Victims of mild traumatic brain injury (“mTBI”) commonly report psychological distress, which is not surprising given the impact the injury can have on every aspect of everyday life including but not limited to balance, vision, sleeping, physical discomfort including headaches, and perhaps most significantly thinking clearly. Patients often report that they are not the same person and fear that person will never return.
We often recommend counseling support, but this has been based more on instinct and anecdotal information than on data. In prior posts we have reported on studies showing that depression is a common sequelae of mTBI that should be treated before it becomes disabling.
A recent 10-year matched cohort study of workers’ compensation claims, published in the Journal of the American College of Occupational and Environmental Medicine, provides data supporting the importance of early mental health intervention to improve mTBI outcomes.
Natasha Nanwa,PhD, et. al. note that providers are often reluctant to make a referral for psychological treatment early in the course of recovery in an effort to avoid “over medicalization” of psychological factors. The authors posit that looking back historically, early referrals have more likely been made where 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 that the study data showed just the opposite. The group of patients who received early mental health interventions in fact incurred reduced health care costs and shorter durations of disability. The narrow message of the study is that workers compensation insurers would benefit from authorizing early mental health treatment following mTBI because it is likely to lead to lower long-term costs.
The broader implication of the study is that early mental health intervention should be considered by all providers where there is any indication that mTBI symptoms are persisting beyond the acute stage.
