Brain drawings following traumatic brain injury (TBI) and links to illness perceptions and health outcomes – Findings from a population-based study

Abstract

Objective: Individuals’ illness perceptions predict health behaviours and influence functional outcomes. This study examined associations between a novel assessment of illness perceptions, in the form of adult’s brain drawings after traumatic brain injury (TBI) and questionnaire measures of illness perceptions, quality of life and post-concussive symptoms.

Design: Population-based, prospective longitudinal study examining 245 adults with predominantly mild TBI with high risk of complications.

Main outcome measures: Participants were asked to draw pictures of what they thought their brain looked like before injury and at baseline and one month post-injury. Drawing characteristics (height, width and percentage damage at one month) were examined in relation to each outcome of interest at six months.

Results: Greater damage at one month was associated with more negative illness perceptions (rs = .23), poorer mental health (rs = −.21), and more total post-concussive symptoms (rs = .27 to r = .35) at six months. The extent of damage depicted reduced over time (p < .001). No associations were found between the amount of damage drawn and injury severity, nor the height or width of drawings and injury severity or illness perceptions.

Conclusion: Drawings post-TBI offer a simple, cost- and time-effective way to begin discussions and improve understanding of peoples’ illness perceptions.

Keywords:

• drawings
• post-concussion symptoms
• illness perceptions
• traumatic brain injury
• quality of life

Abbreviations:

• BIONIC, Brain Injury Incidence and Outcomes New Zealand in the Community
• BIPQ, Brief Illness Perception Questionnaire
• GCS, Glasgow Coma Score
• M, Mean
• TBI, Traumatic Brain Injury
• PCS, Post-Concussive Symptoms
• QoL, Quality of Life
• RPQ, Rivermead Post-Concussion Symptoms Questionnaire
• SD, Standard Deviation
• SPSS, Statistical Package for the Social Sciences

Acknowledgements

The funder had no direct input into the study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication. We are indebted to the research team for their dedication and performance. Members of the BIONIC study group include: Valery Feigin (Principal Investigator), Suzanne Barker-Collo, Kathryn McPherson, Robert Kydd, P. Alan Barber, Varsha Parag, Paul Brown, Nicola Starkey, Anthony Dowell, Michael Kahan, Alice Theadom, Shanthi Ameratunga, Grant Christey, Kelly Jones, Amy Jones, Natalie Hardaker, Braden Te Ao. A full list of members of the BIONIC team is available at www.nisan.aut.ac.nz. Alice Theadom was co-funded by ABI Rehabilitation Management during this study and Kathryn McPherson holds the Laura Fergusson Trust Chair.