Patient perceptions of persistent symptoms after mild traumatic brain injury and their influence on mental health treatment-seeking: a grounded theory study

Mental health conditions after mild traumatic brain injury (mTBI) are common and can complicate injury outcomes, but are under-treated. According to the Common Sense Model of Self-Regulation, the way patients perceive their health conditions can influence the way they manage them, including if, when, and how they seek treatment. This study explored how individuals perceive persistent symptoms after mTBI, in order to develop a grounded theory about what motivates and demotivates them to seek mental health treatment after their injury. Seventeen adults experiencing persistent symptoms after mTBI participated in semi-structured interviews, which were analyzed using constructivist grounded theory. An explanatory model of patient perceptions was developed with three interrelated categories: (1) Symptom persistence and uncertainty result in life challenges; (2) Self-advocating for answers through extensive treatment-seeking; preference for biomedical treatment; (3) Mental health problems are caused by symptom persistence, therefore mental health treatment is supplementary. Findings suggest a potential barrier to seeking mental health treatment during complicated mTBI recovery: if patients do not consider mental health as an important cause of their ongoing symptoms, they may feel less motivated to prioritize mental health treatment. Mental health conditions after mild traumatic brain injury (mTBI) are common and can complicate injury outcomes, but are under-treated.Patient perceptions of their persistent symptoms after mTBI can play a guiding role in their treatment decisions, including for mental health.Clinicians should validate patients’ physical symptom concerns and their debilitating consequences after mTBI, while introducing the possibility of psychological influences on recovery. Mental health conditions after mild traumatic brain injury (mTBI) are common and can complicate injury outcomes, but are under-treated. Patient perceptions of their persistent symptoms after mTBI can play a guiding role in their treatment decisions, including for mental health. Clinicians should validate patients’ physical symptom concerns and their debilitating consequences after mTBI, while introducing the possibility of psychological influences on recovery.