Noah D Silverberg, Mathilde Rioux, Ana Mikolić, David L Perez, Matthew J Burke, Andrew Howard
{"title":"轻度创伤性脑损伤后躯体症状障碍。","authors":"Noah D Silverberg, Mathilde Rioux, Ana Mikolić, David L Perez, Matthew J Burke, Andrew Howard","doi":"10.1097/HTR.0000000000001068","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>Mild traumatic brain injury (mTBI) may be a common precipitant of Somatic Symptom Disorder (SSD). This study examined the prevalence, correlates, predictors, and functional impact of SSD after mTBI.</p><p><strong>Setting: </strong>Follow up of patients recruited from emergency departments and urgent care centers.</p><p><strong>Participants: </strong>Adults with mTBI (N = 476).</p><p><strong>Design: </strong>Secondary analysis of a clinical trial (Clinicaltrials.gov NCT04704037).</p><p><strong>Main measures: </strong>Early illness beliefs (Illness Perceptions Questionnaire-Revised; IPQ-R) were assessed ~2 weeks after mTBI and outcomes were assessed at 6 months post-injury, including SSD symptoms (Somatic Symptom Disorder-B Criteria Scale; SSD-12), post-concussion symptoms (Rivermead Post Concussion Symptoms Questionnaire; RPQ), disability (World Health Organization Disability Assessment Schedule; WHODAS), and psychiatric diagnoses (MINI Neuropsychiatric Inventory). SSD diagnosis was operationalized as having persistent symptoms and SSD-12 ≥ 16 (≥23 in sensitivity analyses).</p><p><strong>Results: </strong>15-27% of the sample met criteria for SSD at 6 months post-injury. Participants with SSD reported more pain and post-concussion symptoms, and were more likely to have comorbid Major Depressive Disorder (OR = 9.1, 95% CI = 5.3, 16.2) and at least 1 anxiety disorder (OR = 5.6, 95% CI = 3.6-8.8) compared to those without SSD. Early illness beliefs, specifically that mTBI has serious life consequences (OR = 1.2, 95% CI = 1.1-1.3) and causes distress (OR = 1.1, 95% CI = 1.0-1.2), were associated with later SSD. SSD symptoms contributed to prediction of global functional disability (WHODAS) over and above post-concussion symptom severity (RPQ; ΔDeviance = 0.22, P < .001).</p><p><strong>Conclusions: </strong>SSD after mTBI is associated with an increased burden of symptoms, comorbidity, and disability. Early identification of at-risk patients appears feasible. SSD may be a useful framework for conceptualizing poor outcome from mTBI in patients with prominent psychological distress and guiding rehabilitation.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.3000,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Somatic Symptom Disorder After Mild Traumatic Brain Injury.\",\"authors\":\"Noah D Silverberg, Mathilde Rioux, Ana Mikolić, David L Perez, Matthew J Burke, Andrew Howard\",\"doi\":\"10.1097/HTR.0000000000001068\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>Mild traumatic brain injury (mTBI) may be a common precipitant of Somatic Symptom Disorder (SSD). This study examined the prevalence, correlates, predictors, and functional impact of SSD after mTBI.</p><p><strong>Setting: </strong>Follow up of patients recruited from emergency departments and urgent care centers.</p><p><strong>Participants: </strong>Adults with mTBI (N = 476).</p><p><strong>Design: </strong>Secondary analysis of a clinical trial (Clinicaltrials.gov NCT04704037).</p><p><strong>Main measures: </strong>Early illness beliefs (Illness Perceptions Questionnaire-Revised; IPQ-R) were assessed ~2 weeks after mTBI and outcomes were assessed at 6 months post-injury, including SSD symptoms (Somatic Symptom Disorder-B Criteria Scale; SSD-12), post-concussion symptoms (Rivermead Post Concussion Symptoms Questionnaire; RPQ), disability (World Health Organization Disability Assessment Schedule; WHODAS), and psychiatric diagnoses (MINI Neuropsychiatric Inventory). SSD diagnosis was operationalized as having persistent symptoms and SSD-12 ≥ 16 (≥23 in sensitivity analyses).</p><p><strong>Results: </strong>15-27% of the sample met criteria for SSD at 6 months post-injury. Participants with SSD reported more pain and post-concussion symptoms, and were more likely to have comorbid Major Depressive Disorder (OR = 9.1, 95% CI = 5.3, 16.2) and at least 1 anxiety disorder (OR = 5.6, 95% CI = 3.6-8.8) compared to those without SSD. Early illness beliefs, specifically that mTBI has serious life consequences (OR = 1.2, 95% CI = 1.1-1.3) and causes distress (OR = 1.1, 95% CI = 1.0-1.2), were associated with later SSD. SSD symptoms contributed to prediction of global functional disability (WHODAS) over and above post-concussion symptom severity (RPQ; ΔDeviance = 0.22, P < .001).</p><p><strong>Conclusions: </strong>SSD after mTBI is associated with an increased burden of symptoms, comorbidity, and disability. Early identification of at-risk patients appears feasible. SSD may be a useful framework for conceptualizing poor outcome from mTBI in patients with prominent psychological distress and guiding rehabilitation.</p>\",\"PeriodicalId\":15901,\"journal\":{\"name\":\"Journal of Head Trauma Rehabilitation\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":3.3000,\"publicationDate\":\"2025-05-09\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Head Trauma Rehabilitation\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/HTR.0000000000001068\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Head Trauma Rehabilitation","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/HTR.0000000000001068","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
摘要
目的：轻度外伤性脑损伤（mTBI）可能是躯体症状障碍（SSD）的常见诱因。本研究调查了mTBI后SSD的患病率、相关性、预测因素和功能影响。设置：随访从急诊科和紧急护理中心招募的患者。参与者：患有mTBI的成年人（N = 476）。设计：临床试验的二次分析（Clinicaltrials.gov NCT04704037）。主要测量：早期疾病信念（疾病认知问卷-修订）；在mTBI后约2周评估IPQ-R，并在损伤后6个月评估结果，包括SSD症状(躯体症状障碍- b标准量表；SSD-12)，脑震荡后症状(Rivermead脑震荡后症状问卷；RPQ)、残疾(世界卫生组织残疾评估表；WHODAS)和精神病诊断（MINI神经精神病量表）。SSD诊断为持续症状且SSD-12≥16（敏感性分析≥23）。结果：15-27%的样本在损伤后6个月符合SSD标准。与没有SSD的参与者相比，患有SSD的参与者报告了更多的疼痛和脑震荡后症状，并且更有可能合并重度抑郁症（OR = 9.1, 95% CI = 5.3, 16.2）和至少1种焦虑症（OR = 5.6, 95% CI = 3.6-8.8）。早期疾病信念，特别是mTBI具有严重的生命后果（OR = 1.2, 95% CI = 1.1-1.3）和导致痛苦（OR = 1.1, 95% CI = 1.0-1.2）与后来的SSD相关。SSD症状有助于预测整体功能障碍（WHODAS），高于脑震荡后症状严重程度(RPQ；ΔDeviance = 0.22, P < 0.001)。结论：mTBI后的SSD与症状负担、合并症和残疾增加有关。早期识别高危患者似乎是可行的。SSD可能是一个有用的框架，用于概念化mTBI患者的不良结果突出的心理困扰和指导康复。
Somatic Symptom Disorder After Mild Traumatic Brain Injury.
Objective: Mild traumatic brain injury (mTBI) may be a common precipitant of Somatic Symptom Disorder (SSD). This study examined the prevalence, correlates, predictors, and functional impact of SSD after mTBI.
Setting: Follow up of patients recruited from emergency departments and urgent care centers.
Participants: Adults with mTBI (N = 476).
Design: Secondary analysis of a clinical trial (Clinicaltrials.gov NCT04704037).
Main measures: Early illness beliefs (Illness Perceptions Questionnaire-Revised; IPQ-R) were assessed ~2 weeks after mTBI and outcomes were assessed at 6 months post-injury, including SSD symptoms (Somatic Symptom Disorder-B Criteria Scale; SSD-12), post-concussion symptoms (Rivermead Post Concussion Symptoms Questionnaire; RPQ), disability (World Health Organization Disability Assessment Schedule; WHODAS), and psychiatric diagnoses (MINI Neuropsychiatric Inventory). SSD diagnosis was operationalized as having persistent symptoms and SSD-12 ≥ 16 (≥23 in sensitivity analyses).
Results: 15-27% of the sample met criteria for SSD at 6 months post-injury. Participants with SSD reported more pain and post-concussion symptoms, and were more likely to have comorbid Major Depressive Disorder (OR = 9.1, 95% CI = 5.3, 16.2) and at least 1 anxiety disorder (OR = 5.6, 95% CI = 3.6-8.8) compared to those without SSD. Early illness beliefs, specifically that mTBI has serious life consequences (OR = 1.2, 95% CI = 1.1-1.3) and causes distress (OR = 1.1, 95% CI = 1.0-1.2), were associated with later SSD. SSD symptoms contributed to prediction of global functional disability (WHODAS) over and above post-concussion symptom severity (RPQ; ΔDeviance = 0.22, P < .001).
Conclusions: SSD after mTBI is associated with an increased burden of symptoms, comorbidity, and disability. Early identification of at-risk patients appears feasible. SSD may be a useful framework for conceptualizing poor outcome from mTBI in patients with prominent psychological distress and guiding rehabilitation.
期刊介绍：
The Journal of Head Trauma Rehabilitation is a leading, peer-reviewed resource that provides up-to-date information on the clinical management and rehabilitation of persons with traumatic brain injuries. Six issues each year aspire to the vision of “knowledge informing care” and include a wide range of articles, topical issues, commentaries and special features. It is the official journal of the Brain Injury Association of America (BIAA).
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