Patients “At Risk” of Suffering from Persistent Complaints after Mild Traumatic Brain Injury: The Role of Coping, Mood Disorders, and Post-Traumatic Stress

Abstract

Although most patients recover fully following mild traumatic brain injury (mTBI), a minority (15-25%) of all patients develop persistent post-traumatic complaints (PTC) that interfere with the resumption of previous activities. An early identification of patients who are at risk for PTC is currently performed by measuring the number of complaints in the acute phase. However, only part of this group will actually develop persisting complaints, stressing the need for studies on additional risk factors. This study aimed to compare this group of patients with many complaints with patients with few and no complaints to identify potential additional discriminating characteristics and to evaluate which of these factors have the most predictive value for being at risk. We evaluated coping style, presence of psychiatric history, injury characteristics, mood-related symptoms, and post-traumatic stress. We included 820 patients (Glasgow Coma Scale [GCS] score 13-15) admitted to three level-1 trauma centers as part of the UPFRONT-study. At 2 weeks after injury, 60% reported three or more complaints (PTC-high), 25% reported few complaints (PTC-low), and 15% reported no complaints (PTC-zero). Results showed that PTC-high consisted of more females (78% vs. 73% and 52%, p < 0.001), were more likely to have a psychiatric history (7% vs. 2% and 5%), and had a higher number of reported depression (22% vs. 6% and 3%, p < 0.001), anxiety (25% vs. 7% and 5%), and post-traumatic stress (37% vs. 27% and 19%, p < 0.001) than the PTC-low and PTC-zero groups. We conclude that in addition to reported complaints, psychological factors such as coping style, depression, anxiety, and post-traumatic stress symptoms had the highest predictive value and should be taken into account in the identification of at-risk patients for future treatment studies.

The psychological distress and coping styles in the early stages of the 2019 coronavirus disease (COVID-19) epidemic in the general mainland Chinese population: A web-based survey

“…The population with negative coping style showed higher level of psychological distress. The previous study related to traumatic stress events has reported that those in the general population with traumatic stress experiences were more likely to adopt a negative coping style [9]. Many previous studies have shown that different coping styles, especially negative coping styles, for trauma stress events are also related to subsequent mental illness [7,10,32].…”

“…At the same time, as the epidemic continues, general population gradually experience different levels of psychological distress, such as nervousness, fear of infection, anxiety, depression, sleep problems, and inattention [3,4]. Previous studies have reported that some psychological problems often occur during similar epidemic [5,6] or other traumatic stress events, such as natural disasters [7,8], disease [9], or long-term employment in high stress occupations [10][11][12], and may last for a long time [13,14].…”

Subjective complaints after acquired brain injury: presentation of the Brain Injury Complaint Questionnaire (BICoQ)

“…The reverse pattern was found after mild TBI. Subjective complaints after mild TBI seem to be strongly influenced by mental distress and post‐traumatic stress disorder rather than by injury severity by itself (de Koning et al, ; Scheenen et al, ).…”

Unraveling the Biopsychosocial Factors of Fatigue and Sleep Problems After Traumatic Brain Injury: Protocol for a Multicenter Longitudinal Cohort Study (Preprint)

“…[9]. Multiple researchers suggested integrated biopsychosocial approaches for future studies to best explain the outcome of TBI [80][81][82][83]. However, few studies have yet examined identified biopsychosocial factors in a comprehensive model over time to determine the significant underlying factors that contribute to post-TBI fatigue and sleep problems.…”