The Relationship Between Sex, Fatigue, and Post-Concussion Symptoms Differs Between Those With Mild Traumatic Brain Injury Versus Trauma Control and Healthy Control Participants.

Abstract

Objective: Sex, fatigue and subjective sleep disruption have been shown to be associated with poor subjective recovery after mild traumatic brain injury (mTBI). This study aimed to determine whether the relationship between these factors and post-concussion symptom (PCS) reporting are unique to individuals who have incurred an mTBI. Setting, Participants, Design and Main Measures: In this observational study, a group of 208 pre-morbidly healthy adults was assessed with measures of fatigue (Multi-dimensional Fatigue Inventory), subjective sleep disturbance (Pittsburgh Sleep Quality Index), depression (Inventory of Depressive Symptomatology) and anxiety (Beck Anxiety Inventory) symptomatology, and PCS endorsement (Rivermead Post-Concussion Symptoms Questionnaire).

Results: Individuals who were admitted to hospital approximately 8-weeks prior with systemic traumatic injury and mTBI (mTBI; n = 86) and with systemic traumatic injury without head injury (TC; n = 46) had equivalent and elevated levels of fatigue, subjective sleep disturbance and PCS endorsement relative to a healthy community-based control sample (HC; n = 76). Female sex (P = .028) and an elevated sense of general tiredness (P = .037) independently explained significant variance in global PCS endorsement in the mTBI group, but sex did not independently explain variance in PCS reporting in either control group. Psychological status was the only variable that independently explained variance in PCS reporting in all groups.

Conclusions: This study indicates that the vulnerability of females to report elevated PCS in the post-acute period after traumatic injury is specific to those who have incurred a concomitant mTBI. Further, only some subcomponents of fatigue independently explain variance in PCS reporting, with the groups showing variability in these associations. Further work is needed to understand whether it is the "biological" and/or "socio-environmental" aspect of being female that increases the risk of higher PCS endorsement after mTBI.