Prognosis after Mild Traumatic Brain Injury: Influence of Psychiatric Disorders

Ivan Marinkovic; Harri Isokuortti; Antti Huovinen; Daniela Trpeska Marinkovic; Kaisa Mäki; Taina Nybo; Antti Korvenoja; Raj Rahul; Risto Vataja; Susanna Melkas

doi:10.3390/brainsci10120916

Prognosis after Mild Traumatic Brain Injury: Influence of Psychiatric Disorders

Brain Sci. 2020 Nov 27;10(12):916. doi: 10.3390/brainsci10120916.

Authors

Affiliations

¹ Neurology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, Helsinki P.O. Box 340, FIN-00029 HUS Helsinki, Finland.
² Psychiatry, University of Helsinki and City of Helsinki, Nordenskiöldinkatu 20, P.O. Box 6800, FIN-00099 City of Helsinki, Finland.
³ Neuropsychology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, Helsinki P.O. Box 340, FIN-00029 HUS Helsinki, Finland.
⁴ HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, Helsinki P.O. Box 340, FIN-00029 HUS Helsinki, Finland.
⁵ Neurosurgery, University of Helsinki and Helsinki University Hospital, Topeliuksenkatu 5, Helsinki P.O. Box 266, FIN-00029 HUS Helsinki, Finland.
⁶ Psychiatry, University of Helsinki and Helsinki University Hospital, Välskärinkatu 12, Helsinki P.O. Box 590, FIN-00029 HUS Helsinki, Finland.

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.

Keywords: brain concussion; mental disorders; post-concussion symptoms; return to work.