Gender Differences in Seeking and Receiving Healthcare After Mild Traumatic Brain Injury.

Abstract

Objectives: To investigate gender differences in seeking and receiving healthcare following mild traumatic brain injury (mTBI).

Setting: Participants were recruited from 6 emergency departments and 2 urgent care facilities in the Greater Vancouver Area, Canada.

Participants: 254 adults (56% women, 2% gender-diverse; aged 18-69 years) who presented to emergency department/urgent care within 72 hours after mTBI and were randomized to usual care in the parent study.

Design: Secondary analysis of a clinical trial evaluating the effectiveness of a guideline implementation tool for managing mental health complications after mTBI (ClinicalTrials.gov Registry: NCT04704037).

Main measures: Self-reported use of rehabilitation and health services were assessed with questionnaires at 3- and 6-months post-injury. Chief symptoms, prescribed interventions and referrals to specialists within 6 months post-injury were extracted from general practitioner (GP) charts. Post-concussion symptoms were assessed using the Rivermead Post-Concussion Symptoms Questionnaire, and mental health symptoms using the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, and the Primary Care Post-Traumatic Stress Disorder (PTSD) for DSM-5 at 6 months post-injury. Perceived need for mental health care was assessed with an adapted interview version of the Perceived Need for Care Questionnaire.

Results: Approximately 62% of men and 74% of women reported visiting their GP within 6 months after mTBI. They received similar interventions and referrals from GPs. Besides GP visits, no substantial differences were found in use of allied health and rehabilitation services. Women reported more severe post-concussion and mental health symptoms and more frequently having unmet mental health care needs (32% vs 19%).

Conclusions: Women reported worse symptoms but did not receive more specialty clinical care. Women are more likely to report having under-treated mental health problems. Future studies are needed to confirm whether women have a greater mismatch between their need for and receipt of rehabilitation services and explore mechanisms contributing to this gap.