Illness perceptions and outcome in mild head injury: a longitudinal study

BACKGROUND: A range of neuropathological and psychosocial factors have been implicated in the aetiology and maintenance of post-concussional syndrome (PCS), with a growing consensus in the literature that this is a complex, multifactorial condition. The role of patients' perceptions in PCS has not been examined to date. OBJECTIVE: This longitudinal study examines the role of illness perceptions in predicting outcome following mild head injury, controlling for severity of injury, post-traumatic stress symptoms, anxiety and depression, using a logistic regression analysis. METHOD: 73 patients were admitted to an accident and emergency department with mild head injury (Glasgow Coma Scale score 13-15; loss of consciousness <20 min; post-traumatic amnesia <24 h). Data on PCS symptomatology, illness perceptions, post-traumatic stress symptoms, anxiety and depression were collected after the injury and at the 3 month follow-up. Logistic regression analysis was used to evaluate predictors of outcome. RESULTS: Following a mild head injury, symptomatic patients who believe that their symptoms have serious negative consequences on their lives and will continue to do so, are at heightened risk of experiencing significant enduring post-concussional symptoms (p<0.001). Adding measures of severity of injury, post-traumatic stress symptoms, anxiety and depression to the regression model did not improve prediction of outcome. CONCLUSION: Whatever other physical or psychological factors may be involved, patients' perceptions of their illness early after head injury play a part in the persistence of PCS.