© The Author(s) 2021. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com https://doi.org/10.1093/arclin/acab095 Advance Access publication 22 December 2021 Archives of Clinical Neuropsychology 37 (2022) 583–594 Post-traumatic Stress Disorder after Severe Traumatic Brain Injury: A Systematic Review Dolores Villalobos 1,2,3, *, Umberto Bivona 4 1 Department of Experimental Psychology, School of Psychology, Complutense University, Madrid, Spain 2 Laboratory of Cognitive and Computational Neuroscience, Center for Biomedical Technology (Technical University of Madrid and Complutense University of Madrid), Madrid, Spain 3 The European Centre of Neuroscience, Madrid, Spain 4 IRCCS Fondazione Santa Lucia, Neuroriabilitazione 2, Rome, Italy *Corresponding author at: Department of Experimental Psychology, School of Psychology. Complutense University, Campus de Somosaguas, Ctra. de Húmera, s/n, 28223 Pozuelo de Alarcón, Madrid, Spain. Tel.: (+34) 91 394 3110. E-mail address: dolores.villalobos@ctb.upm.es (D. Villalobos). Accepted 30 November 2021 Abstract Objective: The review aimed to summarize the existing knowledge base regarding post-traumatic stress disorder after severe traumatic brain injury (TBI) and try to guide future research. Method: Web of Science, Scopus, and PubMed databases were used to identify original studies that explored the relationship between severe TBI and post-traumatic stress disorder. Results: A total of 13 studies were included in the review. They have been examined in terms of potentially compatible and incompatible mechanisms, as well as of possible confounding factors in relation to the diagnosis of post-traumatic stress disorder after severe TBI. Conclusion: Only a few studies in the literature have addressed the present topic; therefore, the prevalence of post-traumatic stress disorder in patients with severe TBI still needs to be further investigated. In particular, future studies should be conducted only in severe TBI populations, considering their premorbid personality characteristics and their reactivity alteration. They should also obtain an accurate and appropriate assessment of post-traumatic stress disorder with clinical interviews as well as clarifying the role of post-traumatic amnesia in this population by incorporating control groups of patients. Keywords: Traumatic brain injury; Post-traumatic stress disorder; Post-traumatic amnesia; Loss of consciousness Introduction The severity of traumatic brain injury (TBI) can range from mild to severe, based on different indexes: (a) the length of loss of consciousness (LOC); (b) the length of post-traumatic amnesia (PTA), also known as “post-traumatic confusional state” (PTCS; Stuss et al., 1999) or “post traumatic delirium” (PTD; Ponsford et al., 2014); and (c) the Glasgow Coma scale (GCS; Jennett & Bond, 1975), which is probably the most used measure to assess the TBI severity, associated with LOC and PTA. Table 1 shows the different criteria to define TBI severity (Baxendale, Heaney, Rugg-Gunn, & Friedland, 2019; Mild Traumatic Brain Injury Committee, A.C.o.R.M, 1993; World Health Organization, 1992). In particular, severe TBI (sTBI) is one of the main health problems due to its high functional impact on patients (Ciurli, Formisano, Bivona, Cantagallo, & Angelelli, 2011; Dikmen, Machamer, Powell, & Temkin, 2003) and their caregivers’ psychological status (Bivona et al., 2020; D’Ippolito et al., 2018; Formisano et al., 2017). Indeed, sTBI can usually cause physical motor, cognitive, motivational, and emotional/behavioral symptoms, including extensive changes in the patients’ personalities Downloaded from https://academic.oup.com/acn/article/37/3/583/6474495 by guest on 07 June 2023