A Prospective Biopsychosocial Study of the Persistent Post-Concussion Symptoms following Mild Traumatic Brain Injury
Abstract
This study examined multiple biopsychosocial factors relating to post-concussion symptom (PCS) reporting in patients with mild traumatic brain injuries (mTBI), including structural (computed tomography and magnetic resonance imaging [MRI]) and microstructural neuroimaging (diffusion tensor imaging [DTI]). Patients with mTBIs completed several questionnaires and cognitive testing at approximately one month ( n =126) and one year ( n =103) post-injury. At approximately three weeks post-injury, DTI was undertaken using a Siemens 3T scanner in a subgroup ( n =71). Measures of fractional anisotropy were calculated for 16 regions of interest (ROIs) and measures of apparent diffusion coefficient were calculated for 10 ROIs. Patients were compared with healthy control subjects. Using International Classification of Diseases, Tenth Revision (ICD-10) PCS criteria and mild or greater symptom reporting, 59% of the mTBI sample met criteria at one month and 38% met criteria at one year. However, 31% of the healthy control sample also met criteria for the syndrome—illustrating a high false-positive rate. Significant predictors of ICD-10 PCS at one month were pre-injury mental health problems and the presence of extra-cranial bodily injuries. Being symptomatic at one month was a significant predictor of being symptomatic at one year, and depression was significantly related to PCS at both one month and one year. Intracranial abnormalities visible on MRI were present in 12.1% of this sample, and multifocal areas of unusual white matter as measured by DTI were present in 50.7% (compared with 12.4% of controls). Structural MRI abnormalities and microstructural white matter findings were not significantly associated with greater post-concussion symptom reporting. The personal experience and reporting of post-concussion symptoms is likely individualized, representing the cumulative effect of multiple variables, such as genetics, mental health history, current life stress, medical problems, chronic pain, depression, personality factors, and other psychosocial and environmental factors. The extent to which damage to the structure of the brain contributes to the persistence of post-concussion symptoms remains unclear.
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PPCS have a biopsychosocial conceptualisation.
“it has been argued that PPCS have a biopsychosocial conceptualisation.”
From Acceptance and commitment therapy for mild traumatic brain injury (ACTion-mTBI): a quasiexperimental feasibility study (2025) · cites this paper as [14]
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Self-citationRecovery after Traumatic Brain Injury
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Mild Traumatic Brain Injury (mTBI) and chronic cognitive impairment: A scoping review
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- Authors
- Wäljas, M., Iverson, G. L., Lange, R. T., Hakulinen, U., Dastidar, P., Huhtala, H., Liimatainen, S., Hartikainen, K., & Öhman, J.
- Affiliations
- Tampere University Hospital (FI)
- Harvard University (US)
- University of British Columbia (CA)
- University of Tampere (FI)
- Pirkanmaa Hospital District (FI)
- Corresponding author
- Wäljas, Minna
- Venue
- Journal of Neurotrauma
- Publisher
- SAGE Publications
- Published
- 2015-04
- Volume
- 32
- Issue
- 8
- Pages
- 534-547
- ISSN
- 0897-7151 (ISSN-L)
- 1557-9042
- OpenAlex
- W1531091112
- Cited by
- 247
- References
- 106
- Citations by year
- 2026: 11 · 2025: 12 · 2024: 22 · 2023: 17 · 2022: 27 · 2021: 31 · 2020: 23 · 2019: 30 · 2018: 21 · 2017: 27 · 2016: 14 · 2015: 12
- FWCI
- 13.37
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Neurotrauma (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
- Health Sciences › Medicine › Neurology › Long-Term Effects of COVID-19
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Automotive and Human Injury Biomechanics
- Keywords
- post-concussion syndrome, mild traumatic brain injury, persistent post-concussion symptoms, biopsychosocial factors, depression, white matter microstructure, fractional anisotropy, apparent diffusion coefficient, structural brain abnormalities, symptom persistence
- MeSH terms
- Adolescent, Adult, Brain Injuries, Female, Follow-Up Studies, Humans, Male, Middle Aged, Risk Factors, Post-Concussion Syndrome, Young Adult
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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