Bay Esther, Sikorskii Alla
College of Nursing, Michigan State University, East Lansing, Michigan 48824, USA.
Biol Res Nurs. 2009 Jan;10(3):213-25. doi: 10.1177/1099800408326453. Epub 2008 Nov 17.
It is well known that individuals experience difficulties with depressive symptoms and functional status after traumatic brain injury. However, it is unclear what the relationship is between these 2 phenomena and whether there is a biological explanation for. In this secondary analysis, we examined whether depressive symptoms explained postinjury functional status and whether chronic stress and salivary cortisol influenced this relationship. Participants included 75 persons within 24 months of their injury dates who were evaluated or treated in specialty clinics. All participants and a family member or significant other completed survey data, and 50 of the participants provided cortisol data. Results indicated that chronic stress, measured using Cohen's Perceived Stress Scale, completely mediated the relationship between depressive symptoms, measured using the Center for Epidemiological Studies Depression Scale, and psychological functioning, measured using the Patient Competency Rating Scale. Furthermore, those who provided cortisol data displayed hypocortisolemia in their 12-hr profile. Results from this analysis suggest that interventions focused on addressing the chronic stress experience may be important in limiting depressive symptoms and improving psychological functioning. Longitudinal study of this phenomenon is required to understand the progression of chronic stress after traumatic brain injury.
众所周知，个体在创伤性脑损伤后会出现抑郁症状和功能状态方面的困难。然而，这两种现象之间的关系是什么，以及是否存在生物学解释尚不清楚。在这项二次分析中，我们研究了抑郁症状是否能解释损伤后的功能状态，以及慢性应激和唾液皮质醇是否会影响这种关系。参与者包括75名在受伤日期后24个月内，在专科诊所接受评估或治疗的人。所有参与者以及一名家庭成员或重要他人完成了调查数据，其中50名参与者提供了皮质醇数据。结果表明，使用科恩感知压力量表测量的慢性应激，完全介导了使用流行病学研究中心抑郁量表测量的抑郁症状与使用患者能力评定量表测量的心理功能之间的关系。此外，提供皮质醇数据的参与者在其12小时的记录中显示出低皮质醇血症。该分析结果表明，专注于解决慢性应激体验的干预措施，对于限制抑郁症状和改善心理功能可能很重要。需要对这一现象进行纵向研究，以了解创伤性脑损伤后慢性应激的发展过程。
