School of Psychology, University of Waikato, Hamilton, New Zealand.
National Institute for Stroke and Applied Neurosciences, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand.
PLoS One. 2022 May 27;17(5):e0269101. doi: 10.1371/journal.pone.0269101. eCollection 2022.
The long-term effects of mild TBI (mTBI) are not well understood, and there is an ongoing debate about whether there are sex differences in outcomes following mTBI. This study examined i) symptom burden and functional outcomes at 8-years post-injury in males and females following mTBI; ii) sex differences in outcomes at 8-years post-injury for those aged <45 years and ≥45 years and; iii) sex differences in outcomes for single and repetitive TBI. Adults (≥16 years at injury) identified as part of a population-based TBI incidence study (BIONIC) who experienced mTBI 8-years ago (N = 151) and a TBI-free sample (N = 151) completed self-report measures of symptoms and symptom burden (Rivermead Post-Concussion Symptom Questionnaire, Hospital Anxiety and Depression Scale, Post-traumatic Stress Disorder Checklist), and functional outcomes (Participation Assessments with Recombined Tools, Work Limitations Questionnaire). The mTBI group reported significantly greater post-concussion symptoms compared to the TBI-free group (F(1,298) = 26.84, p<.01, ηp2 = .08). Females with mTBI were twice as likely to exceed clinical cut-offs for post-concussive (X2 (1)>5.2, p<.05, V>.19) and PTSD symptoms (X2(1) = 6.10, p = .014, V = .20) compared to the other groups, and reported their health had the greatest impact on time-related work demands (F(1,171) = 4.36, p = .04, ηp2 = .03. There was no interaction between sex and age on outcomes. The repetitive mTBI group reported significantly greater post-concussion symptoms (F(1,147) = 9.80, p<.01, ηp2 = .06) compared to the single mTBI group. Twice the proportion of women with repetitive mTBI exceeded the clinical cut-offs for post-concussive (X2(1)>6.90, p<.01, V>.30), anxiety (X2(1)>3.95, p<.05, V>.23) and PTSD symptoms (X2(1)>5.11, p<.02, V>.26) compared with males with repetitive TBI or women with single TBI. Thus, at 8-years post-mTBI, people continued to report a high symptom burden. Women with mTBI, particularly those with a history of repetitive mTBI, had the greatest symptom burden and were most likely to have symptoms of clinical significance. When treating mTBI it is important to assess TBI history, particularly in women. This may help identify those at greatest risk of poor long-term outcomes to direct early treatment and intervention.
轻度创伤性脑损伤（mTBI）的长期影响尚不清楚，并且关于 mTBI 后结局是否存在性别差异仍存在争议。本研究考察了 i）mTBI 后 8 年男性和女性的症状负担和功能结局；ii）45 岁以下和≥45 岁患者的 8 年结局的性别差异；iii）单次和重复性 TBI 的结局的性别差异。成年人（受伤时≥16 岁）作为基于人群的 TBI 发生率研究（BIONIC）的一部分，在 8 年前经历过 mTBI（N=151）和无 TBI 样本（N=151）完成了自我报告的症状和症状负担（Rivermead 脑震荡后症状问卷、医院焦虑和抑郁量表、创伤后应激障碍检查表）以及功能结局（采用重组工具的参与评估、工作限制问卷）。与无 TBI 组相比，mTBI 组报告的脑震荡后症状明显更多（F（1,298）=26.84，p<.01，ηp2=.08）。与其他组相比，患有 mTBI 的女性出现脑震荡后（X2（1）>5.2，p<.05，V>.19）和创伤后应激障碍症状（X2（1）=6.10，p=.014，V=.20）的临床临界值的可能性是其他组的两倍，并且报告她们的健康状况对与时间相关的工作要求的影响最大（F（1,171）=4.36，p=.04，ηp2=.03。性别和年龄之间没有交互作用。重复性 mTBI 组报告的脑震荡后症状明显更多（F（1,147）=9.80，p<.01，ηp2=.06）。与单次 mTBI 组相比。患有重复性 mTBI 的女性中，有两倍以上的人超过了脑震荡后（X2（1）>6.90，p<.01，V>.30）、焦虑（X2（1）>3.95，p<.05，V>.23）和创伤后应激障碍症状（X2（1）>5.11，p<.02，V>.26）的临床临界值，而患有重复性 TBI 的男性或患有单次 TBI 的女性则没有。因此，在 mTBI 后 8 年，人们继续报告存在高症状负担。患有 mTBI 的女性，尤其是有重复性 mTBI 病史的女性，症状负担最大，最有可能出现具有临床意义的症状。在治疗 mTBI 时，重要的是要评估 TBI 病史，尤其是在女性中。这可能有助于确定那些存在长期预后不良风险的人，以便进行早期治疗和干预。
