Post-concussion symptom reporting and the "good-old-days" bias following mild traumatic brain injury
Rael T Lange1, Grant L Iverson, Alice Rose
1British Columbia Mental Health and Addiction Services, University of British Columbia, Vancouver, British Columbia, Canada. rael.lange@gmail.com
Abstract:
The purpose of this study was to examine the influence of the "good-old-days" bias on symptom reporting following mild traumatic brain injury (MTBI). The MTBI sample consisted of 86 patients (51.2% men) referred to a hospital-based concussion clinic in Vancouver, Canada. The majority of patients (83.7%) were evaluated within 3 months following their injury (M = 1.8 months, SD = 1.7, range = 0.2-8.0 months). Patients provided retrospective preinjury symptom ratings on the British Columbia Post-Concussion Symptom Inventory (BC-PSI). Ratings were compared with 177 healthy controls recruited from the community and a local university. MTBI retrospective ratings were significantly lower than the control group on the BC-PSI total score (p < .01, d = 0.27, small effect size) and 6 of the 13 individual items (all p < .05, d = 0.23-0.36, small to small-medium effect sizes). Patients who were currently in litigation reported more post-injury symptoms (p = .009, d = 0.63, medium-large effect size). However, litigation status was not associated with self-reported preinjury retrospective symptom ratings. Consistent with the "good-old-days" bias, patients with MTBI appear to misperceive their preinjury functioning as better than the average person.
Insights
Patients with mild traumatic brain injury (MTBI) may experience the "good-old-days" bias, underestimating their pre-injury symptoms. This bias affects how individuals recall their health status before the injury.
Area of Science:
- Neuroscience
- Psychology
- Rehabilitation Medicine
Background:
- Mild traumatic brain injury (MTBI) can lead to persistent post-concussive symptoms.
- Accurate assessment of pre-injury functioning is crucial for understanding MTBI recovery.
- Cognitive biases, such as recall bias, can influence self-reported symptom severity.
Purpose of the Study:
- To investigate the impact of the "good-old-days" bias on symptom reporting in patients with MTBI.
- To compare retrospective pre-injury symptom ratings in MTBI patients with healthy controls.
Main Methods:
- Retrospective pre-injury symptom ratings were collected from 86 MTBI patients using the British Columbia Post-Concussion Symptom Inventory (BC-PSI).
- MTBI patient ratings were compared to 177 healthy community and university controls.
- The influence of litigation status on symptom reporting was also examined.
Main Results:
- MTBI patients reported significantly lower pre-injury symptoms than controls on the BC-PSI total score and 6 individual items, indicating a "good-old-days" bias.
- Patients involved in litigation reported more post-injury symptoms, but this did not affect their retrospective pre-injury symptom ratings.
- Effect sizes for the bias ranged from small to small-medium.
Conclusions:
- Patients with MTBI demonstrate a "good-old-days" bias, perceiving their pre-injury functioning as better than average.
- This bias may affect the accurate assessment of symptom burden following MTBI.
- Litigation status influences current symptom reporting but not the recall of pre-injury functioning.
