Examination of outcome after mild traumatic brain injury: The contribution of injury beliefs and Leventhal's Common Sense Model

Abstract

Associations between components of Leventhal's common sense model of health behaviour (injury beliefs, coping, distress) and outcome after mild traumatic brain injury (MTBI) were examined. Participants (n = 147) were recruited within three months following MTBI and assessed six months later, completing study questionnaires at both visits (Illness Perceptions Questionnaire Revised, Brief COPE, Hospital Anxiety and Depression Scale). Outcome measures included the Rivermead Post-Concussion Symptoms Questionnaire and Rivermead Head Injury Follow-Up Questionnaire. Univariate and multivariate (logistic regression) analyses examined associations between injury beliefs, coping and distress at baseline, and later outcome. Participants endorsing stronger injury identity beliefs (p < .01), expectations of lasting severe consequences (p < .01), and distress (p < .01) at time one, had greater odds of poor outcome at time two. Coping styles were also associated with later outcome although variability in findings limited interpretability. Associations between psychological variables and outcome were examined and 76.5% of cases were correctly classified by the model. Consistent with Leventhal's model, participant beliefs about their injury and recovery had significant associations with outcome over time. Coping also appeared to have important associations with outcome but more research is required to examine these. Current reassurance-based interventions may be improved by targeting variables such as injury beliefs, coping and adjustment soon after injury.

The contribution of psychological factors to recovery after mild traumatic brain injury: Is cluster analysis a useful approach?

“…Seven items measure anxiety symptoms and a further seven measure depressive symptoms, with each item rated on a 4-point scale, ranging from 0-3. The seven items in each sub-scale are summed and total scores for each sub-scale range from 0-21, characterized as normal (0-7), mild (8-10), moderate (11)(12)(13)(14) or severe (15)(16)(17)(18)(19)(20)(21). Internal consistency for the sub-scales was high (Anxiety ¼ 0.83; Depression ¼ 0.85).…”

“…However, these models tend to be descriptive and still lack high quality empirical evidence to support the hypothesized associations. Research in other chronic health conditions demonstrates that psychological constructs such as illness perceptions held by patients can significantly impact on recovery and adjustment [13]. Potentially then, how individuals understand their condition could also have important implications for the assessment and treatment of MTBI.…”

“…More recently the contribution of the SRM to understanding outcomes after TBI has been investigated [13,16,[25][26][27] suggesting that expectations of severe consequences and slow recovery timeline, high perceived symptom burden (strong injury identity) and emotional salience are significantly associated with prolonged recovery after a TBI.…”

Brain drawings following traumatic brain injury (TBI) and links to illness perceptions and health outcomes – Findings from a population-based study

“…Associations between negative illness perceptions assessed using more traditional measures and poor mental health, as well as post-concussive syptoms have been well established within TBI populations (Snell et al, 2013;Var & Rajeswaran, 2012). On the basis of correlational analyses, a novel finding here is evidence that the amount of damage depicted in a brain drawing offers an informative insight into people's experience of their TBI, and an opportunity for clinicians to start a conversation around illness perceptions.…”

“…Based on the CSM, associations between negative illness perceptions, the development of PCS and/or poor QoL post-TBI may be due to a number of factors, for example: discrepancies in anticipated and actual rates of recovery leading to a reassessment of the severity and impact of the illness; the choice of coping behaviour and its perceived effectiveness; the impact of elevated psychological distress (Snell, Jean, Hay-Smith, Surgenor, & Siegert, 2013); sense of control (or lack thereof) over the illness (Mulhern & McMillan, 2006); and/or poor adherence to treatment and preventative measures to promote recovery (Var & Rajeswaran, 2012). Together, these findings demonstrate the clinical importance of considering and understanding patients' perceptions of their injury following TBI as a method of predicting behaviour and risk of negative outcomes post-injury, as well as identifying opportunities to assist individuals in their adjustment to illness (Weinman & Petrie, 1997).…”