Prediction of postconcussional syndrome from personality and health psychology variables

The phenomenon of postconcussional syndrome has existed in the literature for well over a century. However, its etiology remains unclear. Demographic variables, organic/neurological variables, involvement in litigation, and psychosocial factors have all been suggested as possible causes of the syndrome. It was hypothesized that Postconcussion Syndrome is a special case of a somaticizing disorder, or illness behavior. This study identified 76 patients presenting at two hospital emergency rooms with head injuries. Participants included 30 males and 46 females, with a mean age of 30.39 and a mean educational level of 13.59 years. The participants were administered a battery of personality and health psychology measures seven to ten days after their injury. Also, demographic data and information about the patients' plans to litigate about the injury were collected. Three months after the initial evaluation, a follow-up assessment of Postconcussion Syndrome symptoms and a measure of attention and concentration were taken. From these measures, two diagnostic variables: overall PCS symptoms and DSM-IV diagnosis were derived. Results indicated that litigation, Agreeableness and Conscientiousness were negatively correlated with PCS symptoms. Neuroticism was positively correlated with symptoms. Among health psychology measures, the Illness Worry Scale, Personal Body Consciousness, the Symptom Interpretation Questionnaire Biological Attributions subscale, and the Multidimensional Health Locus of Control Chance Attributions scale were positively related to PCS symptoms. The Symptom Interpretation Questionnaire Psychological Attributions subscale was positively related to DSM-IV diagnosis. In a Multiple Regression model, only Neuroticism and the Illness Worry Scale were significant predictors of PCS symptoms. Age, years of education, and a tendency to attribute physical symptoms to psychological causes were significant predictors of DSM-IV diagnosis. In sum, individuals high on Neuroticism are likely predisposed to develop symptoms of Postconcussion Syndrome. When these individuals also tend to worry about unpleasant body sensations, they are at even greater risk to develop persistent symptoms. Involvement in litigation is also an operant contingency affecting PCS symptoms, though not with every patient. The study concludes that Postconcussion Syndrome may be conceptualized as a special case of illness behavior which could benefit from cognitive behavioral interventions targeting personality and health psychology variables.