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The role of illness perceptions in mental health treatment-seeking and outcomes after mild traumatic brain injury Otamendi, Thalia

Abstract

Mental health complications are common but undertreated after mild traumatic brain injury (mTBI). Patient-related barriers to the use of mental health treatment after mTBI are unclear. According to the Common Sense Model of Self-Regulation, how individuals understand their health condition (i.e., illness perceptions) influences their coping strategies (e.g., treatment-seeking), and in turn, clinical outcomes. This research program had three objectives: 1) To understand the association between patients’ illness perceptions (e.g., about the cause, prognosis, consequences of their symptoms) and their perceived need for mental health care after mTBI; 2) To determine if the influence of illness perceptions on mTBI clinical outcomes is mediated by individuals’ access to mental health treatment; 3) To develop an explanatory model, rooted in the lived experiences of people with persistent symptoms after mTBI, that describes treatment-seeking decisions, including for mental health. The first two objectives were addressed with secondary analyses of a prospective inception cohort of adults with mTBI (N = 308 to 506) and the third objective with qualitative interviews (N = 17). Participants who believed their symptoms were threatening (OR = 1.16; 95% CI: 1.02 – 1.31) and caused by mental health difficulties (OR = 1.04; 95% CI: 1.02 – 1.05) were more likely to perceive the need for mental health care. Perceived threat (B = 0.02; 95% CI: 0.01- 0.03) and poor mental health as a cause for symptoms (B = 0.19; 95% CI: 0.09 – 0.29) were also associated with subsequent access to mental health treatment. Accessing mental health treatment did not mediate the relationship between illness perceptions and subsequent symptoms, likely due to a study design that did not allow sufficient time to capture treatment benefits. Qualitative data suggested that people can view mental health problems as a consequence, rather than a potential cause of ongoing mTBI symptoms, which might dissuade them from prioritizing mental health treatment. This research program demonstrates the relevance of illness perceptions on treatment-seeking after mTBI. Findings point to a potential barrier to the recommended use of mental health care when it does not align with patients’ beliefs about what is causing their symptoms.

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Attribution-NonCommercial-NoDerivatives 4.0 International