Stable predictors of postconcussion syndrome: female sex and premorbid psychological disorder

Susanne Meares, E. Arthur Shores, Allan J. Taylor, Jennifer Batchelor, Richard A. Bryant, Ian J. Baguley, Jennifer Chapman, Joseph Gurka, Jeno E. Marosszeky

Research output: Contribution to journalMeeting abstractResearch

Abstract

Objectives: Recent research has suggested that psychological symptoms following mild traumatic brain injury (mTBI) are present much earlier than expected in the development of post-concussion syndrome (PCS). Furthermore, in the acute stage post-trauma (i.e. within 14 days) Meares et al. found the variables most strongly related to a diagnosis of PCS were the presence of a previous affective or anxiety disorder and female sex, rather than the occurrence of the mTBI itself. The question of the extent to which these factors contribute to persistent PCS is central. The aim of the current study was to examine predictors of PCS at two time points, within the acute stage and in the chronic phase (i.e. 3 months) post-trauma. The relationship between preinjury psychiatric disorder, demographic factors, injury-related characteristics, neuropsychological and psychological variables and PCS was investigated. Method: Consecutive trauma admissions to a Level 1 trauma hospital were prospectively enrolled if they had suffered a traumatic injury. The final sample comprised 62 mTBI and 58 non-brain injured trauma controls who were assessed at both time points, a mean 4.88 days (SD=2.72) and a mean 106.23 days (SD=14.85) post-trauma. On both occasions participants were administered a PCS checklist and neuropsychological and psychological measures. Diagnosis of PCS was based on the presence and frequency of three or more PCS symptom complaints from the International Classification of Diseases PCS diagnostic criteria. Mixed-effects logistic regression was used to test associations between subject characteristics and the effect of time. Multiple imputation was used to handle missing data at the subject level. Results: At both times a diagnosis of PCS was not specific to mTBI (acute stage: mTBI 40.3%, controls 50.0%; chronic phase: mTBI 46.8%, control 48.3%). The strongest predictor of PCS in both the acute and chronic phase was female sex (OR: 2.77, 95% CI, 1.01–7.55). Individuals with premorbid anxiety or affective disorder were 2.72- times more likely to have PCS at both times than those without psychological histories (95% CI, 1.04–7.17). Pain and post-traumatic stress disorder (PTSD) were each individually significant predictors of PCS ~3 months post-trauma. At this time participants were 3.6-times more likely to have PCS if they were experiencing both pain and PTSD (95% CI, 1.21–10.72). Conclusions: Female sex and premorbid anxiety and affective disorder were stable predictors of PCS, suggesting that PCS may be validly diagnosed in the acute stage post-trauma. The diagnosis of PCS in the acute stage, rather than later in the chronic phase, followed by early intervention may reduce the development of psychological disorders in these vulnerable individuals.

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Post-Concussion Syndrome
Psychology
Brain Concussion
Wounds and Injuries
Anxiety Disorders
Mood Disorders
Post-Traumatic Stress Disorders

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Meares, Susanne ; Shores, E. Arthur ; Taylor, Allan J. ; Batchelor, Jennifer ; Bryant, Richard A. ; Baguley, Ian J. ; Chapman, Jennifer ; Gurka, Joseph ; Marosszeky, Jeno E. / Stable predictors of postconcussion syndrome : female sex and premorbid psychological disorder. In: Brain injury : abstracts of the 7th World Congress on Brain Injury. 2008 ; Vol. 22, No. Suppl. 1. pp. 60-61.
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title = "Stable predictors of postconcussion syndrome: female sex and premorbid psychological disorder",
abstract = "Objectives: Recent research has suggested that psychological symptoms following mild traumatic brain injury (mTBI) are present much earlier than expected in the development of post-concussion syndrome (PCS). Furthermore, in the acute stage post-trauma (i.e. within 14 days) Meares et al. found the variables most strongly related to a diagnosis of PCS were the presence of a previous affective or anxiety disorder and female sex, rather than the occurrence of the mTBI itself. The question of the extent to which these factors contribute to persistent PCS is central. The aim of the current study was to examine predictors of PCS at two time points, within the acute stage and in the chronic phase (i.e. 3 months) post-trauma. The relationship between preinjury psychiatric disorder, demographic factors, injury-related characteristics, neuropsychological and psychological variables and PCS was investigated. Method: Consecutive trauma admissions to a Level 1 trauma hospital were prospectively enrolled if they had suffered a traumatic injury. The final sample comprised 62 mTBI and 58 non-brain injured trauma controls who were assessed at both time points, a mean 4.88 days (SD=2.72) and a mean 106.23 days (SD=14.85) post-trauma. On both occasions participants were administered a PCS checklist and neuropsychological and psychological measures. Diagnosis of PCS was based on the presence and frequency of three or more PCS symptom complaints from the International Classification of Diseases PCS diagnostic criteria. Mixed-effects logistic regression was used to test associations between subject characteristics and the effect of time. Multiple imputation was used to handle missing data at the subject level. Results: At both times a diagnosis of PCS was not specific to mTBI (acute stage: mTBI 40.3{\%}, controls 50.0{\%}; chronic phase: mTBI 46.8{\%}, control 48.3{\%}). The strongest predictor of PCS in both the acute and chronic phase was female sex (OR: 2.77, 95{\%} CI, 1.01–7.55). Individuals with premorbid anxiety or affective disorder were 2.72- times more likely to have PCS at both times than those without psychological histories (95{\%} CI, 1.04–7.17). Pain and post-traumatic stress disorder (PTSD) were each individually significant predictors of PCS ~3 months post-trauma. At this time participants were 3.6-times more likely to have PCS if they were experiencing both pain and PTSD (95{\%} CI, 1.21–10.72). Conclusions: Female sex and premorbid anxiety and affective disorder were stable predictors of PCS, suggesting that PCS may be validly diagnosed in the acute stage post-trauma. The diagnosis of PCS in the acute stage, rather than later in the chronic phase, followed by early intervention may reduce the development of psychological disorders in these vulnerable individuals.",
author = "Susanne Meares and Shores, {E. Arthur} and Taylor, {Allan J.} and Jennifer Batchelor and Bryant, {Richard A.} and Baguley, {Ian J.} and Jennifer Chapman and Joseph Gurka and Marosszeky, {Jeno E.}",
year = "2008",
doi = "10.1080/02699050801984326",
language = "English",
volume = "22",
pages = "60--61",
journal = "Brain injury : abstracts of the 7th World Congress on Brain Injury",
issn = "0269-9052",
publisher = "Informa Healthcare",
number = "Suppl. 1",

}

Stable predictors of postconcussion syndrome : female sex and premorbid psychological disorder. / Meares, Susanne; Shores, E. Arthur; Taylor, Allan J.; Batchelor, Jennifer; Bryant, Richard A.; Baguley, Ian J.; Chapman, Jennifer; Gurka, Joseph; Marosszeky, Jeno E.

In: Brain injury : abstracts of the 7th World Congress on Brain Injury, Vol. 22, No. Suppl. 1, 2008, p. 60-61.

Research output: Contribution to journalMeeting abstractResearch

TY - JOUR

T1 - Stable predictors of postconcussion syndrome

T2 - Brain injury : abstracts of the 7th World Congress on Brain Injury

AU - Meares, Susanne

AU - Shores, E. Arthur

AU - Taylor, Allan J.

AU - Batchelor, Jennifer

AU - Bryant, Richard A.

AU - Baguley, Ian J.

AU - Chapman, Jennifer

AU - Gurka, Joseph

AU - Marosszeky, Jeno E.

PY - 2008

Y1 - 2008

N2 - Objectives: Recent research has suggested that psychological symptoms following mild traumatic brain injury (mTBI) are present much earlier than expected in the development of post-concussion syndrome (PCS). Furthermore, in the acute stage post-trauma (i.e. within 14 days) Meares et al. found the variables most strongly related to a diagnosis of PCS were the presence of a previous affective or anxiety disorder and female sex, rather than the occurrence of the mTBI itself. The question of the extent to which these factors contribute to persistent PCS is central. The aim of the current study was to examine predictors of PCS at two time points, within the acute stage and in the chronic phase (i.e. 3 months) post-trauma. The relationship between preinjury psychiatric disorder, demographic factors, injury-related characteristics, neuropsychological and psychological variables and PCS was investigated. Method: Consecutive trauma admissions to a Level 1 trauma hospital were prospectively enrolled if they had suffered a traumatic injury. The final sample comprised 62 mTBI and 58 non-brain injured trauma controls who were assessed at both time points, a mean 4.88 days (SD=2.72) and a mean 106.23 days (SD=14.85) post-trauma. On both occasions participants were administered a PCS checklist and neuropsychological and psychological measures. Diagnosis of PCS was based on the presence and frequency of three or more PCS symptom complaints from the International Classification of Diseases PCS diagnostic criteria. Mixed-effects logistic regression was used to test associations between subject characteristics and the effect of time. Multiple imputation was used to handle missing data at the subject level. Results: At both times a diagnosis of PCS was not specific to mTBI (acute stage: mTBI 40.3%, controls 50.0%; chronic phase: mTBI 46.8%, control 48.3%). The strongest predictor of PCS in both the acute and chronic phase was female sex (OR: 2.77, 95% CI, 1.01–7.55). Individuals with premorbid anxiety or affective disorder were 2.72- times more likely to have PCS at both times than those without psychological histories (95% CI, 1.04–7.17). Pain and post-traumatic stress disorder (PTSD) were each individually significant predictors of PCS ~3 months post-trauma. At this time participants were 3.6-times more likely to have PCS if they were experiencing both pain and PTSD (95% CI, 1.21–10.72). Conclusions: Female sex and premorbid anxiety and affective disorder were stable predictors of PCS, suggesting that PCS may be validly diagnosed in the acute stage post-trauma. The diagnosis of PCS in the acute stage, rather than later in the chronic phase, followed by early intervention may reduce the development of psychological disorders in these vulnerable individuals.

AB - Objectives: Recent research has suggested that psychological symptoms following mild traumatic brain injury (mTBI) are present much earlier than expected in the development of post-concussion syndrome (PCS). Furthermore, in the acute stage post-trauma (i.e. within 14 days) Meares et al. found the variables most strongly related to a diagnosis of PCS were the presence of a previous affective or anxiety disorder and female sex, rather than the occurrence of the mTBI itself. The question of the extent to which these factors contribute to persistent PCS is central. The aim of the current study was to examine predictors of PCS at two time points, within the acute stage and in the chronic phase (i.e. 3 months) post-trauma. The relationship between preinjury psychiatric disorder, demographic factors, injury-related characteristics, neuropsychological and psychological variables and PCS was investigated. Method: Consecutive trauma admissions to a Level 1 trauma hospital were prospectively enrolled if they had suffered a traumatic injury. The final sample comprised 62 mTBI and 58 non-brain injured trauma controls who were assessed at both time points, a mean 4.88 days (SD=2.72) and a mean 106.23 days (SD=14.85) post-trauma. On both occasions participants were administered a PCS checklist and neuropsychological and psychological measures. Diagnosis of PCS was based on the presence and frequency of three or more PCS symptom complaints from the International Classification of Diseases PCS diagnostic criteria. Mixed-effects logistic regression was used to test associations between subject characteristics and the effect of time. Multiple imputation was used to handle missing data at the subject level. Results: At both times a diagnosis of PCS was not specific to mTBI (acute stage: mTBI 40.3%, controls 50.0%; chronic phase: mTBI 46.8%, control 48.3%). The strongest predictor of PCS in both the acute and chronic phase was female sex (OR: 2.77, 95% CI, 1.01–7.55). Individuals with premorbid anxiety or affective disorder were 2.72- times more likely to have PCS at both times than those without psychological histories (95% CI, 1.04–7.17). Pain and post-traumatic stress disorder (PTSD) were each individually significant predictors of PCS ~3 months post-trauma. At this time participants were 3.6-times more likely to have PCS if they were experiencing both pain and PTSD (95% CI, 1.21–10.72). Conclusions: Female sex and premorbid anxiety and affective disorder were stable predictors of PCS, suggesting that PCS may be validly diagnosed in the acute stage post-trauma. The diagnosis of PCS in the acute stage, rather than later in the chronic phase, followed by early intervention may reduce the development of psychological disorders in these vulnerable individuals.

U2 - 10.1080/02699050801984326

DO - 10.1080/02699050801984326

M3 - Meeting abstract

VL - 22

SP - 60

EP - 61

JO - Brain injury : abstracts of the 7th World Congress on Brain Injury

JF - Brain injury : abstracts of the 7th World Congress on Brain Injury

SN - 0269-9052

IS - Suppl. 1

ER -