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We aimed to determine whether emotional well-being is associated with the extent and\/or location of structural brain injury in individuals with chronic TBI. We studied 188 adults with chronic (\u22651 year postinjury) TBI enrolled in the multicenter Late Effects of TBI (LETBI) study. Participants underwent T1-weighted MRI to assess cortical lesion location and volume, and diffusion MRI to measure white matter fractional anisotropy (FA). The primary outcome was emotional well-being, measured as the RAND-36 emotional well-being subscale T score. To identify associations between structural injury and the primary outcome, we used multivariable linear models adjusted for age, sex, years of education, time since injury, history of seeking psychiatric care, and multiple indices of scan quality. The cohort was predominantly male (68%) and white (88%), with a mean age of 58 years (SD 15) and median time since injury of 8 years (IQR 14). The presence of cortical lesions was independently associated with greater emotional well-being scores (RAND-36 adjusted T score was 4.1; 95% CI: [1.0, 7.0] points higher in participants with vs without lesions;\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    = 0.009). Right temporal and lateral orbitofrontal lesions are associated with lower (worse) emotional well-being scores, and left hemispheric lesions are associated with higher (better) scores. Lower global white matter FA was independently associated with greater emotional well-being scores (RAND-36 adjusted T score was 2.7 [0.8, 4.7] points higher per 1 SD decrease in FA;\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    = 0.008). The strongest associations between individual white matter tract integrity and emotional well-being were in the anterior (genu) corpus callosum (\u03b2 = \u22123.0, [\u22121.3, \u22124.7]; p\n                    <jats:sub>Holm<\/jats:sub>\n                    = 0.034) and the left cingulum bundle (\u03b2 = \u22123.0, [\u22121.2, \u22124.8]; p\n                    <jats:sub>Holm<\/jats:sub>\n                    = 0.048). In a large cohort of participants with chronic TBI, structural brain injuries were associated with better emotional well-being scores. These findings challenge traditional interpretations of emotional disturbances after TBI and motivate future studies to determine whether specific structural brain injury locations may be causally associated with improvements in emotional well-being.\n                  <\/jats:p>","DOI":"10.1177\/08977151261468930","type":"journal-article","created":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T06:03:56Z","timestamp":1784873036000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Structural Injuries Are Associated with Better Emotional Well-being after Traumatic Brain Injury"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6965-7890","authenticated-orcid":false,"given":"Samuel B.","family":"Snider","sequence":"first","affiliation":[{"name":"Department of Neurology, Brigham and Women\u2019s Hospital and Harvard Medical School, Boston, Massachusetts, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Shi","sequence":"additional","affiliation":[{"name":"Department of Neurology, Brigham and Women\u2019s Hospital and Harvard Medical School, Boston, Massachusetts, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Maffei","sequence":"additional","affiliation":[{"name":"Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Boston, Massachusetts, USA."},{"name":"Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA."},{"name":"Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, Massachusetts, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalie","family":"Gilmore","sequence":"additional","affiliation":[{"name":"Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA."},{"name":"Tampa VA Research and Education Foundation, Tampa, Virginia, USA."},{"name":"Research Service, James A. Haley Veterans\u2019 Hospital, Tampa, Virginia, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Holly J.","family":"Freeman","sequence":"additional","affiliation":[{"name":"Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Boston, Massachusetts, USA."},{"name":"Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander S.","family":"Atalay","sequence":"additional","affiliation":[{"name":"Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Boston, Massachusetts, USA."},{"name":"Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian","family":"Li","sequence":"additional","affiliation":[{"name":"Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Boston, Massachusetts, USA."},{"name":"Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA."},{"name":"Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, Massachusetts, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica A.","family":"Yeager","sequence":"additional","affiliation":[{"name":"Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Boston, Massachusetts, USA."},{"name":"Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0858-3533","authenticated-orcid":false,"given":"Raj G.","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Belinda","family":"Yew","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin M.","family":"Conley","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ariana L.","family":"Velazquez","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Kirschenbaum","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enna","family":"Selmanovic","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Holly","family":"Carrington","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yelena G.","family":"Bodien","sequence":"additional","affiliation":[{"name":"Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Boston, Massachusetts, USA."},{"name":"Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA."},{"name":"Department of Surgery, Department of Physical Medicine, &amp; Rehabilitation, Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeanne M.","family":"Hoffman","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, Washington, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Mac Donald","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Washington, Seattle, Washington, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian L.","family":"Edlow","sequence":"additional","affiliation":[{"name":"Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Boston, Massachusetts, USA."},{"name":"Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA."},{"name":"Athinoula A. 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