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Mild traumatic brain injury (mTBI) accounts for most cases of TBI, and many patients show incomplete long-term functional recovery. We aimed to create a prognostic model for functional outcome by combining demographics, injury severity, and psychological factors to identify patients at risk for incomplete recovery at 6 months. In particular, we investigated additional indicators of emotional distress and coping style at 2 weeks above early predictors measured at the emergency department. The UPFRONT study was an observational cohort study done at the emergency departments of three level-1 trauma centres in the Netherlands, which included patients with mTBI, defined by a Glasgow Coma Scale score of 13–15 and either post-traumatic amnesia lasting less than 24 h or loss of consciousness for less than 30 min. Emergency department predictors were measured either on admission with mTBI—comprising injury severity (GCS score, post-traumatic amnesia, and CT abnormalities), demographics (age, gender, educational level, pre-injury mental health, and previous brain injury), and physical conditions (alcohol use on the day of injury, neck pain, headache, nausea, dizziness)—or at 2 weeks, when we obtained data on mood (Hospital Anxiety and Depression Scale), emotional distress (Impact of Event Scale), coping (Utrecht Coping List), and post-traumatic complaints. The functional outcome was recovery, assessed at 6 months after injury with the Glasgow Outcome Scale Extended (GOSE). We dichotomised recovery into complete (GOSE=8) and incomplete (GOSE≤7) recovery. We used logistic regression analyses to assess the predictive value of patient information collected at the time of admission to an emergency department (eg, demographics, injury severity) alone, and combined with predictors of outcome collected at 2 weeks after injury (eg, emotional distress and coping). Between Jan 25, 2013, and Jan 6, 2015, data from 910 patients with mTBI were collected 2 weeks after injury; the final date for 6-month follow-up was July 6, 2015. Of these patients, 764 (84%) had post-traumatic complaints and 414 (45%) showed emotional distress. At 6 months after injury, outcome data were available for 671 patients; complete recovery (GOSE=8) was observed in 373 (56%) patients and incomplete recovery (GOSE ≤7) in 298 (44%) patients. Logistic regression analyses identified several predictors for 6-month outcome, including education and age, with a clear surplus value of indicators of emotional distress and coping obtained at 2 weeks (area under the curve [AUC]=0·79, optimism 0·02; Nagelkerke R2=0·32, optimism 0·05) than only emergency department predictors at the time of admission (AUC=0·72, optimism 0·03; Nagelkerke R2=0·19, optimism 0·05). Psychological factors (ie, emotional distress and maladaptive coping experienced early after injury) in combination with pre-injury mental health problems, education, and age are important predictors for recovery at 6 months following mTBI. These findings provide targets for early interventions to improve outcome in a subgroup of patients at risk of incomplete recovery from mTBI, and warrant validation. Dutch Brain Foundation.

Background The Strengths and Difficulties Questionnaire (SDQ) is widely used to screen for psychosocial problems among adolescents. As the severity of such problems is known to be related to age and gender, screening could be improved by interpreting SDQ scale scores with age-specific and perhaps gender-specific norms. Up to now, such norms are lacking. The aim of the current study is to present gender-specific and joint normative data per year of age for the Dutch self-reported and parent-reported SDQ versions for use among 12- to 17-year-old adolescents. Methods The norm groups for the self-reported and parent-reported SDQ versions consisted of 993 adolescents and 736 parents, respectively, from the general Dutch population. Per SDQ version, both gender-specific norms and joint norms (percentiles and cutoffs) per year of age were calculated through regression-based norming (Rigby in J Roy Stat Soc Ser C 54:507, 2005). Additionally, these norms were compared to the widely used British norms that are neither age-specific nor gender-specific. Results By design, gender-specific ‘abnormal’ cutoffs (i.e., cutoffs aimed at identifying max. 10% of the most extremely scoring males and max. 10% of the most extremely scoring females) resulted in about equal percentages of ‘abnormal’ scoring male and female adolescents per SDQ scale. In contrast, joint ‘abnormal’ cutoffs (i.e., cutoffs aimed at identifying max. 10% of the most extremely scoring adolescents) resulted in relatively more male (7.6 to 13.6%, depending on age) than female (3.3 to 8.9%, depending on age) adolescents as scoring ‘abnormal’ on scales measuring externalizing behavior (self-reported and parent-reported SDQ versions), and relatively more female (3.9 to 14.3%, depending on age) than male (1.8 to 6.9%, depending on age) adolescents as scoring ‘abnormal’ on scales measuring internalizing behavior (self-reported SDQ version). In both types of norms, minor age effects were present. Among Dutch adolescents, the British norms yielded detection rates much lower than the expected 10%. Conclusions Our findings indicate that detection rates depend on the reference group that is used (British or Dutch general adolescent population; specific gender group or not). The normative data in this paper facilitate the comparison of an adolescent’s scores to different reference groups, and allow for cross-country/cultural comparisons of adolescents’ psychosocial behavior.

While several studies documented a positive correlation between childhood maltreatment severity and dissociation severity, it is currently unknown whether specific dissociative symptoms cluster together among individuals with childhood trauma histories ranging from none to severe. We aimed to explore symptom constellations across the whole spectrum of dissociative processing from patients with severe dissociative disorders to healthy controls and relate these to maltreatment severity and sociodemographic characteristics. We employed latent profile analysis to explore symptom profiles based on five subscales, measuring absorption, depersonalization, derealization, somatoform and identity alteration, based on the 20 items of the German short version of the Dissociative Experiences Scale-II ( 20) in a large aggregate sample (  = 3,128) overrepresenting patients with trauma-related disorders. We then related these profiles to maltreatment severity as measured by the five subscales of the Childhood Trauma Questionnaire as well as sociodemographic characteristics. Based on the five FDS subscales, six clusters differentiated by symptom severity, but not symptom constellations, were identified. Somatoform dissociation varied in accordance with the remaining symptom clusters. The cluster with the highest overall symptom severity entailed nearly all subjects diagnosed with Dissociative Identity Disorder and was characterized by extreme levels of childhood maltreatment. Both abuse and neglect were predictive of cluster membership throughout. The higher the severity of dissociative processing in a cluster, the more subjects reported high severity and multiplicity of childhood maltreatment. However, some subjects remain resilient to the development of dissociative processing although they experience extreme childhood maltreatment.

Impairments in social behavior are frequently found in moderate to severe traumatic brain injury (TBI) patients and are associated with an unfavorable outcome with regard to return to work and social reintegration. Neuropsychological tests measuring aspects of social cognition are thought to be sensitive to these problems. However, little is known about the effect of general cognitive problems on these tests, nor about their sensitivity to injury severity and frontal lesions. In the present study 28 chronic TBI patients with a moderate to severe TBI were assessed with tests for social cognition (emotion recognition, Theory of Mind, and empathy), and for general, non-social cognition (memory, mental speed, attention, and executive function). The patients performed significantly worse than healthy controls on all measures, with the highest effect size for the emotion recognition test, the Facial Expressions of Emotion-Stimuli and Tests (FEEST). Correlation analyses yielded no significant (partial) correlations between social and non-social cognition tests. Consequently, poor performance on social cognition tests was not due to general cognitive deficits. In addition, the emotion recognition test was the only measure that was significantly related to post-traumatic amnesia (PTA) duration, Glasgow Coma Scale (GCS) score, and the presence of prefrontal lesions. Hence, we conclude that social cognition tests are a valuable supplement to a standard neuropsychological examination, and we strongly recommend the incorporation of measurements of social cognition in clinical practice. Preferably, a broader range of social cognition tests would be applied, since our study demonstrated that each of the measures represents a unique aspect of social cognition, but if capacity is limited, at least a test for emotion recognition should be included.

To explore structural differences and similarities in multivariate multiblock data (e.g., a number of variables have been measured for different groups of subjects, where the data for each group constitute a different data block), researchers have a variety of multiblock component analysis and factor analysis strategies at their disposal. In this article, we focus on three types of multiblock component methods—namely, principal component analysis on each data block separately, simultaneous component analysis, and the recently proposed clusterwise simultaneous component analysis, which is a generic and flexible approach that has no counterpart in the factor analysis tradition. We describe the steps to take when applying those methods in practice. Whereas plenty of software is available for fitting factor analysis solutions, up to now no easy-to-use software has existed for fitting these multiblock component analysis methods. Therefore, this article presents the MultiBlock Component Analysis program, which also includes procedures for missing data imputation and model selection.

Physical activity is increasingly incorporated in trauma-focused treatments as an augmentation strategy to improve treatment outcome. In a novel VR exposure treatment known as 3MDR (Multi-modal Motion-assisted Memory Desensitization and Reconsolidation), patients engage in low-intensity physical activity by walking on a treadmill throughout the therapy session, approaching trauma-related pictures that progressively enlarge until fully displayed in a VR environment. Physical activity is considered a key augmentation strategy in this treatment, with the proposed mechanism that walking toward a trauma-related picture facilitates the reduction of trauma-related avoidance, thereby improving treatment outcome. However, neither the specific effect of walking during this treatment nor the proposed working mechanism have been scientifically examined yet. In this paper we describe the rationale and study design of a randomised controlled trial (RCT) to examine the specific effect of walking toward trauma-related stimuli during VR exposure on treatment outcome. In addition, we will test whether walking toward trauma-related pictures facilitates a greater reduction in trauma-related avoidance. Patients with PTSD (  = 158) are randomised to two treatment conditions: (VR exposure while walking) or (VR exposure without walking), while keeping all other treatment aspects constant. Participants in both conditions receive two preparatory treatment sessions, 6 or 12 VR exposure sessions, and one closure session. The primary outcome is clinician-rated PTSD symptom severity. Secondary outcomes are both clinician-rated- and self-reported trauma-related avoidance symptom severity, as well as self-reported PTSD symptom severity. Assessments take place pre- and after 6 and 12 VR exposure sessions (posttreatment), and at 3-, 6-, 12- and 18- months follow-up. This RCT aims to examine whether incorporating walking during trauma-focused treatment in a VR exposure environment augments the treatment of patients with PTSD.

Background Neuropsychological symptoms in the Cognitive, Energetic, Behavioural, and Affective (CEBA) domains are common in people with multiple sclerosis (PwMS) and can negatively affect societal participation. The current study aims to investigate whether there are combinations of symptoms in the different CEBA domains that consistently occur together, that is, if there are CEBA profiles that can be identified. If so, this study aims to develop a screening instrument identifying CEBA profiles in PwMS to select the most suitable neuropsychological rehabilitation treatment for a given CEBA profile and consequently improve the societal participation of PwMS. Methods This study is an observational, prospective cohort study consisting of 3 phases. Phase 1 focuses on the identification of CEBA profiles in a large sample of PwMS ( n  = 300). Phase 2 focuses on validating these CEBA profiles through replication of results in a new sample ( n  = 100) and on the development of the screening instrument. Phase 3 focuses on qualitatively evaluating in a small group of PwMS whether the selected treatment is suitable for the given CEBA profile or whether existing neuropsychological treatments should be adapted to meet the needs of PwMS suffering from symptoms in multiple CEBA domains simultaneously. Primary outcome is the CEBA profile, which will be derived from performance on neuropsychological assessment consisting of tests and questionnaires regarding the CEBA domains using a latent profile analysis. Inclusion criteria include MS diagnosis, sufficient ability in the Dutch language, and an age between 18 and 70 years. Discussion The results of the current study will contribute to a more comprehensive understanding of the entire spectrum of neuropsychological symptoms in PwMS. Identification of possible CEBA profiles, and accordingly, the development of a screening instrument determining the CEBA profile of PwMS in clinical practice, contributes to the timely referral of PwMS to the most suitable neuropsychological rehabilitation treatment. If necessary, adjustments to existing treatments will be suggested in order to sufficiently meet the needs of PwMS. All of this with the ultimate aim to improve societal participation, and thereby quality of life, of PwMS. Trial registration Dutch Central Committee on Research Involving Human Subjects (CCMO) NL83954.042.23; ClinicalTrials.gov NCT06016309.

Background This study validates the Spanish version of the Brief-COPE in the Colombian context. This tool assesses 14 different coping strategies, including positive coping, planning, emotional support, instrumental support, substance use, and religion, among others. The structural validations of this tool in Latin America, Europe, North America, and Asia yielded heterogeneous results, with validations in Latin America often having limitations in their data analysis methodologies and sample size. This study aims to address these limitations and provide methodologically sound evidence on the structural validity, reliability, and convergent and divergent validity of the instrument for adults in Colombia. Methods A total of 762 participants completed the Brief-COPE along with the ERQ, the Wellbeing Index, the HSCL-25, the PCL-C, and the Kessler 6. Categorical Confirmatory Factor Analysis (CFA) was employed to assess the fit of 12 different theory and data-driven models. After identifying the best-fitting model, reliability, divergent, and convergent validity were assessed for the resulting factors. Results The best-fitting CFA model for the Brief-COPE had 11 factors: active coping, social support, acceptance, venting, self-distraction, behavioral disengagement, denial, self-blame, humor, religion, and substance use. Substance use, active coping, religion, social support, humor, self-blame, denial, and behavioral disengagement demonstrated good reliability ( Omega  > = .7 ) , whereas the remaining subscales demonstrated insufficient reliability ( Omega  >  .6 and Omega  < .7). Maladaptive coping strategies were found to positively correlate with distress measures, while adaptive strategies exhibited negative correlations, as expected. However, social support and humor presented significant positive associations with PCL-C and HSCL. Conclusions This study provides evidence supporting an 11-factor structure for the Brief-COPE in Colombian adults, with most factors demonstrating satisfactory reliability. Researchers should use caution when interpreting subscales with lower reliability. The results also underscore the influence of cultural context on coping patterns, given the heterogeneous factor structures found in other validations. Future studies should recruit more diverse samples to enhance generalizability and further investigate the predictive validity of this adapted tool.

In many fields of research, so-called 'multiblock' data are collected, i.e., data containing multivariate observations that are nested within higher-level research units (e.g., inhabitants of different countries). Each higher-level unit (e.g., country) then corresponds to a 'data block'. For such data, it may be interesting to investigate the extent to which the correlation structure of the variables differs between the data blocks. More specifically, when capturing the correlation structure by means of component analysis, one may want to explore which components are common across all data blocks and which components differ across the data blocks. This paper presents a common and cluster-specific simultaneous component method which clusters the data blocks according to their correlation structure and allows for common and cluster-specific components. Model estimation and model selection procedures are described and simulation results validate their performance. Also, the method is applied to data from cross-cultural values research to illustrate its empirical value.

Metabolomics has attracted the interest of the medical community for its potential in predicting early derangements from a healthy to a diseased metabolic phenotype. One key issue is the diversity observed in metabolic profiles of different healthy individuals, commonly attributed to the variation of intrinsic (such as (epi)genetic variation, gut microbiota, etc.) and extrinsic factors (such as dietary habits, life-style and environmental conditions). Understanding the relative contributions of these factors is essential to establish the robustness of the healthy individual metabolic phenotype. To assess the relative contribution of intrinsic and extrinsic factors we compared multilevel analysis results obtained from subjects of Homo sapiens and Macaca mulatta, the latter kept in a controlled environment with a standardized diet by making use of previously published data and results. We observed similarities for the two species and found the diversity of urinary metabolic phenotypes as identified by nuclear magnetic resonance (NMR) spectroscopy could be ascribed to the complex interplay of intrinsic factors and, to a lesser extent, of extrinsic factors in particular minimizing the role played by diet in shaping the metabolic phenotype. Moreover, we show that despite the standardization of diet as the most relevant extrinsic factor, a clear individual and discriminative metabolic fingerprint also exists for monkeys. We investigate the metabolic phenotype both at the static (i.e., at the level of the average metabolite concentration) and at the dynamic level (i.e., concerning their variation over time), and we show that these two components sum up to the overall phenotype with different relative contributions of about 1/4 and 3/4, respectively, for both species. Finally, we show that the great degree diversity observed in the urinary metabolic phenotype of both species can be attributed to differences in both the static and dynamic part of their phenotype.