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

Objective: To prospectively assess the association between litigation and n eurobehavioural symptoms following mild Traumatic Brain Injury (TBI). Design: a prospective study with the inception cohort assessed on average 4 2.2(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 inju ry outcome measures, the Glasgow Outcome Scale (GOS) and the Rivermead Head Injury Follow-up Questionnaire (RHFUQ). Results: Demographic characteristics, TBI severity ratings and premorbid ri sk factors for poor outcome did not differ between litigants (27.8 per cent of the sample) and non-litigants. However, litigants were significantly mo re 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 <0.0 02). There were no cognitive differences between the groups. Conclusions: the data demonstrate an association between litigation and inc reased psychological distress at the outset of the litigation process. Whil e 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 expr ession of symptoms following mild traumatic brain injury.