Abstract
Somatization may contribute to persistent symptoms after mild traumatic brain injury (mTBI). In two independently-recruited study samples, we characterized the extent to which symptoms atypical of mTBI but typical for patients suffering from somatization (e.g., gastrointestinal upset, musculoskeletal, and cardiorespiratory complaints) were present in adult patients with prolonged recovery following mTBI. The first sample was cross-sectional and consisted of mTBI patients recruited from the community who reported ongoing symptoms attributable to a previous mTBI (n = 16) along with a healthy control group (n = 15). The second sample consisted of patients with mTBI prospectively recruited from a Level 1 trauma center who had either good recovery (GOSE = 8; n = 32) or poor recovery (GOSE < 8; n = 29). In all participants, we evaluated atypical somatic symptoms using the Patient Health Questionnaire-15 and typical post-concussion symptoms with the Rivermead Post-Concussion Symptom Questionnaire. Participants with poor recovery from mTBI had significantly higher “atypical” somatic symptoms as compared to the healthy control group in Sample 1 (b = 4.308, p < 0.001) and to mTBI patients with good recovery in Sample 2 (b = 3.169, p < 0.001). As would be expected, participants with poor outcome in Sample 2 had a higher burden of typical rather than atypical symptoms [t(28) = 4.750, p < 0.001, d = 0.88]. However, participants with poor recovery still reported atypical somatic symptoms that were significantly higher (1.4 standard deviations, on average) than those with good recovery. Our results suggest that although “typical” post-concussion symptoms predominate after mTBI, a broad range of somatic symptoms also frequently accompanies mTBI, and that somatization may represent an important, modifiable factor in mTBI recovery.
Highlights
An estimated forty-two million people experience mild traumatic brain injuries worldwide annually [1]
Informed consent was provided by all participants, and studies were approved by the University of British Columbia (UBC) Clinical Research Ethics Board (H16-01307 and H15-01063)
In the cross-sectional study, as anticipated, post-concussion symptom scores (b = 31.650, 95% CI: 25.10–37.73, p < 0.001, adjusted R2 = 0.77) and global somatic symptom scores (b = 8.757, 95% CI: 6.34–10.99, p < 0.001, adjusted R2 = 0.64) were higher in the symptomatic group as compared to the control group, adjusting for age, and sex
Summary
An estimated forty-two million people experience mild traumatic brain injuries (mTBI) worldwide annually [1]. Like most other studies analyzing somatic symptoms after mTBI, Nelson et al [13] evaluated somatization using a composite score reflective of somatic complaints across multiple body systems, and did not distinguish the somatic symptoms that would be conventionally associated with mTBI (e.g., headache and dizziness) from others that could not logically be attributed to the trauma (e.g., intestinal upset, diffuse body pains, etc) In so doing, they are potentially conflating organic brain injury with psychopathology. These studies consistently document an elevated level of somatic symptoms not plausibly related to head injury after TBI (e.g., chest pain, heart pounding or racing, shortness of breath) [9,10,11] These atypical somatic symptoms may be prognostic, as a study in military personnel by Lee et al [11] found that an aggregated metric of pre-injury somatic symptoms was associated with the subsequent development of post-concussion syndrome [11]. Support for this hypothesis would provide further evidence for an association between somatization and prolonged recovery from mTBI
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
