Post-concussive syndrome (PCS) is a common but controversial disorder that affects 5-30% of people following a mild head injury. Patients with PCS present with a variety of physical and psychological symptoms including headache, dizziness, fatigue, cognitive and personality changes. Such symptoms are disabling for patients and their families and can persist for months or years after seemingly minor head injuries. While the existence of PCS as a clinical entity is not questioned, conflicting findings regarding the aetiology and possible predisposing factors persist. Currently, recognised risk factors for PCS include loss of consciousness, amnesia and abnormal post-injury neurobehavioral test results. Non-injury factors such as pre-existing personality types that are characterised by excessive somatic concerns and anxiety are particularly prevalent in cases of PCS and there is evidence that ongoing anxiety plays a critical role in the maintenance of physical symptoms in patients with PCS. These findings highlight the potential interaction between psychological and neurological factors in the emergence and maintenance of PCS, but much remains to be understood about the condition.
While the rate of mild head injuries in Singapore is on par with most western countries, Singapore has the additional issue of high rates of anxiety. The high prevalence of anxiety disorders in the population, socio-cultural tendencies to 'internalise' stress and significant environment influences may lead to greater incidence and severity of PCS within the community. The aim of this study is to investigate the role of anxiety in the predisposition to, emergence and maintenance of PCS. In particular, we seek to determine if premorbid disposition to anxiety, so called 'trait-anxiety', predicts the emergence, severity and duration of PCS and evaluate the relative contributions of other dispositional factors such as depression. The study will also develop and evaluate a brief psychotherapeutic treatment to prevent or offset the potential for PCS following mild head injury.
A preliminary analysis consisting of 61 mild traumatic brain injury (MTBI) patients and 50 healthy controls who were recruited and assessed at baseline and at three months on standardized self-report measures of anxiety, depression, locus of control and the NEO-FFI personality inventory, as well as, a battery of neuropsychological tests revealed the following results:
At baseline, 21 (34%) of MTBI patients demonstrated moderate to severe post concussive symptoms and significantly higher scores in trait and state anxiety, depression, locus of control and NEO-FFI neuroticism compared with patients who had no evidence of PCS or mild PCS. At three months, 9 (13%) of the moderate-severe group showed persistent PCS and retained high state anxiety and depression, but displayed no difference in the locus of control measure from the comparison group. Correlations at both the baseline and follow-up assessments revealed strong and significant associations between trait anxiety and PCS score (0.50 and 0.66), NEO-FFI neuroticism and PCS score (0.44 and 0.47), and trait anxiety and NEO-FFI neuroticism (0.70 and 0.67).
These preliminary findings suggest that premorbid disposition to anxiety and neuroticism may be important factors in the development and maintenance of moderate to severe post-concussive symptoms and may also play a role in the predisposition to debilitating post concussive syndrome.
Collinson, S., Meyyappan, A . , & Ang, C. B. T. (2008) The role of anxiety in the emergence, severity and maintenance of post-concussive syndrome (Abstract). Brain Injury, Volume 22, Suppl 1.
The role of anxiety in the emergence, severity and maintenance of post-concussive syndrome (Abstract). Presented at the 7 th World Congress of Brain Injury, Lisbon Portugal April 2008.
Clinical Neuropsychology Research Group