ObjectiveThe purpose of this study was to review the literature relating to the psychosocial costs associated with traumatic brain injury (TBI).MethodsNine online journal databases, including MEDLINE, CINAHL, PsychINFO, and PUBMED, were queried for studies between July 2010 and May 2012 pertaining to the economic burden of head injuries. Additional studies were identified through searching bibliographies of related publications and using Google internet search engine.ResultsOne hundred and eight potentially relevant abstracts were identified from the journal databases. Ten papers were chosen for discussion in this review. All but two of the chosen papers were US studies. The studies included a cost-benefit analysis of the implementation of treatment guidelines from the US brain trauma foundation and a cost-effectiveness analysis of post-acute traumatic brain injury rehabilitation.ConclusionVery little research has been published on the economic burden that mild and moderate traumatic brain injury patients pose to their families, careers, and society as a whole. Further research is needed to estimate the economic burden of these patients on healthcare providers and social services and how this can impact current health policies and practices.

Opinions about persisting post-concussional symptoms after minor traumatic brain injury still reflect a polarization of views around the sterile debate concerning the psychological vs organic origins of symptoms. Reviews of the experimental literature do not always integrate the often diverse perspectives that explain persisting symptoms of concussion. As a result, the disorder is still poorly understood. In this review, a diasthesis-stress paradigm examines the interaction between physiological and psychological factors that generate and maintain post-concussional symptoms. Motivational factors and different coping strategies are considered to explain why some people are at risk of developing a post-concussional syndrome. The early iatrogenic potential of GPs and hospital doctors who may create insecurity or reinforce illness perceptions is considered. Finally, the rationale and effectiveness of interventions that ameliorate the impact of early post-concussional symptoms is reviewed to see if prevention of the post-concussional syndrome is more effective than cure.

The frequency of alexithymia and the proportion of cases reporting low emotional empathy after traumatic brain injury (TBI) were compared with a control group. The study also examined the relationship between alexithymia and emotional empathy, controlling for the influence of cognitive ability, severity of head injury, and time since injury. A total of 64 TBI patients and matched controls completed the 20-Item Toronto Alexithymia Scale (TAS-20) and Balanced Emotional Empathy Scale (BEES). The TBI group exhibited a significantly higher frequency of alexithymia (60.9%) and low emotional empathy (64.4%) than did the control group (10.9% and 34.4%). Significant moderate negative correlations were found between TAS-20 and BEES scores, with TAS-20 total scores accounting for a significant amount of variance in BEES scores. However, no significant correlation was obtained between Subscale 1 of the TAS-20 (difficulty identifying feelings) and BEES scores in the TBI group. Additionally, there were no significant relationships between alexithymia, emotional empathy, injury severity, and time since injury. The results suggest an inverse relationship between alexithymia and emotional empathy.

Demographic factors and cognitive impairment have been found previously to have associations with outcome after brain injury. Kendall and Terry (1996) suggest that preinjury psychosocial functioning, neurological factors, and cognitive impairment have a direct relationship with multidimensional psychosocial adjustment, but that cognitive impairment also has an indirect relationship by means of the mediation of appraisal and coping variables. The aim of this study was to explore these theoretical relationships at very late stages of recovery after brain injury. A total of 131 participants who were more than 10 years after injury (mean 5 15.31 yr) completed a neuropsychological assessment, plus outcome measures that included employment status, community integration, life satisfaction, quality of life (QoL), and emotion. Results indicated that injury severity was predictive of life satisfaction; gender and relationship status predicted community integration; and age at injury predicted employment status. Impairment in working memory directly predicted all outcomes except QoL and anxiety. An indirect relationship was also evident between working memory, life satisfaction, and depression. Results partially support Kendall and Terry's model but the variables that significantly influence outcome seem to be determined by the outcome dimensions selected. (JINS, 2006, 12, 350-358.)