Category: Brain Injury; Clinical Practice (assessment, diagnosis, treatment, knowledge translation/EBP, implementation science, program development)
Objective : To investigate the relationship between blame attribution and recovery following mild traumatic brain injury (mTBI). We hypothesized that those who blamed others at baseline would have higher rates of post-concussive symptoms and potentially other negative outcomes at six months post-mTBI.
Design : Secondary data analysis of a two-group randomized clinical trial of telephone delivered follow-up after mTBI.
Setting : Baseline data were collected in-person in the emergency department of two public hospitals. Six month follow-up data were collected via telephone interviews.
Participants (or Animals, Specimens, Cadavers) : 338 participants diagnosed in the emergency department with mTBI within 48 hours of injury.
Interventions : None.
Main Outcome Measure(s) : Six-month outcomes including evidence of post-concussive syndrome (PCS) and post-traumatic stress disorder (PTSD), litigation status, employment changes, functional impairment, and health-related quality of life.
Results : Forty-seven percent of participants externalized blame at baseline. Those involved in motor vehicle crashes (52%) and violent acts (81%) were more likely to blame others. By six months post injury, of those who externalized blame, 24% reported PTSD vs. 10% of those who did not blame others, 18% vs. 10% had anxiety, 30% vs. 13% had depression, 49% vs. 36% had evidence of PCS, and 50% vs. 18% were involved in litigation. They also had more functional impairment (p =0.004).
Conclusions : Providers treating individuals with mTBI may consider screening for external blame attribution and referring for psychotherapy as it appears to place individuals at higher risk for poorer functional and mental health outcomes. Providers may consider educating patients about blame attribution in recovery, especially if they are in litigation. Future research could include a prospective study to determine whether blame changes both over time and with intervention.
Orli Shulein– PhD Student, University of Washington, Seattle, Washington
Sylvia Lucas– Clinical Professor of Neurology & Neurological Surgery; Adjunct, Rehabilitation Medicine, University of Washington Medical Center, Seattle, Washington
Nancy Temkin– Professor, University of Washington, Seattle, Washington
Jeanne Hoffman– Professor, University of Washington School of Medicine, Seattle, Washington