’ ‘postconcussion’ ‘resilience’ and ‘hardiness’. Inclusion criteria were peer reviewed original research reports published in English, human participants aged 18 years and over with brain injury, and an accepted definition of mild TBI. Hand searching of identified articles was also undertaken. Of the 71 studies identified, five studies were accepted for review. These studies were formally assessed for risk of bias by two independent reviewers. Each study carried a risk of bias, most commonly a detection bias, but none were excluded on this basis. A narrative interpretation of the findings was used because the studies reflected fundamental differences in the conceptualization of resilience. No studies employed a trajectory based approach to measure a resilient outcome. In most cases, the eligible studies assessed trait resilience with a scale and used it as a predictor of outcome (postconcussion symptoms). Three of these studies showed that greater trait resilience was associated with better mild TBI outcomes (fewer symptoms). Future research of the adult mild TBI response that predicts a resilient outcome is encouraged. These studies could yield empirical evidence for a resilient, and other possible mild TBI outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Notes

  1. We also use the phrases “resilient outcome” and “resilient response” for this idea.

  2. The results were not stratified by injury severity.

References

  • American Congress of Rehabilitation Medicine. (1993). Mild Traumatic Brain Injury Committee of the Head Injury Interdisciplinary Special Interest Group of the American Congress of Rehabilitation Medicine: Definition of mild traumatic brain injury. The Journal of Head Trauma Rehabilitation, 8, 86–87.

    Article  Google Scholar 

  • Barker-Collo, S. L., & Feigin, V. L. (2008). Capturing the spectrum: suggested standards for conducting population-based traumatic brain injury incidence studies. Neuroepidemiology, 32, 1–3. doi:10.1159/000170084.

    Article  PubMed  Google Scholar 

  • Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the Beck Depression Inventory-II (Finnish version). San Antonio.

  • Belanger, H. G., Vanderploeg, R. D., & Curtiss, G. (in press). TBC. In J. E. Morgan, & J. H. Ricker (Eds.), Textbook of clinical neurospcyhology: Second edition. Taylor & Francis.

  • Bonanno, G. A. (2004). Loss, trauma, and human resilience: Have we underestimated the human capacity to thrive after extremely aversive events? American Psychologist, 59(1), 20–28.

    Article  PubMed  Google Scholar 

  • Bonanno, G. A. (2012). Uses and abuses of the resilience construct: Loss, trauma, and health-related adversities. Social Science & Medicine, 74(5), 753–756.

    Article  Google Scholar 

  • Bonanno, G. A., & Diminich, E. D. (2013). Positive adjustment to adversity: Trajectories of minimal-impact resilience and emergent resilience. Journal of Child Psychology and Psychiatry: Annual Research Review, 54, 378–401.

    Article  Google Scholar 

  • Bonanno, G. A., Kennedy, P., Galatzer-Levy, I. R., Lude, P., & Elfström, M. L. (2012). Trajectories of resilience, depression, and anxiety following spinal cord injury. Rehabilation Psychology, 57(3), 236–247. doi:10.1037/a0029256.

    Article  Google Scholar 

  • Borgaro, S. R., Gierok, S., Caples, H., & Kwasnica, C. (2004). Fatigue after brain injury: Initial reliability study of the BNI Fatigue Scale. Brain Injury, 18(7), 685–690. doi:10.1080/02699050310001646080.

    Article  PubMed  Google Scholar 

  • Broshek, D. K., De Marco, A. P., & Freeman, J. R. (2015). A review of post-concussion syndrome and psychological factors associated with concussion. Brain Injury, 29, 228–237.

    Article  PubMed  Google Scholar 

  • Bryant, R. A., Moulds, M. L., & Guthrie, R. M. (2000). Acute stress disorder scale: A self-report measure of acute stress disorder. Psychological Assessment, 12(1), 61–68. doi:10.1037/1040-3590.12.1.61.

    Article  CAS  PubMed  Google Scholar 

  • Cassidy, J. D., Carroll, L. J., Peloso, P. M., Borg, J., von Holst, H., Holm, L., et al. (2004). Incidence, risk factors and prevention of mild traumatic brain injury: Results of the WHO collaborating centre task force on mild traumatic brain injury. Journal of Rehabilitation Medicine, 36(1 supp 43), 28–60. doi:10.1080/16501960410023732.

    Article  Google Scholar 

  • Cicerone, K. D., & Kalmar, K. (1995). Persistent postconcussion syndrome: The structure of subjective complaints after mild traumatic brain injury. Journal of Head Trauma Rehabilitation, 10(3), 1–17. doi:10.1097/00001199-199506000-00002.

    Article  Google Scholar 

  • Connor, K., & Davidson, J. (2003). Development of a new resilience scale: The Connor-Davidson Resilience Scale (CD-RISC). Depression and Anxiety, 18, 76–82.

    Article  PubMed  Google Scholar 

  • Coronado, V. G., Haileyesus, T., Cheng, T. A., Bell, J. M., Haarbauer-Krupa, J., Lionbarger, M. R., et al. (2015). Trends in sports-and recreation-related traumatic brain injuries treated in US emergency departments: the national electronic injury surveillance system-all injury program (NEISS-AIP) 2001-2012. Journal of Head Trauma Rehabilitation, 30(3), 185–197. doi:10.1097/HTR.0000000000000156.

  • da Costa, B. R., Cevallos, M., Altman, D. G., Rutjes, A. W. S., & Egger, M. (2014). Uses and misues of the STROBE statement: Bibliographic study. British Medical Journal Open, 1, e000048. doi:10.1136/bmjopen-2010-000048.

    Google Scholar 

  • Diaz-Arrastia, R., & Kenney, K. (2014). Epidemiology of traumatic brain injury. In Traumatic brain injury (pp. 181–191). Wiley.

  • Fletcher, D., & Sarkar, M. (2013). Psychological resilience: A review and critique of definitions, concepts, and theory. European Psychologist, 18(1), 12–23. doi:10.1027/1016-9040/a000124.

    Article  Google Scholar 

  • Galatzer-Levy, I. R., & Bonanno, G. A. (2012). Beyond normality in the study of bereavement: Heterogeneity in depression outcomes following loss in older adults. Social Science & Medicine, 74(12), 1987–1994.

    Article  Google Scholar 

  • Galatzer-Levy, I. R., Bonanno, G. A., & Mancini, A. D. (2010). From marianthal to latent growth mixture modeling: A return to the exploration of individual differences in response to unemployment. Journal of Neuroscience, Psychology, and Economics, 3(2), 116–125.

    Article  Google Scholar 

  • Graham, D. P., Helmer, D. A., Harding, M. J., Kosten, T. R., Petersen, N. J., & Nielsen, D. A. (2013). Serotonin transporter genotype and mild traumatic brain injury independently influence resilience and perception of limitations in veterans. Journal of Psychiatric Research, 47(6), 835–842.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hirtz, D., Thurman, D., Gwinn-Hardy, K., Mohamed, M., Chaudhuri, A., & Zalutsky, R. (2007). How common are the “common” neurologic disorders? Neurology, 68(5), 326–337.

    Article  CAS  PubMed  Google Scholar 

  • Hyder, A. A., Wunderlich, C. A., Puvanachandra, P., Gururaj, G., & Kobusingye, O. C. (2007). The impact of traumatic brain injuries: A global perspective. NeuroRehabilitation-An Interdisciplinary Journal, 22(5), 341–354.

    Google Scholar 

  • Iverson, G. L. (2012). A biopsychosocial conceptualization of poor outcome from mild traumatic brain injury. In R. A. Vasterling, R. A. Bryant, & T. M. Keane (Eds.), PTSD and mild traumatic brain injury (pp. 37–60). New York: Guilford Press.

    Google Scholar 

  • Johnson, D. C., Polusny, M. A., Erbes, C. R., King, D., King, L., Litz, B. T., et al. (2011). Development and initial validation of the Response to Stressful Experiences Scale. Military Medicine, 176(2), 161–169.

    Article  PubMed  Google Scholar 

  • King, N. S., Crawford, S., Wenden, F. J., Moss, N. E., & Wade, D. T. (1995). The Rivermead Post Concussion Symptoms Questionnaire: A measure of symptoms commonly experienced after head injury and its reliability. Journal of Neurology, 242(9), 587–592. doi:10.1007/BF00868811.

    Article  CAS  PubMed  Google Scholar 

  • Lange, R. T., Brickell, T. A., Ivins, B., Vanderploeg, R. D., & French, L. M. (2013). Variable, not always persistent, postconcussion symptoms after mild TBI in U.S. military service members: A five-year cross-sectional outcome study. Journal of Neurotrauma, 30(11), 958–969. doi:10.1089/neu.2012.2743.

    Article  PubMed  Google Scholar 

  • Losoi, H., Silverberg, N. D., Waljas, M., Turunen, S., Rosti-Otajarvi, E., Helminen, M., et al. (2015). Resilience is associated with outcome from mild traumatic brain injury. Journal of Neurotrauma, 32(13), 942–949. doi:10.1089/neu.2014.3799.

    Article  PubMed  Google Scholar 

  • Luoto, T. M., Tenovuo, O., Kataja, A., Brander, A., Ohman, J., & Iverson, G. L. (2013). Who getst recruited in mild traumatic brain injury research? Journal of Neurotrauma, 30, 11–16. doi:10.1089/neu.2012.2611.

    Article  PubMed  Google Scholar 

  • Luthar, S. S., & Cushing, G. (2002). Measurement issues in the empirical study of resilience. In M. D. Glantz & J. L. Johnson (Eds.), Resilience and development: Positive life adaptations (pp. 129–160). New York: Kluwer Academic Publishers.

    Chapter  Google Scholar 

  • Luthar, S. S., Cicchetti, D., & Becker, B. (2000). The construct of resilience: A critical evaluation and guidelines for future work. Child Development, 71(3), 543–562.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • McCauley, S. R., Wilde, E. A., Miller, E. R., Frisby, M. L., Garza, H. M., Varghese, R., et al. (2013). Preinjury resilience and mood as predictors of early outcome following mild traumatic brain injury. Journal of Neurotrauma, 30(8), 642–652.

    Article  PubMed  Google Scholar 

  • McCrea, M., Iverson, G. L., McAllister, T. W., Hammeke, T. A., Powell, M. R., Barr, W. B., et al. (2009). An integrated review of recovery after mild traumatic brain injury (MTBI): Implications for clinical management. The Clinical Neuropsychologist, 23(8), 1368–1390. doi:10.1080/13854040903074652.

    Article  PubMed  Google Scholar 

  • McCrea, M., Broshek, D. K., & Barth, J. T. (2015). Sports concussion assessment and management: Future research directions. Brain Injury, 29(2), 276–282. doi:10.3109/02699052.2014.965216.

    Article  PubMed  Google Scholar 

  • McMahon, P., Hricik, A., Yue, J. K., Puccio, A. M., Inoue, T., Lingsma, H. F., et al. (2014). Symptomatology and functional outcome in mild traumatic brain injury: Results from the prospective TRACK-TBI study. Journal of Neurotrauma, 31(1), 26–33. doi:10.1089/neu.2013.2984.

    Article  PubMed  PubMed Central  Google Scholar 

  • Merritt, V. C., Lange, R. T., & French, L. M. (2015). Resilience and symptom reporting following mild traumatic brain injury in military service members. Brain Injury(ahead-of-print), 1–12.

  • Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & Group, T. P. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Medicine, 6(6), e1000097. doi:10.1371/journal.pmed1000097.

    Article  PubMed  PubMed Central  Google Scholar 

  • Norris, F. H., Tracy, M., & Galea, S. (2009). Looking for resilience: Understanding the longitudinal trajectories of responses to stress. Social Science & Medicine, 68(12), 2190–2198. doi:10.1016/j.socscimed.2009.03.043.

    Article  Google Scholar 

  • Pielmaier, L., Walder, B., Rebetez, M. M. L., & Maercker, A. (2011). Post-traumatic stress symptoms in relatives in the first weeks after severe traumatic brain injury. Brain Injury, 25(3), 259–265.

    Article  PubMed  Google Scholar 

  • Rabinowitz, A. R., Li, X., & Levin, H. (2014). Sport and nonsport etilologies of mild traumati brain injury: Similarities and differences. Annual Review of Psychology, 65, 301–331. doi:10.1146/annurev-psych-010213-115103.

    Article  PubMed  Google Scholar 

  • Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1(3), 385–401. doi:10.1177/014662167700100306.

    Article  Google Scholar 

  • Resnik, L., Plow, M., & Jette, A. (2009). Development of CRIS: Measure of community reintegration of injured service members. Journal of Rehabilitation Research and Development, 46(4), 469–480.

    Article  PubMed  PubMed Central  Google Scholar 

  • Rice, M. E., & Harris, G. T. (2005). Comparing effect sizes in follow-up studies: ROC Area, Cohen’s d, and r. Law and Human Behavior, 29(5), 615–620. doi:10.2307/4499443.

    Article  PubMed  Google Scholar 

  • Ruff, R. M., & Hibbard, K. M. (2003). Ruff Neurobehavioral Inventory professional manual. Lutz.

  • Ruff, R. M., Iverson, G. L., Barth, J. T., Bush, S. S., & Broshek, D. K. (2009). Recommendations for diagnosing a mild traumatic brain injury: A National Academy of Neuropsychology education paper. Archives of Clinical Neuropsychology, 24(1), 3–10.

    Article  PubMed  Google Scholar 

  • Sigurdardottir, S., Andelic, N., Roe, C., & Schanke, A. K. (2014). Identifying longitudinal trajectories of emotional distress symptoms 5 years after traumatic brain injury. Brain Injury, 28(12), 1542–1550.

    Article  CAS  PubMed  Google Scholar 

  • Smith, B. W., Dalen, J., Wiggins, K., Tooley, E., Christopher, P., & Bernard, J. (2008). The brief resilience scale: Assessing the ability to bounce back. International Journal of Behavioral Medicine, 15, 194–200.

    Article  PubMed  Google Scholar 

  • Southwick, S. M., Bonanno, G. A., Masten, A. S., Panter-Brick, C., & Yehuda, R. (2014). Resilience definitions, theory, and challenges: Interdisciplinary perspectives. European Journal of Psychotraumatology, 5, 25338. doi:10.3402/ejpt.v5.25338.

    Article  Google Scholar 

  • Sterling, M., Hendrikz, J., & Kenardy, J. (2010). Compensation claim lodgement and health outcome developmental trajectories following whiplash injury: A prospective study. PAIN, 150(1), 22–28. doi:10.1016/j.pain.2010.02.013.

    Article  PubMed  Google Scholar 

  • Sullivan, K. A., Edmed, S. L., Allan, A. C., Smith, S. S., & Karlsson, L. J. E. (2015). The role of psychological resilience and mTBI as predictors of postconcussional syndrome symptomatology. Rehabilitation Psychology, 60(2), 147–154. doi:10.1037/rep0000037.

    Article  PubMed  Google Scholar 

  • Vanderploeg, R., Belanger, H., & Curtiss, G. (2006). Mild traumatic brain injury: Neuropsychological causality modelling. In G. Young, K. Nicholson, & A. Kane (Eds.), Psychological knowledge in court (pp. 279–307). Springer US.

  • Viswanathan, M., Berkman, N., Dryden, M., & Hartling, L. (2013). Assessng risk of bias and confounding in observational studies of interventions or exposures: Further development of the RTI Item Bank. Methods Research Report. Prepared by RTI-UNC Evidence-based Practice Center under Contract No. 290-2007-10056-1. Publication No. 13-EHC106-EF. Rockville, MD: Agency for Healthcare Research and Quality (AHRQ).

  • von Steinbuechel, N., Wilson, L., Gibbons, H., Muehlan, H., Schmidt, H., Schmidt, S., et al. (2012). QOLIBRI Overall Scale: A brief index of health-related quality of life after traumatic brain injury. Journal of Neurology, Neurosurgery and Psychiatry. doi:10.1136/jnnp-2012-302361.

    Google Scholar 

  • Wagnild, G. M. (2009). The resilience scale user’s guide: For the US english version of the resilience scale and the 14-item Resilience Scale (RS-14). Resilience center.

  • Weathers, F., Litz B., Herman, D., Huska, J., & Keane, T. (1993). The PTSD Checklist (PCL): Reliability, validity, and diagnostic utility. In 9th Annual Convention of the International Society for Traumatic Stress Studies. San Antonio.

  • Yeates, K. O., Taylor, H. G., Rusin, J., Bangert, B., Dietrich, A., Nuss, K., et al. (2009). Longitudinal trajectories of postconcussive symptoms in children with mild traumatic brain injuries and their relationship to acute clinical status. Pediatrics, 123(3), 735–743.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

The authors acknowledge the assistance of S. Kate Devitt, PhD (QUT) for guidance on conducting systematic database searches. The authors thank Simon Smith, PhD (QUT) for assistance with the final production of Fig. 1.

Author information

Authors and Affiliations

  1. School of Psychology and Counselling, Queensland University of Technology (QUT), O Block B Wing, Kelvin Grove Campus, Victoria Park Road, Kelvin Grove, 4059, Brisbane, Queensland, Australia

    Karen A. Sullivan, Chloe B. Kempe & Shannon L. Edmed

  2. Institute of Health and Biomedical Innovation, Queensland University of Technology (QUT), Brisbane, Australia

    Karen A. Sullivan & Shannon L. Edmed

  3. Teachers College, Department of Counseling and Clinical Psychology, Colombia University, New York, NY, USA

    George A. Bonanno

Authors
  1. Karen A. Sullivan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chloe B. Kempe
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shannon L. Edmed
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. George A. Bonanno
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Karen A. Sullivan.

Ethics declarations

Conflict of Interest

Sullivan, Kempe, Edmed and Bonanno declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sullivan, K.A., Kempe, C.B., Edmed, S.L. et al. Resilience and Other Possible Outcomes After Mild Traumatic Brain Injury: a Systematic Review. Neuropsychol Rev 26, 173–185 (2016). https://doi.org/10.1007/s11065-016-9317-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11065-016-9317-1

Keywords

Search

Navigation