How Are TBI Symptoms Interconnected? A Network Analysis Approach

Abstract

Background: Many patients with traumatic brain injury (TBI) across all levels of severity experience persistent psycho-emotional, cognitive, and somatic symptoms. Psychological network theory views disorders as intricate systems rather than discrete diseases. This study employs an exploratory network analysis method to uncover potential causal links among long-term TBI symptoms. Methods: We examined persistent symptoms using secondary data from 250 TBI patients undergoing an inpatient “brain check” procedure. We constructed two partial correlation networks: one for the entire sample and another for a mild TBI subgroup, each consisting of 14 symptoms and three covariates. The symptoms and their connections were visualized in network graphs to identify potential causal, and structural indicators and centrality indices were calculated. Results: The analysis revealed two dense networks characterized by multiple complex connections. In the overall network, symptoms are clustered into psycho-emotional and cognitive communities, with attention deficits serving as a crucial link between them. One finding was that self-reported cognitive impairments do not align with objectively measured deficits. Within the mild TBI subgroup, PTSD emerges as a central node in the network. Conclusion: Network analysis reveals the multidimensional and reciprocal nature of long-term TBI symptoms. Attention deficits bridge cognitive and psycho-emotional areas, whereas psycho-emotional symptoms influence self-perceived performance. Self-reported cognitive impairments should be emphasized in therapy as they are linked rather to sleep, visual disturbances, and anxiety than to objective deficits. Network analysis is valuable for understanding TBI symptom complexity and exploring treatment options. Future research should utilize longitudinal designs to validate our findings.