Date of Award

Winter 12-19-2023

Document Type

Open Access Thesis

Degree Name

Doctor of Psychology (PsyD)



First Advisor

Abby Hughes Scalise, PhD, LP

Second Advisor

Margit Berman, PhD, LP

Third Advisor

Marcia Bennett, PhD, LP


Background: Traumatic Brain Injury (TBI) is one of the leading causes of physical and cognitive disability worldwide. TBI can negatively impact cognitive, physical, social, and psychological functioning.

Objective: This study investigated interactions between TBI severity, mental health symptom severity, and community engagement among older adults. Specific aims included investigating 1) the relationship between TBI severity at the time of injury and psychiatric symptom severity at one-year post-TBI; 2) the relationship between TBI severity and community engagement at one-year post-TBI; and 3) whether mental health symptom severity moderated the relationship between TBI and post-injury community engagement.

Methods: Archival data was analyzed from the TBI Model Systems Program (TBIMS) database. Individuals aged 65 years and older with a diagnosis of TBI and without a military history were included in the sample.

Results: Findings showed no significant relationships between TBI severity and anxiety symptom severity, TBI severity and depression symptom severity, or TBI severity and community engagement. Anxiety symptom severity was found to have no significant impact on community engagement. Depression symptom severity was found to have a significant negative impact on community engagement; however, there was no evidence of depression or anxiety symptom severity moderating the relationship between TBI severity and community engagement.

Conclusions: Despite limitations, the current study highlighted a need for clinicians to avoid assuming that patients with more severe TBI will have more negative mental health outcomes.


SC 11.PsyD.2023.Tomford.A