Hostname: page-component-cd9895bd7-q99xh Total loading time: 0 Render date: 2024-12-26T15:46:04.809Z Has data issue: false hasContentIssue false
  • English
  • Français

Predictors of postconcussion symptom complex in community dwelling male veterans

Published online by Cambridge University Press:  12 February 2004

CHERYL A. LUIS ,
RODNEY D. VANDERPLOEG  and
GLENN CURTISS
CHERYL A. LUIS
Affiliation:
James A. Haley VA Medical Center, Tampa, Florida
RODNEY D. VANDERPLOEG
Affiliation:
James A. Haley VA Medical Center, Tampa, Florida Department of Psychiatry and Behavioral Medicine, University of South Florida, Tampa Department of Psychology, University of South Florida, Tampa Defense and Veterans Brain Injury Center, Tampa, Florida
GLENN CURTISS
Affiliation:
James A. Haley VA Medical Center, Tampa, Florida Department of Psychiatry and Behavioral Medicine, University of South Florida, Tampa Defense and Veterans Brain Injury Center, Tampa, Florida
Get access Rights & Permissions [Opens in a new window]

Abstract

The presence of a persistent postconcussion symptom complex (PPCSC) was examined in a non-referred sample of male veterans with a history of mild head injury and a comparison group without a history of head injury. Hierarchical logistic regression procedures were used to determine possible predictors of PPCSC using variables supported by previous research (i.e., preexisting psychiatric difficulties, demographic and social support variables, and history of an accidental injurious event). Although PPCSC was common in all groups (23% of the total sample), a significantly greater proportion of individuals in the mild head injury with loss of consciousness group (37.2%) had PPCSC compared with three other groups (head injury without loss of consciousness = 26.1%; motor vehicle accident without head injury = 23%; and control = 17.3%). However, the most salient predictors of PPCSC were early life psychiatric difficulties such as anxiety or depression, limited social support, lower intelligence, and interactions among these variables. The predictive value of loss of consciousness was significant, but low (1.4% of unique variance). The findings provide support for the premise that PPCSC is mediated in part by individual resilience, preexisting psychological status, and psychosocial support. (JINS, 2003, 9, 1001–1015.)

Keywords

Brain concussionHead injuryMinorNeurobehavioral manifestationsMental disordersSocial supportSequelae
Type
Research Article
Information
Journal of the International Neuropsychological Society , Volume 9 , Issue 7 , November 2003 , pp. 1001 - 1015
Copyright
© 2003 The International Neuropsychological Society

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Accordino, M.P. & Herbert, J.T. (2000). Treatment outcomes of four rehabilitation interventions for persons with serious mental illness. Journal of Mental Health, 22, 268–272.Google Scholar
Alexander, M.P. (1992). Neuropsychiatric correlates of persistent postconcussive syndrome. Journal of Head Trauma Rehabilitation, 7, 60–69.CrossRefGoogle Scholar
Alves, W., Macciocchi, S.N., & Barth, J.T. (1993). Postconcussive symptoms after uncomplicated mild head injury. Journal of Head Trauma Rehabilitation, 8, 48–59.CrossRefGoogle Scholar
American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders (3rd ed.). Washington, DC: Author.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.
Andersen, C.V. & Bigler, E.D. (1995). Ventricular dilation, cortical atrophy, and neuropsychological outcome following traumatic brain injury. Journal of Neuropsychiatry and Clinical Neurosciences, 7, 42–48.Google Scholar
Binder, L.M. (1997). A review of mild head trauma. Part II: Clinical implication. Journal of Clinical and Experimental Neuropsychology, 19, 432–457.Google Scholar
Binder, L.M. & Rohling, M.L. (1996). Money matters, a meta-analytic review of the effects of financial incentives on recovery after closed-head injury. American Journal of Psychiatry, 153, 7–10.Google Scholar
Binder, L.M., Rohling, M.L., & Larrabee, G.J. (1997). A review of mild head trauma, Part I: Meta-analytic review of neuropsychological studies. Journal of Clinical and Experimental Neuropsychology, 19, 421–431.CrossRefGoogle Scholar
Bohnen, N., Jolles, J., Twijnstra, A., Mellink, R., & Sulon, J. (1992). Coping styles, cortisol reactivity, and performance on vigilance task of patients with persistent postconcussive symptoms after mild head injury. International Journal of Neuroscience, 64, 97–105.CrossRefGoogle Scholar
Bryant, R. & Harvey, A.G. (1999). Postconcussive symptoms and posttraumatic stress disorder after mild traumatic brain injury. Journal of Nervous and Mental Disease, 5, 302–305.CrossRefGoogle Scholar
Butcher, J.N., Dahlstrom, W.G., Graham, J.R., Tellegen, A.M., & Kaemmer, B. (1989). The Minnesota Multiphasic Personality Inventory–2: Manual for administration and scoring. Minneapolis, MN: University of Minnesota Press.
Centers for Disease Control. (1988a). Health status of Vietnam veterans: I. Psychosocial characteristics. The Centers for Disease Control Vietnam Experience Study. Journal of the American Medical Association, 18, 2701–2707.Google Scholar
Centers for Disease Control. (1988b). Health status of Vietnam veterans: II. Physical health. The Centers for Disease Control Vietnam Experience Study. Journal of the American Medical Association, 18, 2708–2714.Google Scholar
Centers for Disease Control. (1989). Health status of Vietnam veterans: Vol. IV. Psychological and neuropsychological evaluation. Atlanta, GA: Author.
Centers for Disease Control and Prevention. (1999). Traumatic brain injury in the United States: A report to congress. Retrieved September 14, 2002, from http://www.cdc.gov/ncipc/pub-res/tbicongress.htm
Christman, C.W., Grady, M.S., Walkre, S.A., Holloway, K.L., & Povlishock, J.T. (1994). Ultrastructural studies of diffuse axonal injury in humans. Journal of Neurotrauma, 11, 173–186.Google Scholar
Curtiss, G. & Vanderploeg, R.D. (2001, August). Long-term mental health and psychiatric consequences of mild head injury. In R.D. Vanderploeg (Chair), Resolving controversies in mild TBI: Neuropsychological, psychosocial, and psychiatric outcomes. Symposium conducted at the meeting of the American Psychological Association, San Francisco, CA.
Deb, S., Lyons, I., & Koutzoukis, C. (1999). Neurobehavioural symptoms one year after a head injury. British Journal of Psychiatry, 174, 360–365.CrossRefGoogle Scholar
DeMaris, A. (2002). Explained variance in logistic regression: A Monte Carlo study of proposed measures. Sociological Methods of Research, 31, 27–74.Google Scholar
Di Gallo, A., Barton, J., & Parry-Jones, W. (1997). Road traffic accidents: Early psychological consequences in children and adolescents. British Journal of Psychiatry, 170, 358–362.Google Scholar
Dikmen, S., McLean, A., & Temkin, N. (1986). Neuropsychological and psychosocial consequences of minor head injury. Journal of Neurology, Neurosurgery, and Psychiatry, 49, 1227–1232.CrossRefGoogle Scholar
Dunn, J.T., Lees-Haley, P.R., Brown, R.S., Williams, C.W., & English, L.T. (1995). Neurotoxic complaint base rates of personal injury claimants: Implications for neuropsychological assessment. Journal of Clinical Psychology, 51, 577–584.3.0.CO;2-E>CrossRefGoogle Scholar
Eisenberg, H.M. & Levin, H.S. (1989). Computed tomography and magnetic resonance imaging in mild to moderate head injury. In H.S. Levin, H.M. Eisenberg, & A.L. Benton (Eds.), Mild head injury (pp. 133–141). New York: Oxford University Press.
Elson, L.M. & Ward, C.C. (1994). Mechanisms and pathophysiology of mild head trauma. Seminars in Neurology, 14, 8–18.Google Scholar
Fann, J.R., Katon, W.J., Uomoto, J.M., & Esselman, P.C. (1995). Psychiatric disorders and functional disability in outpatients with traumatic brain injuries. American Journal of Psychiatry, 152, 1493–1499.Google Scholar
Fenton, G., McClelland, R., Montgomery, A., MacFlynn, G., & Rutherford, W. (1993). The postconcussional syndrome: Social antecedents and psychological sequelae. British Journal of Psychiatry, 162, 69–74.Google Scholar
Fox, D.D., Lees-Haley, P.R., Earnest, K., & Dolezal-Wood, S. (1995a). Base rates of postconcussive symptoms in health maintenance organization patients and controls. Neuropsychology, 4, 606–611.Google Scholar
Fox, D.D., Lees-Haley, P.R., Earnest, K., & Dolezal-Wood, S. (1995b). Post-concussive symptoms: Base rates and etiology in psychiatric patients. Clinical Neuropsychologist, 9, 89–92.Google Scholar
Gaetz, M. & Weinberg, H. (2000). Electrophysiological indices of persistent post-concussion symptoms. Brain Injury, 9, 815–832.Google Scholar
Gasquoine, P.G. (1997). Postconcussion symptoms. Neuropsychological Review, 7, 77–85.CrossRefGoogle Scholar
Goldberg, L., & Gara, M.A. (1990). A typology of psychiatric reactions to motor vehicle accidents, victims of nonserious accidents. Psychopathology, 23, 15–20.Google Scholar
Gouvier, W.D., Cubic, B., Jones, G., Brantley, P., & Cutlip, Q. (1992). Postconcussion symptoms and daily stress in normal and head injured college populations. Archives of Clinical Neuropsychology, 7, 193–211.CrossRefGoogle Scholar
Grady, M.S., McLaughling, M.R., Chistman, C.W., Valadka, A.B., Flingner, C.L., & Povlishock, J.T. (1993). The use of antibodies targeted against the neurofilament subunits for the detection of diffuse axonal injury in humans. Journal of Neuropathology and Experimental Neurology, 52, 143–152.CrossRefGoogle Scholar
Greiffenstein, M.F. (2000). Late post-concussion syndrome as learned illness behavior: Proposal for a multifactorial model. Brain Injury Source, 4, 26–27.Google Scholar
Greiffenstein, F.M. & Baker, J.W. (2001). Comparison of premorbid and postinjury MMPI-2 profiles in late postconcussion claimants. Clinical Neuropsychologist, 15, 162–170.CrossRefGoogle Scholar
Gronwall, D. (1989). Behavioral assessment during the acute stages of traumatic brain injury. In M.D. Lezak (Ed.), Assessment of the behavioral consequences of head trauma. Vol. 7: Frontiers of clinical neuroscience. New York: Alan R. Liss.
Guerrero, J., Thurman, D.J., & Sniezek, J.E. (2000). Emergency department visits association with traumatic brain injury: United States, 1995–1996. Brain Injury, 14, 181–186.Google Scholar
Hartlage, L.C., Durant-Wilson, D., & Patch, P.C. (2001). Persistent neurobehavioral problems following mild traumatic brain injury. Archives of Clinical Neuropsychology, 16, 561–570.CrossRefGoogle Scholar
Hathaway, S.R. & McKinley, J.C. (1983). The Minnesota Multiphasic Personality Inventory, Minneapolis, MN: National Computer Systems.
Hayes, R.L. & Dixon, C.E. (1994). Neurochemical changes in mild head injury. Seminars in Neurology, 14, 25–31.Google Scholar
Iverson, G.I. & McCracken, L.M. (1997). Postconcussive symptoms in persons with chronic pain. Brain Injury, 11, 783–790.CrossRefGoogle Scholar
Jane, J.A., Steward, O., & Gennarelli, T. (1985). Axonal degeneration induced by experimental noninvasive minor head injury. Journal of Neurosurgery, 62, 96–100.CrossRefGoogle Scholar
Karzmark, P., Hall, K., & Englander, J. (1995). Late-onset post-concussion syndrome after mild head injury: The role of premorbid, injury-related, environmental, and personality factors. Brain Injury, 9, 21–26.Google Scholar
King, N.S. (1996). Emotional, neuropsychological, and organic factors: Their use in prediction of persisting postconcussion symptoms after moderate and mild head injuries. Journal of Neurology, Neurosurgery, and Psychiatry, 61, 75–81.CrossRefGoogle Scholar
Kolakowsky-Hayner, S.A., Gourley, E.V., Kreutzer, J.S., Marwitz, J.H., Cifu, D.X., & McKinley, W.O. (1999). Pre-injury substance abuse among persons with brain injury and persons with spinal cord injury. Brain Injury, 13, 571–581.Google Scholar
Lees-Haley, P.R. & Brown, R.S. (1993). Neuropsychological complaint base rates of 170 personal injury claimants. Archives of Clinical Neuropsychology, 8, 203–209.CrossRefGoogle Scholar
Leininger, B.E., Gramling, S.E., Farrell, A.D., Kreutzer, J.S., & Peck, E.A. (1990). Neuropsychological deficits in symptomatic minor head injury patients after concussion and mild concussion. Journal of Neurology, Neurosurgery, and Psychiatry, 53, 293–296.CrossRefGoogle Scholar
Levin, H.S., Gary, H.E., High, W.M., Jr., Mattis, S., Ruff, R.M., Eisenberg, H.M., Marshall, L.F., & Tabaddor, K. (1987a). Minor head injury and the postconcussional syndrome: Methodological issues in outcome studies. In H.S. Levin, J. Grafman, & H.M Eisenberg (Eds.), Neurobehavioral recovery from head injury (pp. 262–275). New York: Oxford University Press.
Levin, H.S., Mattis, S., Ruff, R.M., Eisenberg, H.M., Marshall, L.F., Tabaddor, K., High, W.M., Jr., Frankowski, R.F. (1987b). Neurobehavioral outcome following minor head injury: A three-center study. Journal of Neurosurgery, 66, 234–243.Google Scholar
Luis, C. & Mittenberg, W. (2002). Mood and anxiety disorders following pediatric traumatic brain injury: A prospective study. Journal of Clinical and Experimental Neuropsychology, 24, 270–279.Google Scholar
Marsh, H.V. & Smith, M.D. (1995). Post-concussion syndrome and the coping hypothesis. Brain Injury, 9, 553–562.Google Scholar
McKelvey, R.D. & Zavoina, W. (1975). A statistical model for the analysis of ordinal dependent variables. Journal of Mathematical Sociology, 4, 103–120.Google Scholar
Miller, L. (1996). Neuropsychology and pathophysiology of mild head injury and the postconcussion syndrome: Clinical and forensic considerations. Journal of Cognitive Rehabilitation, 14, 8–23.Google Scholar
Miller, L. & Mittenberg, W. (1998). Brief cognitive behavioral interventions in mild traumatic brain injury. Applied Neuropsychology, 5, 172–183.CrossRefGoogle Scholar
Mittenberg, W., DiGiulio, D.V., Perrin, S., & Bass, A.E. (1992). Symptoms following mild head injury: Expectation as aetiology. Journal of Neurology, Neurosurgery, and Psychiatry, 55, 200–204.Google Scholar
Mittenberg, W. & Strauman, S. (2000). Diagnosis of mild head injury and the postconcussion syndrome. Journal of Head Trauma Rehabilitation, 15, 783–791.Google Scholar
Montague, E., William, H., Lubin, A., & Gieseking, C. (1957). Army tests for assessment of intellectual deficit. United States Armed Forces Medical Journal, 8, 883–892.Google Scholar
Novack, T.A., Bush, B.A., Meythaler, J.M., & Canupp, K. (2001). Outcome after traumatic brain injury: Pathway analysis of contributions from premorbid, injury severity, and recovery variables. Archives of Physical Medicine Rehabilitation, 82, 300–305.CrossRefGoogle Scholar
Ponsford, J., Willmott, C., Rothwell, A., Cameron, P., Kelly, A.M., Nelms, R., Curran, C., & Ng, K. (2000). Factors influencing outcome following mild traumatic brain injury in adults. Journal of the International Neuropsychological Society, 6, 568–579.CrossRefGoogle Scholar
Povlishock, J.T. & Coburn, T.H. (1989). Morphopathological change associated with mild head injury. In H.S. Levin, H.M. Eisenberg, & A.L. Benton (Eds.), Mild head injury (pp. 37–53). New York: Oxford University Press.
Powell, T.J., Collin, C., & Sutton, K. (1996). A follow-up study of patients hospitalized after minor head injury. Disability and Rehabilitation: An International Multidisciplinary Journal, 18, 231–237.CrossRefGoogle Scholar
Radanov, B.P., Di Stefano, G., Shinidrig, A., & Ballinari, P. (1991). Role of psychosocial stress in recovery from common whiplash. Lancet, 338, 712–715.CrossRefGoogle Scholar
Robertson, E., Rath, B., Fournet, G., Zelhart, P., & Estes, R. (1994). Assessment of mild brain trauma: A preliminary study of the influence of premorbid factors. Clinical Neuropsychologist, 8, 69–74.Google Scholar
Robins, L.N., Helzer, J.E., Croughan, J., & Ratcliff, K.A. (1981). National Institute of Mental Health Diagnostic Interview Schedule: Its history, characteristics, and validity. Archives of General Psychiatry, 38, 381–389.CrossRefGoogle Scholar
Santa Maria, M.P., Pinkston, J.B., Miller, S.R., & Gouvier, W.D. (2001). Stability of postconcussion symptomatology differs between high and low responders and by gender but not by mild head injury status. Archives of Clinical Neuropsychology, 16, 133–140.Google Scholar
Satz, P. (1993). Brain reserve capacity on symptom onset after brain injury: A formulation and review of evidence from threshold theory. Neuropsychology, 7, 273–295.CrossRefGoogle Scholar
Shaffer, D., Schwab-Stone, M., Fisher, P., Cohen, P., Piacentini, J., & Davies, M. (1993). The Diagnostic Interview for Children–Revised Version (DISC–R): I. Preparation, field testing, interrater reliability, and acceptability. Journal of the American Academy of Child and Adolescent Psychiatry, 32, 643–650.Google Scholar
Sosin, D.M., Sniezek, J.E., & Thurman, D. (1996). Incidence of mild and moderate brain injury in the United States, 1991. Brain Injury, 10, 47–54.Google Scholar
Stern, Y. (2002). What is cognitive reserve? Theory and research application of the reserve concept. Journal of the International Neuropsychological Society, 8, 448–460.Google Scholar
Timmerman, I.G., Emmelkamp, P.M., & Sanderman, R. (1998). The effects of a stress-management training program in individuals at risk in the community at large. Behavior Research and Therapy, 36, 863–875.CrossRefGoogle Scholar
Trahan, D.E., Ross, C.E., & Trahan, S.L. (2001). Relationship among postconcussional-type symptoms, depression, and anxiety in neurologically normal young adults and victims of mild brain injury. Archives of Clinical Neuropsychology, 16, 435–445.CrossRefGoogle Scholar
Wong, J.M., Regennitter, T., & Barrios, F.X. (1994). Base rates and simulated symptoms of mild head injury among normals. Archives of Clinical Neuropsychology, 9, 411–425.CrossRefGoogle Scholar
World Health Organization. (1992). International statistical classification of diseases and related health problems (10th ed.). Geneva: Author.
Wood, F., Novack, T.A., & Long, C.J. (1984). Post-concussion symptoms: Cognitive, emotional, and environmental aspects. International Journal of Psychiatry in Medicine, 4, 277–283.Google Scholar
Youngjohn, J.R., Burrows, L., & Erdal, K. (1995). Brain damage or compensation neurosis? The controversial post-concussion syndrome. Clinical Neuropsychologist, 9, 112–123.CrossRefGoogle Scholar