Experience of mTBI-like symptoms in a sample without brain injury in Aotearoa/New Zealand
Jason Chua
A * and Alice Theadom A
A
Abstract
Post-mild traumatic brain injury (mTBI) symptoms are not specific to mTBI and are experienced in populations without brain injury. Understanding how people without brain injury experience mTBI-like symptoms and factors influencing symptom reporting is important to determine how symptom experience differs following an mTBI.
To understand how people without a history of brain injury experience mTBI-like symptoms, we conducted a cross-sectional survey comprising sociodemographic characteristics, the Brain Injury Screening Tool symptom scale, general health rating, Illness Attitude Scale, Positive and Negative Affect Scale and Perceived Stress Scale. The mean total symptom score and proportion of people experiencing moderate or severe symptoms (≥4) were reported. Associations between sociodemographic variables, stress, negative affect, illness attitudes, health status and symptoms were examined using regression models.
One-hundred and seventy-three people completed the survey with a mean age of 40 years (s.d. = 15.8; n = 82, 47.4% male). The mean total symptom score was 34.5( ± 26.6). Commonly experienced symptoms were tiredness (n = 73, 42.2%), poor sleep (n = 64, 37.0%) and headaches (n = 56, 32.4%). Regression analysis revealed that on average higher levels of worry about illness and negative affect were associated with higher symptoms (β = 0.5, P = 0.027 and β = 0.9, P = 0.020 respectively) but there were no significant associations with other variables.
Cognitive and vestibular-ocular symptoms occur much less frequently than physical symptoms in the general population and may be more specific to mTBI. However, there is a need to consider vestibular-ocular symptoms alongside illness attitudes due to greater concerns about these symptoms by patients.
Keywords: illness attitudes, injury, mood, mild traumatic brain injury, negative affect, post-concussion symptoms, stress, symptom experience.
References
Alla S, Sullivan SJ, Hale L, McCrory P (2009) Self-report scales/checklists for the measurement of concussion symptoms: a systematic review. British Journal of Sports Medicine 43(Suppl 1), i3-i12.
| Crossref | Google Scholar | PubMed |
Bardel A, Wallander M-A, Wallman T, Rosengren A, Johansson S, Eriksson H, Svärdsudd K (2019) Age and sex related self-reported symptoms in a general population across 30 years: patterns of reporting and secular trend. PLoS One 14(2), e0211532.
| Crossref | Google Scholar | PubMed |
Cassidy JD, Cancelliere C, Carroll LJ, Côté P, Hincapié CA, Holm LW, Hartvigsen J, Donovan J, Nygren-de Boussard C, Kristman VL, Borg J (2014) Systematic review of self-reported prognosis in adults after mild traumatic brain injury: results of the International Collaboration on Mild Traumatic Brain Injury Prognosis. Archives of Physical Medicine and Rehabilitation 95(3 Suppl), S132-S151.
| Crossref | Google Scholar | PubMed |
Chan RC (2001) Base rate of post-concussion symptoms among normal people and its neuropsychological correlates. Clinical Rehabilitation 15(3), 266-273.
| Crossref | Google Scholar | PubMed |
Cohen S, Kamarck T, Mermelstein R (1983) A global measure of perceived stress. Journal of Health and Social Behavior 24, 385-396.
| Crossref | Google Scholar |
Crawford JR, Henry JD (2004) The Positive and Negative Affect Schedule (PANAS): construct validity, measurement properties and normative data in a large non-clinical sample. British Journal of Clinical Psychology 43(3), 245-265.
| Crossref | Google Scholar |
Dewan MC, Rattani A, Gupta S, Baticulon RE, Hung YC, Punchak M, Agrawal A, Adeleye AO, Shrime MG, Rubiano AM, Rosenfeld JV, Park KB (2018) Estimating the global incidence of traumatic brain injury. Journal of Neurosurgery 130, 1080-1097.
| Crossref | Google Scholar | PubMed |
Echemendia RJ, Meeuwisse W, McCrory P, Davis GA, Putukian M, Leddy J, Makdissi M, Sullivan SJ, Broglio SP, Raftery M, Schneider K, Kissick J, McCrea M, Dvořák J, Sills AK, Aubry M, Engebretsen L, Loosemore M, Fuller G, et al. (2017) The Sport Concussion Assessment Tool 5th Edition (SCAT5): background and rationale. British Journal of Sports Medicine 51(11), 848-850.
| Crossref | Google Scholar | PubMed |
Feigin VL, Theadom A, Barker-Collo S, Starkey NJ, McPherson K, Kahan M, Dowell A, Brown P, Parag V, Kydd R, Jones K, Jones A, Ameratunga S, BIONIC Study Group (2013) Incidence of traumatic brain injury in New Zealand: a population-based study. Lancet Neurology 12(1), 53-64.
| Crossref | Google Scholar | PubMed |
Ferguson E, Daniel E (1995) The Illness Attitudes Scale (IAS): a psychometric evaluation on a non-clinical population. Personality and Individual Differences 18(4), 463-469.
| Crossref | Google Scholar |
Garden N, Sullivan KA (2010) An Examination of the Base Rates of Post-Concussion Symptoms: The Influence of Demographics and Depression. Applied Neuropsychology 17(1), 1-7.
| Crossref | Google Scholar | PubMed |
Garden N, Sullivan KA, Lange RT (2010) The relationship between personality characteristics and postconcussion symptoms in a nonclinical sample. Neuropsychology 24(2), 168-175.
| Crossref | Google Scholar | PubMed |
Goldman SL, Kraemer DT, Salovey P (1996) Beliefs about mood moderate the relationship of stress to illness and symptom reporting. Journal of Psychosomatic Research 41(2), 115-128.
| Crossref | Google Scholar | PubMed |
Goodyear-Smith F, Ashton T (2019) New Zealand health system: universalism struggles with persisting inequities. The Lancet 394(10196), 432-442.
| Crossref | Google Scholar | PubMed |
Hedman E, Ljótsson B, Andersson E, Andersson G, Lindefors N, Rück C, Axelsson E, Lekander M (2015) Psychometric properties of Internet-administered measures of health anxiety: an investigation of the Health Anxiety Inventory, the Illness Attitude Scales, and the Whiteley Index. Journal of Anxiety Disorders 31, 32-37.
| Crossref | Google Scholar | PubMed |
Hoaglin DC, Iglewicz B (1987) Fine-Tuning Some Resistant Rules for Outlier Labeling. Journal of the American Statistical Association 82(400), 1147-1149.
| Crossref | Google Scholar |
Hou R, Moss-Morris R, Peveler R, Mogg K, Bradley BP, Belli A (2012) When a minor head injury results in enduring symptoms: a prospective investigation of risk factors for postconcussional syndrome after mild traumatic brain injury. Journal of Neurology, Neurosurgery and Psychiatry 83(2), 217-223.
| Crossref | Google Scholar | PubMed |
Iverson GL, Lange RT (2003) Examination of 'Postconcussion-Like' Symptoms in a Healthy Sample. Applied Neuropsychology 10(3), 137-144.
| Crossref | Google Scholar | PubMed |
Iverson GL, Williams MW, Gardner AJ, Terry DP (2020) Systematic review of preinjury mental health problems as a vulnerability factor for worse outcome after sport-related concussion. Orthopaedic Journal of Sports Medicine 8(10), 2325967120950682.
| Crossref | Google Scholar | PubMed |
Johnson LW, Diaz I (2023) Exploring the social determinants of health and health disparities in traumatic brain injury: a scoping review. Brain Sciences 13(5), 707.
| Crossref | Google Scholar | PubMed |
King NS, Crawford S, Wenden FJ, Moss NEG, Wade DT (1995) The Rivermead Post Concussion Symptoms Questionnaire: a measure of symptoms commonly experienced after head injury and its reliability. Journal of Neurology 242(9), 587-592.
| Crossref | Google Scholar | PubMed |
Kjeldsberg M, Tschudi-Madsen H, Dalen I, Straand J, Bruusgaard D, Natvig B (2013) Symptom reporting in a general population in Norway: results from the Ullensaker study. Scandinavian Journal of Primary Health Care 31(1), 36-42.
| Crossref | Google Scholar | PubMed |
Koerte IK, Schultz V, Sydnor VJ, Howell DR, Guenette JP, Dennis E, Kochsiek J, Kaufmann D, Sollmann N, Mondello S, Shenton ME, Lin AP (2020) Sex‐Related Differences in the Effects of Sports‐Related Concussion: A Review. Journal of Neuroimaging 30(4), 387-409.
| Crossref | Google Scholar | PubMed |
Lee E-H (2012) Review of the Psychometric Evidence of the Perceived Stress Scale. Asian Nursing Research 6(4), 121-127.
| Crossref | Google Scholar | PubMed |
Maas AIR, Menon DK, Adelson PD, Andelic N, Bell MJ, Belli A, Bragge P, Brazinova A, Büki A, Chesnut RM, Citerio G, Coburn M, Cooper DJ, Crowder AT, Czeiter E, Czosnyka M, Diaz-Arrastia R, Dreier JP, Duhaime A-C, et al. (2017) Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research. The Lancet Neurology 16(12), 987-1048.
| Crossref | Google Scholar | PubMed |
Mayer AR, Quinn DK, Master CL (2017) The spectrum of mild traumatic brain injury. Neurology 89(6), 623-632.
| Crossref | Google Scholar | PubMed |
Meuleman B, Loosveldt G, Emonds V (2014) ‘The SAGE Handbook of Regression Analysis and Causal Inference.’ (SAGE Publications) 10.4135/9781446288146
Ministry of Health (2022) Annual Data Explorer 2021/22: New Zealand Health Survey [Data File]. (Ministry of Health) Available at https://minhealthnz.shinyapps.io/nz-health-survey-2021-22-annual-data-explorer/ [Retrieved 18 June]
Mittenberg W, DiGiulio DV, Perrin S, Bass AE (1992) Symptoms following mild head injury: expectation as aetiology. Journal of Neurology, Neurosurgery and Psychiatry 55(3), 200-204.
| Crossref | Google Scholar | PubMed |
Mulhern S, McMillan TM (2006) Knowledge and expectation of postconcussion symptoms in the general population. Journal of Psychosomatic Research 61(4), 439-445.
| Crossref | Google Scholar | PubMed |
Petrie KJ, Faasse K, Crichton F, Grey A (2014) How common are symptoms? Evidence from a New Zealand national telephone survey. BMJ Open 4(6), e005374.
| Crossref | Google Scholar | PubMed |
Roberti JW, Harrington LN, Storch EA (2006) Further psychometric support for the 10‐item version of the perceived stress scale. Journal of College Counseling 9(2), 135-147.
| Crossref | Google Scholar |
Shaikh N, Tokhi Y, Hardaker N, Henshall K, Forch K, Fernando K, King D, Fulcher M, Jewell S, Bastos-Gottgtroy R, Hume P, Theadom A (2022) Brain Injury Screening Tool (BIST): test-retest reliability in a community adult sample. BMJ Open 12(8), e057701.
| Crossref | Google Scholar | PubMed |
Silverberg ND, Iaccarino MA, Panenka WJ, Iverson GL, McCulloch KL, Dams-O’Connor K, Reed N, McCrea M, American Congress of Rehabilitation Medicine Brain Injury Interdisciplinary Special Interest Group Mild TBI Task Force (2020) Management of Concussion and Mild Traumatic Brain Injury: A Synthesis of Practice Guidelines. Archives of Physical Medicine and Rehabilitation 101(2), 382-393.
| Crossref | Google Scholar | PubMed |
Sirri L, Grandi S, Fava GA (2008) The Illness Attitude Scales: a clinimetric index for assessing hypochondriacal fears and beliefs. Psychotherapy and Psychosomatics 77(6), 337-350.
| Crossref | Google Scholar | PubMed |
Snell DL, Siegert RJ, Hay-Smith EJ, Surgenor LJ (2011) Associations between illness perceptions, coping styles and outcome after mild traumatic brain injury: preliminary results from a cohort study. Brain Injury 25(11), 1126-1138.
| Crossref | Google Scholar | PubMed |
Stanley J, Semper K, Millar E, Sarfati D (2018) Epidemiology of multimorbidity in New Zealand: a cross-sectional study using national-level hospital and pharmaceutical data. BMJ Open 8(5), e021689.
| Crossref | Google Scholar | PubMed |
Suhr JA, Gunstad J (2002) Postconcussive Symptom Report: The Relative Influence of Head Injury and Depression. Journal of Clinical and Experimental Neuropsychology 24(8), 981-993.
| Crossref | Google Scholar | PubMed |
Suzanne P, Maryse CC, Ruben GLR, Amra C, Anastasia G, Daphne CV, Christina LM, Juanita AH, Ramon D-A, von Steinbuechel N (2018) A Multidimensional Approach to Post-concussion Symptoms in Mild Traumatic Brain Injury. Frontiers in Neurology 9, 1113.
| Crossref | Google Scholar |
Theadom A, Parag V, Dowell T, McPherson K, Starkey N, Barker-Collo S, Jones K, Ameratunga S, Feigin VL, BIONIC Research Group (2016) Persistent problems 1 year after mild traumatic brain injury: a longitudinal population study in New Zealand. British Journal of General Practice 66(642), e16-e23.
| Crossref | Google Scholar | PubMed |
Theadom A, Barker-Collo S, Jones K, Kahan M, Te Ao B, McPherson K, Starkey N, Feigin V, BIONIC4you Research Group (2017) Work Limitations 4 Years After Mild Traumatic Brain Injury: A Cohort Study. Archives of Physical Medicine and Rehabilitation 98(8), 1560-1566.
| Crossref | Google Scholar | PubMed |
Theadom A, Starkey N, Barker-Collo S, Jones K, Ameratunga S, Feigin V, BIONIC4you Research Group (2018) Population-based cohort study of the impacts of mild traumatic brain injury in adults four years post-injury. PLoS One 13(1), e0191655.
| Crossref | Google Scholar | PubMed |
Theadom A, Hardaker N, Bray C, Siegert R, Henshall K, Forch K, Fernando K, King D, Fulcher M, Jewell S, Shaikh N, Bastos Gottgtroy R, Hume P (2021) The Brain Injury Screening Tool (BIST): tool development, factor structure and validity. PLoS One 16(2), e0246512.
| Crossref | Google Scholar | PubMed |
Viktoriya M (2019) The Interplay Between Stress, Inflammation, and Emotional Attention: Relevance for Depression. Frontiers in Neuroscience 13, 384.
| Crossref | Google Scholar |
Voormolen DC, Cnossen MC, Polinder S, Gravesteijn BY, Von Steinbuechel N, Real RGL, Haagsma JA (2019) Prevalence of post-concussion-like symptoms in the general population in Italy, The Netherlands and the United Kingdom. Brain Injury 33(8), 1078-1086.
| Crossref | Google Scholar | PubMed |
Wagstaff A (2002) Poverty and health sector inequalities. Bulletin of the World Health Organization 80(2), 97-105.
| Google Scholar | PubMed |
Wang Y, Chan RC, Deng Y (2006) Examination of postconcussion-like symptoms in healthy university students: relationships to subjective and objective neuropsychological function performance. Archives of Clinical Neuropsychology 21(4), 339-347.
| Crossref | Google Scholar | PubMed |
Watson D, Clark LA, Tellegen A (1988) Development and validation of brief measures of positive and negative affect: the PANAS scales. Journal of Personality and Social Psychology 54(6), 1063-1070.
| Crossref | Google Scholar | PubMed |
Zakzanis KK, Yeung E (2011) Base rates of post-concussive symptoms in a nonconcussed multicultural sample. Archives of Clinical Neuropsychology 26(5), 461-465.
| Crossref | Google Scholar | PubMed |
Zeldovich M, Bockhop F, Covic A, Cunitz K, Polinder S, Haagsma JA, von Steinbuechel N, CENTER-TBI Participants and Investigators (2022) Reference Values for the Rivermead Post-Concussion Symptoms Questionnaire (RPQ) from General Population Samples in the United Kingdom, Italy, and The Netherlands. Journal of Clinical Medicine 11(16), 4658.
| Crossref | Google Scholar | PubMed |
