Associations between sensory changes and psychological problems after moderate-to-severe traumatic brain injury: A network analysis

BACKGROUND: Moderate-to-severe traumatic brain injury (msTBI) is frequently accompanied by persistent sensory changes that can substantially impair quality of life. Theory suggests that these changes may not occur in isolation but instead be closely intertwined with psychological difficulties (eg, anxiety). A better understanding of the interrelationships between sensory changes and psychological problems may help identify mechanisms underlying symptom persistence and inform rehabilitation efforts. METHODS: We conducted a psychometric network analysis on cross-sectional questionnaire data from 401 individuals with msTBI (mean years post-injury, 12.7; range = 0.4-35.4 years) originally recruited from an inpatient rehabilitation setting. We assessed sensory changes across modalities using a custom checklist and the Somatic Symptom Scale - 8. Guided by theory, 6 psychological problems were selected for analysis and assessed using scales from the Inventory of Depression and Anxiety Symptoms and the Comprehensive Assessment of Traits Relevant to Personality Disorders. RESULTS: Pairwise correlations indicated broad associations between sensory changes and most psychological constructs. When applying more stringent, multivariate network estimation methods, these associations narrowed to a more specific set of unique pathways. Across network models-and after adjusting for all other sensory changes, psychological problems, and covariates (age, sex, injury severity, and time since injury)-up to 10 direct conditional associations were identified between sensory changes and psychological problems, with the most robust links observed between light hypersensitivity and both health anxiety and traumatic avoidance. CONCLUSIONS: These findings support a biopsychosocial account in which biological injury mechanisms likely underpin sensory changes following msTBI, while psychological processes may differentially contribute to their expression, amplification, and maintenance. The results suggest heterogeneity across sensory domains, with some changes potentially reflecting relatively greater neurobiological contributions and others relatively greater psychological influences. This highlights the potential value of targeting specific psychological factors within rehabilitation for individuals experiencing sensory changes following msTBI. DATABASE REGISTRATION: ACTRN12623001267640.