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Chronic Stress and Fatigue-Related Quality of Life After Mild to Moderate Traumatic Brain Injury

Bay, Esther PhD, ACNS, BC; de-Leon, Marita B. PhD

Journal of Head Trauma Rehabilitation:
doi: 10.1097/HTR.0b013e3181f20146
Original Articles

Objective: To determine relationships among chronic stress, fatigue-related quality of life (QOL-F), and related covariates after mild to moderate traumatic brain injury (TBI).

Design: Observational and cross-sectional.

Participants: A total of 84 community-dwelling individuals with mild to moderate TBI recruited from multiple out patient rehabilitation clinics assessed on average 15 months after injury.

Method: Self-report surveys and chart abstraction.

Measures: Neurofunctional Behavioral Inventory, Perceived Stress Scale–14, Impact of Events Scale, McGill Pain Short-form Scale, and modified version of the Fatigue Impact Scale.

Results: QOL-F was associated with somatic symptoms, perceived situational stress, but not with event-related stress (posttraumatic stress disorder symptoms) related to index TBI, preinjury demographic, or postinjury characteristics. Somatic symptoms and chronic situational stress accounted for 42% of the variance in QOL-F.

Conclusions: QOL-F in community-dwelling individuals with mild to moderate TBI is associated with chronic situational stress and somatic symptoms. Symptom management strategies may need to include general stress management to reduce fatigue burden and improve quality of life.

Author Information

Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor.

Correspondence: Esther Bay, PhD, ACNS, BC, Department of Physical Medicine and Rehabilitation, University of Michigan, 325 E Eisenhower, Suite 300, Ann Arbor, MI 48108 (

This study was funded by Office of Vice-President of Research to Dr. Bay at Michigan State University. Dr de-Leon was supported by the National Institutes of Health, the National Institute of Child Health and Human Development, the National Center for Medical Rehabilitation Research grant 5-T32-HD007422-17.

The authors declare no conflict of interest

© 2011 Lippincott Williams & Wilkins, Inc.