Victims of mild traumatic brain injuries (“mTBI”) commonly report psychological distress, which is not surprising given the impact the injury can have on all aspects of daily life, including but not limited to balance, vision, sleep, physical ailments, including headaches, and perhaps most significantly, clear thinking. Patients often report that they are not the same person and fear that person will never return.
We often recommend psychological support, but this has been based more on instinct and anecdotal information than on data. In previous posts we have reported on studies showing that depression is a common sequela of mTBI that must be treated before it becomes disabling.
A recent 10-year matched cohort study of workers’ compensation claimspublished in the Journal of the American College of Occupational and Environmental Medicineprovides data supporting the importance of early mental health intervention to improve mTBI outcomes.
Natasha Nanwa, PhD, et. Alabama. keep in mind that providers are often reluctant to make a referral for psychological treatment early in the course of recovery in an effort to avoid “overmedicating” psychological factors. The authors posit that, looking back historically, earlier referrals are more likely to have been made when psychological distress is more severe, and that these patients would therefore be expected to have more persistent problems and greater difficulty returning to work.
It turns out the study data showed just the opposite. The group of patients who received early mental health interventions actually incurred reduced health care costs and shorter durations of disability. The narrow message from the study is that workers’ compensation insurers would benefit from authorizing early mental health treatment after TBI because it is likely to reduce long-term costs.
The broader implication of the study is that all providers should consider early mental health intervention when there is any indication that TBI symptoms persist beyond the acute stage.
