Fatigue following mild Traumatic Brain Injury: A six-month prospective cohort study

Objective: Fatigue is a frequent and profoundly disabling symptom following mild traumatic brain injury (mTBI), that may even persist for years. Approximately 85–90% of thepatients with TBI sustain a mild TBI, and among these patients, about 68% experience complaints of fatigue in the acute phase following injury. To date, there are little published data on the specific course of fatigue following mTBI. The main objective of the current study was to examine prevalence and severity of fatigue following mTBI over 6 months. In addition, we examined correlates of fatigue, including anxiety, depression and coping styles, and we investigated early predictors of fatigue at 6 months. Method: We included 433 mTBI patients, who all completed questionnaires at 2 weeks, 3 months and 6 months. Fatigue was assessed with the Checklist Individual Strength, comprising four subscales: Fatigue severity, Concentration problems, Reduced motivation and Reduced activity. Furthermore, we examined anxiety and depression (Hospital Anxiety and Depression Scale) and coping styles (Utrecht Coping List).Results: The preliminary results show that severe fatigue was experienced by 37%, 22% and 20% of the mTBI patients at 2weeks, 3 months and 6 months post injury, respectively. There was a statistically significant effect of time on all fatigue subscales. Post-hoc comparisons indicated a significant decrease in fatigue scores between 2 weeks and 3 months, but not between 3 and 6 months, except for the Reduced activity scale. Fatigue at 2 weeks contributed to 42% of the variance in fatigue at 3 months (r=.64, p < .001) and 37% of the variance in fatigue at 6 months (r=.60, p < .001), and fatigue at 3 months contributed to 67% of the variance in fatigue at 6 months (r=.83, p < .001). Furthermore, fatigue was significantly correlated with anxiety, depression, active coping and passive coping at all time intervals. Significant predictors of post-mTBI fatigue at 6 months were depression, anxiety and the presence of severe fatigue at 2 weeks. Conclusions: Fatigue is a frequent and persistent complaint after mTBI that decreases over the first 3 months after injury but then remains relatively the same. Experienced fatigue in the early phase post-injury and levels of anxiety and depression appear to be significant predictors for fatigue at 6months. These findings, together with strong relations found between fatigue and coping styles, may contribute to the development of new treatments for early intervention following mTBI.