Mood and anxiety in concussion and mild traumatic brain injury (MTBI): A systematic review

Objectives: Understanding the relationship between mood/anxiety and mild traumatic brain injury (mTBI) is recognized as necessary, although slow to gain acceptance in practice. We hypothesized that the relevant literature was disjointed and unrelated. Such a state could contribute to a lack of wider acceptance and implementation. Thus we sought to analyze the literature on this topic, and demonstrate the relationships (or lack thereof) through a citation network. Evidence review: PubMed, Academic Search Premier, and PsycINFO were searched for peer-reviewed articles involving concussion, mild traumatic brain injury (mTBI), mood, or anxiety published between January 2005 and June 2015. Studies resulting from the exclusion process were rated for quality using a newly developed scale (Quality of Literature Assessment: QoLA), and incorporated into a citation network to determine interrelationships among studies. Findings: Twenty-four articles met the inclusion criteria. The QoLA identified 16 of moderate quality and none of strong quality; the remaining eight studies were rated as weak. Interrater reliability of the QoLA was acceptable (ICC=.754,p=.04), and raterjudgment of quality matched the empirical scale (Pearson r=.73,p<.001). Conclusions: Inspection of the quality ratings (QoLA) pointed to inadequate methodologies in most studies. Additionally, network analysis demonstrated little overlap of citations, indicating lack of scaffolding of findings that is a hallmark of mature science.