Laura Gorman

Date of Award

August 2024

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Counseling Psychology & Community Services

First Advisor

Kara Wettersten

Abstract

Introduction: Traumatic Brain Injuries (TBI) are the leading cause of disability and mortality for individuals under the age of 45 (Centers for Disease Control and Prevention, 2021; Moore et al., 2014). Previous research has informed us that substance use, perceptions of social support, and TBI severity have all been associated with increased levels of psychological distress. Given the prevalence of TBI and its impact on physical and mental health outcomes, it is important to understand how outside factors (substance use and perceptions of social support) relate with TBI severity to effect overall levels of psychological distress. Objective: Drawing from self-determination theory and previous literature, this study examined the direct effects of TBI severity on psychological distress, the moderating role of substance use on the relationship between TBI severity and psychological distress, and finally the mediating role of perceptions of social support on the relationships between substance use, TBI severity, and psychological distress. It was hypothesized that TBI severity would have a direct effect on psychological distress, substance use would significantly moderate the relationship between TBI severity and psychological distress. In addition to a hypothesized mediation effect from perceptions of social support on the relationships between variables, TBI severity, substance use, and psychological distress. Method: 128 individuals were recruited through targeted convenience sampling from local TBI networks and online survey tools were included in this study. Participants completed questionnaires measuring TBI severity, substance use, perceptions of social support and psychological distress. Hypotheses were tested using path analysis. Results: The findings demonstrated that TBI severity significantly predicted levels of perceived social support, and perceptions of social support significantly predicted psychological distress. Additionally, substance use was found to predict psychological distress, and finally, perceptions of social support had a significant mediating effect on the relationship between TBI severity and psychological distress. No moderation effect was found on substance use between TBI severity and psychological distress, nor did perceptions of social support significantly mediate the relationship between substance use and psychological distress. Conclusion: Implications for future research and clinical practice are discussed. Keywords: Traumatic Brain Injury, Perceptions of Social Support, Substance Use, Psychological Distress

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