The effects of litigation on symptom expression: a prospective study following mild traumatic brain injury

Objective: To prospectively assess the association between litigation and neurobehavioural symptoms following mild Traumatic Brain Injury (TBI). Design: a prospective study with the inception cohort assessed on average 42.2(17.2) days after injury. Setting: an outpatient clinic within a large general hospital. Patients: a consecutive sample of 100 clinic attenders with mild TBI. Outcome measures: A cognitive screen (Mini-Mental State Examination (MMSE), Galveston Orientation and Amnesia Test (GOAT), a measure of psychological distress (the 28 item General Health Questionnaire (GHQ)) and two head injury outcome measures, the Glasgow Outcome Scale (GOS) and the Rivermead Head Injury Follow-up Questionnaire (RHFUQ). Results: Demographic characteristics, TBI severity ratings and premorbid risk factors for poor outcome did not differ between litigants (27.8 per cent of the sample) and non-litigants. However, litigants were significantly more anxious (p <0.0001), depressed (p <0.01), had greater social dysfunction (p <0.0001) and had poorer outcome on the GOS (p <0.002) and RHFUQ (p <0.002). There were no cognitive differences between the groups. Conclusions: the data demonstrate an association between litigation and increased psychological distress at the outset of the litigation process. While association is not synonymous with causality, the absence of demographic, premorbid and TBI related differences between litigants and non-litigants suggests that the pursuit of compensation may influence the subjective expression of symptoms following mild traumatic brain injury.