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How does a trivial head injury result in enduring symptoms? A prospective investigation of outcome after mild traumatic brain injury

How does a trivial head injury result in enduring symptoms? A prospective investigation of outcome after mild traumatic brain injury
How does a trivial head injury result in enduring symptoms? A prospective investigation of outcome after mild traumatic brain injury
Background: Traumatic brain injury is one of the most common neurological conditions. However, the majority of cases 90% are actually mild. Mild traumatic brain injury (MTBI) remains a major, unrecognized public health issue and has been called a “silent epidemic” (1). A significant proportion (15-30%) of patients are at risk of developing Post Concussional Syndrome (PCS) (2)(3), which is a symptom cluster including a number of physical, cognitive, emotional?and behavioural symptoms.

Objective: The aim of this study was to investigate the contributions of cognitive, emotional and behavioural factors to the development of PCS based on a cognitive-behavioural model.

Methods: A prospective cohort design was employed. 126 patients met the diagnosis of MTBI (mean age 38.32 years; male 63%) completed baseline questionnaire assessments within 2 weeks after injury, and 108 patients completed follow-up questionnaire assessments at both 3 and 6 months after injury. A series of self-report measures including the Brief Illness Perception Questionnaire, the Behavioural Response to Illness Questionnaire, the Impact of Event Scale, the Hospital Anxiety and Depression Scale, the Brief Social Support Questionnaire, and the Rivermead Postconcussion Symptoms Questionnaire were used to assess baseline somatic, cognitive, behavioural and emotional responses. The primary outcome measures were the ICD-10 Diagnosis for PCS and the Rivermead Postconcussion Symptoms Questionnaire. Data from 107 patients were entered into final analysis. Demographic and clinical characteristic variables were compared between the PCS cases and non-cases using independent-sample t tests and ?² tests. Significant variables from the individual regression analysis were subjected to multiple logistic regression modelling with PCS outcome entered as the dependent variable. A stepwise backward logistic regression procedure was used to derive the model. The Likelihood Ratio Test was used to select predictor variables in the logistic regression model. Fit of the model was assessed by the Hosmer-Lemeshow ‘‘goodness of fit statistic’’ for significance.

Results: Of 107 participants, 24 (23%) patients met the criteria for PCS at 3 months, and 23 (22%) at 6 months. Somatic symptoms such as headache, fatigue, sleep disturbance, were most prevalent at two follow-ups. Significant predictors indicated by individual logistic regression analysis including illness perceptions, stress, HADS anxiety and depression, and all-or-nothing behaviour, were then entered into two separate multiple regression analysis. The resultant model for PCS at 3 months included all-or-nothing behaviour, and the resultant model at 6 months included all-or-nothing behaviour and negative illness perceptions. All-or-nothing behaviour was found to be an independent predictor for PCS at 3 months (Odds Ratio 1.141, 95% confidence interval 1.050 to 1.240, p = 0.002), while negative illness perceptions was an independent predictor at 6 months after injury (Odds Ratio 1.053, 95% confidence interval 1.008 to 1.101, p = 0.021).

Conclusions: The study provides good support for the proposed cognitive behavioural model for PCS. Patients’ negative illness beliefs and certain behavioural response play important roles in the development of PCS, indicating that they may be important early intervention targets.
Hou, Ruihua
470bdcbc-93a9-4dad-aac5-26d455c34376
Moss-Morris, Rona
a502f58a-d319-49a6-8aea-9dde4efc871e
Peveler, Robert
93198224-78d9-4c1f-9c07-fdecfa69cf96
Belli, Antonio
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Bradley, Brendan P.
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Mogg, Karin
5f1474af-85f5-4fd3-8eb6-0371be848e30
Hou, Ruihua
470bdcbc-93a9-4dad-aac5-26d455c34376
Moss-Morris, Rona
a502f58a-d319-49a6-8aea-9dde4efc871e
Peveler, Robert
93198224-78d9-4c1f-9c07-fdecfa69cf96
Belli, Antonio
33707b7b-b004-4245-aead-98a8e1e2b2e2
Bradley, Brendan P.
bdacaa6c-528b-4086-9448-27ebfe463514
Mogg, Karin
5f1474af-85f5-4fd3-8eb6-0371be848e30

Hou, Ruihua, Moss-Morris, Rona, Peveler, Robert, Belli, Antonio, Bradley, Brendan P. and Mogg, Karin (2011) How does a trivial head injury result in enduring symptoms? A prospective investigation of outcome after mild traumatic brain injury. 19th European Congress of Psychiatry 12-15 March 2011. 1 pp .

Record type: Conference or Workshop Item (Poster)

Abstract

Background: Traumatic brain injury is one of the most common neurological conditions. However, the majority of cases 90% are actually mild. Mild traumatic brain injury (MTBI) remains a major, unrecognized public health issue and has been called a “silent epidemic” (1). A significant proportion (15-30%) of patients are at risk of developing Post Concussional Syndrome (PCS) (2)(3), which is a symptom cluster including a number of physical, cognitive, emotional?and behavioural symptoms.

Objective: The aim of this study was to investigate the contributions of cognitive, emotional and behavioural factors to the development of PCS based on a cognitive-behavioural model.

Methods: A prospective cohort design was employed. 126 patients met the diagnosis of MTBI (mean age 38.32 years; male 63%) completed baseline questionnaire assessments within 2 weeks after injury, and 108 patients completed follow-up questionnaire assessments at both 3 and 6 months after injury. A series of self-report measures including the Brief Illness Perception Questionnaire, the Behavioural Response to Illness Questionnaire, the Impact of Event Scale, the Hospital Anxiety and Depression Scale, the Brief Social Support Questionnaire, and the Rivermead Postconcussion Symptoms Questionnaire were used to assess baseline somatic, cognitive, behavioural and emotional responses. The primary outcome measures were the ICD-10 Diagnosis for PCS and the Rivermead Postconcussion Symptoms Questionnaire. Data from 107 patients were entered into final analysis. Demographic and clinical characteristic variables were compared between the PCS cases and non-cases using independent-sample t tests and ?² tests. Significant variables from the individual regression analysis were subjected to multiple logistic regression modelling with PCS outcome entered as the dependent variable. A stepwise backward logistic regression procedure was used to derive the model. The Likelihood Ratio Test was used to select predictor variables in the logistic regression model. Fit of the model was assessed by the Hosmer-Lemeshow ‘‘goodness of fit statistic’’ for significance.

Results: Of 107 participants, 24 (23%) patients met the criteria for PCS at 3 months, and 23 (22%) at 6 months. Somatic symptoms such as headache, fatigue, sleep disturbance, were most prevalent at two follow-ups. Significant predictors indicated by individual logistic regression analysis including illness perceptions, stress, HADS anxiety and depression, and all-or-nothing behaviour, were then entered into two separate multiple regression analysis. The resultant model for PCS at 3 months included all-or-nothing behaviour, and the resultant model at 6 months included all-or-nothing behaviour and negative illness perceptions. All-or-nothing behaviour was found to be an independent predictor for PCS at 3 months (Odds Ratio 1.141, 95% confidence interval 1.050 to 1.240, p = 0.002), while negative illness perceptions was an independent predictor at 6 months after injury (Odds Ratio 1.053, 95% confidence interval 1.008 to 1.101, p = 0.021).

Conclusions: The study provides good support for the proposed cognitive behavioural model for PCS. Patients’ negative illness beliefs and certain behavioural response play important roles in the development of PCS, indicating that they may be important early intervention targets.

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Published date: March 2011
Additional Information: Vol. 26 Suppl.1 2011
Venue - Dates: 19th European Congress of Psychiatry 12-15 March 2011, 2011-03-01

Identifiers

Local EPrints ID: 185139
URI: http://eprints.soton.ac.uk/id/eprint/185139
PURE UUID: 5d547e2e-c21e-42f6-b4d1-37ca71c81e07
ORCID for Robert Peveler: ORCID iD orcid.org/0000-0001-5596-9394
ORCID for Brendan P. Bradley: ORCID iD orcid.org/0000-0003-2801-4271

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Date deposited: 09 May 2011 14:46
Last modified: 30 Jan 2020 01:31

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Contributors

Author: Ruihua Hou
Author: Rona Moss-Morris
Author: Robert Peveler ORCID iD
Author: Antonio Belli
Author: Karin Mogg

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