Abstract
Background: We evaluated the prevalence of psychiatric disorders in mild traumatic brain injury (MTBI) patients and investigated psychiatric comorbidity in relation to subjective symptoms and return to work (RTW). Methods: We recruited 103 MTBI patients (mean age 40.8 years, SD 3.1) prospectively from University Hospital. The patients were followed up for one year. The Rivermead Post-Concussion Symptom Questionnaire (RPQ) and Extended Glasgow Outcome Scale (GOSE) were administered one month after MTBI. Three months after MTBI, any psychiatric disorders were assessed using the Structured Clinical Interview for DSM-IV Axis I Disorders. Results: Psychiatric disorders were diagnosed in 26 patients (25.2%). The most common disorders were previous/current depression. At three months, there was no difference between patients with psychiatric disorders versus those without them in RTW (95.7% vs. 87.3%, p = 0.260) or at least in part-time work (100% vs. 94.4%, p = 0.245). In Kaplan–Meier analysis, the median time to RTW was 10 days for both groups. The median RPQ score was 13.0 (Interquartile range (IQR) 6.5–19.0) in patients with a psychiatric disorder compared to 8.5 (IQR 2.3–14.0) in those without one (p = 0.021); respectively, the median GOSE was 7.0 (IQR 7.0–8.0) compared to 8.0 (IQR 7.0–8.0, p = 0.003). Conclusions: Approximately every fourth patient with MTBI had a psychiatric disorder. These patients reported more symptoms, and their functional outcome measured with GOSE at one month after MTBI was worse. However, presence of any psychiatric disorder did not affect RTW. Early contact and adequate follow-up are important when supporting the patient’s return to work.
Highlights
Concussions and mild traumatic brain injuries (MTBI) are the most common forms of traumatic brain injury; recovery is rapid by default, but there are potential prolonged symptoms and adverseBrain Sci. 2020, 10, 916; doi:10.3390/brainsci10120916 www.mdpi.com/journal/brainsciBrain Sci. 2020, 10, 916 social, vocational and medicolegal issues [1]
96 patients underwent computed tomography imaging at presentation after mild traumatic brain injury (MTBI), and all patients underwent MR imaging at a median of 10 days (IQR 7–12) after MTBI
Traumatic brain lesions were described in 32 patients (31.1%), including acute subdural hematoma in 19 patients (18.4%), epidural hematoma in 1 patient, traumatic subarachnoid hemorrhage in patients (16.5%), traumatic intracerebral hemorrhage or hemorrhagic contusions in patients (17.5%), and diffuse axonal injury in 25 patients (24.3%)
Summary
Concussions and mild traumatic brain injuries (MTBI) are the most common forms of traumatic brain injury; recovery is rapid by default, but there are potential prolonged symptoms and adverseBrain Sci. 2020, 10, 916; doi:10.3390/brainsci10120916 www.mdpi.com/journal/brainsciBrain Sci. 2020, 10, 916 social, vocational and medicolegal issues [1]. Psychiatric symptoms and disorders are overrepresented in patients with MTBI both before and after the incident [3,4]. We evaluated the prevalence of psychiatric disorders in mild traumatic brain injury (MTBI) patients and investigated psychiatric comorbidity in relation to subjective symptoms and return to work (RTW). There was no difference between patients with psychiatric disorders versus those without them in RTW (95.7% vs 87.3%, p = 0.260) or at least in part-time work (100% vs 94.4%, p = 0.245). Conclusions: Approximately every fourth patient with MTBI had a psychiatric disorder. These patients reported more symptoms, and their functional outcome measured with GOSE at one month after MTBI was worse. Contact and adequate follow-up are important when supporting the patient’s return to work
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