Emotional reserve and prolonged post-concussive symptoms and disability: a Swedish prospective 1-year mild traumatic brain injury cohort study

Abstract

ObjectiveProlonged post-concussive symptoms (PCS) affect a significant minority of patients withmild traumatic brain injury (mTBI). The aetiology is multifactorial depending on preinjury as well as peri-injury and postinjury factors. In this study, we examine outcome from an emotional reserve perspective.DesignProspective cohort study.SettingPatients were recruited from three emergency departments in major university hospitals in Stockholm, Sweden. Follow-up data were collected in an outpatient setting at one of the recruiting hospitals.Participants122 patients with a history of blunt head trauma (aged 15–65 years; admitted for mTBI within 24 hours after trauma (Glasgow Coma Scale score of 14–15, loss of consciousness <30 min and/or post-traumatic amnesia <24 hours). Exclusion criteria were other significant physical injury and other major neurological disorder, including previous significant head injury.ProcedureRecruitment in three emergency departments. Initial assessments were made within 1 week after the injury. Patients were mailed the follow-up questionnaires 1 year postinjury.Outcome measuresA psychiatric assessment was performed at 1 week post injury. The participants also completed a personality inventory, measures of psychological resilience, depression, anxiety and post-traumatic symptoms. One-year outcome was measured by the Rivermead Post Concussion Symptoms and the Rivermead Head Injury Follow-Up questionnaires.ResultsThe psychiatric assessment revealed more symptoms of anxiety, depression and post-traumatic symptoms in the acute stage for patients who later developed PCS.After 1 year, 94 participants were still in the programme (male/female 57/37) and 12% matched the extended criteria for PCS (≥3 symptoms and ≥2 disabilities). PCS patients reported more preinjury and concurrent psychiatric problems, lower level of functioning before the injury and experienced more stress. They showed higher somatic trait anxiety, embitterment, mistrust and lower level of psychological resilience than recovered participants.ConclusionIntrapersonal emotional reserve shape the emergence and persistence of PCS after mTBI.

Personal Factors Associated With Postconcussion Symptoms 3 Months After Mild Traumatic Brain Injury

“…Personality characteristics were also related to persistent symptoms. Not surprisingly, neuroticism, a personality trait linked to an increased tendency of experiencing negative emotions and distress, was associated with PCSs, in line with other studies of patients with MTBI 37,43,44 and people without MTBI. 45 Further, low resilience was a risk factor for PCSs, similar to previous studies.…”

“…45 Further, low resilience was a risk factor for PCSs, similar to previous studies. 37,[46][47][48][49] Low resilience has previously been found to be associated with high neuroticism, 31 and these factors also were correlated in the present study. A person's resilience is considered to be more modifiable than personality traits, 50,51 possibly making it a target for interventions after MTBI.…”

“…Importantly, we found that reduced employment was a strong and unique predictor of PCSs, even when possibly confounding variables were controlled for in the multivariable lasso model (eg, poor sleep quality and psychiatric history, which correlated moderately with reduced employment). Unemployment has previously been found to predict PCS after MTBI 36,37 and poor functional outcome after moderate to severe TBI. 38 Reduced employment might be a vulnerability factor or full-time employment might be a protective factor.…”

“…A history of psychiatric problems is considered to be a risk factor for persistent symptoms after MTBI. 16,37,52 Interestingly, this was not one of the variables most often included in our lasso multivariable model. The reason for this might be that other correlated variables, such as low resilience, high neuroticism, and reduced employment, have greater explanatory power.…”

An active approach in the treatment of post-concussion syndrome - Evidence-based practice in a collective case study

“…Furthermore, depression and anxiety might be risk factors for initially developing PCS. 71,72 Yet, studies on rodents have found evidence of causality, in which induced mTBI disrupts limbic system function, subsequently leading to long lasting depressive, fearful and anxious behavior. [73][74][75] Whatever the case, the neuropsychological nature of PCS makes providing psychosocial coping strategies a viable part of the multidisciplinary approach, and some reviews have supported the use of cognitive behavioral therapy in improving psychosocial outcomes 76 ; however, more research is needed.…”