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Research paper
When a minor head injury results in enduring symptoms: a prospective investigation of risk factors for postconcussional syndrome after mild traumatic brain injury
  1. Ruihua Hou1,
  2. Rona Moss-Morris2,
  3. Robert Peveler1,
  4. Karin Mogg3,
  5. Brendan P Bradley3,
  6. Antonio Belli1
  1. 1Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
  2. 2Psychology Department, Institute of Psychiatry, King's College London, London, UK
  3. 3School of Psychology, University of Southampton, Southampton, UK
  1. Correspondence to Dr R Hou, University of Southampton Faculty of Medicine, University Department of Psychiatry, Academic Centre, College Keep, 4-12 Terminus Terrace, Southampton SO14 3DT, UK; r.hou{at}


Objective A significant proportion (15–30%) of patients with mild traumatic brain injury (MTBI) are at risk of developing postconcussional syndrome (PCS). The aim of this study was to investigate the contributions of cognitive, emotional, behavioural and social factors to the development of PCS and identify early predictors.

Methods A prospective cohort design was employed. 126 MTBI patients completed baseline questionnaire assessments within 2 weeks of the injury and 107 completed follow-up questionnaire assessments at 3 and 6 months. A series of self-report measures were used to assess cognitive, behavioural and emotional responses to MTBI. The primary outcome was the ICD-10 diagnosis for PCS. Demographic and clinical characteristic variables were compared between PCS cases and non-cases using independent sample t tests and χ2 tests. Individual and multivariate logistic regression analyses were used to detect predictors of PCS.

Results Of 107 MTBI patients, 24 (22%) met the criteria for PCS at 3 months and 22 (21%) at 6 months. Individual logistic regression analysis indicated that negative MTBI perceptions, stress, anxiety, depression and all-or-nothing behaviour were associated with the risk of PCS. Multivariate analysis revealed that all-or-nothing behaviour was the key predictor for the onset of PCS at 3 months while negative MTBI perceptions predicted PCS at 6 months.

Conclusions The study provides good support for the proposed cognitive behavioural model. Patients' perceptions of their head injury and their behavioural responses play important roles in the development of PCS, indicating that cognitive and behavioural factors may be potential targets for early preventive interventions.

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  • Funding This study was funded by the Faculty of Medicine Research Management Committee at the University of Southampton (grant reference code: 503836112).

  • Competing interests None.

  • Ethics approval This study was reviewed and approved by the Southampton and South West Hampshire Research Ethics Committee (B) (reference No: 08/H0504/106).

  • Provenance and peer review Not commissioned; externally peer reviewed.