En livsrystelse: En kvalitativ undersøgelse af eksistentielle og psykosociale følger efter hjernerystelse og anbefalinger til en psykosocial rehabiliteringsindsats

Abstract

Background: Concussion, also referred to as mild traumatic brain injury, can result in a wide range of symptoms, and for up to 20 % of people acquiring a concussion, these symptoms will persist for over a year, thus becoming long-lasting symptoms. The Danish healthcare system has been criticized for its current procedures regarding this group of patients on account of it being fragmented and offering inadequate options for referral. Hence, this group is left by itself regarding the management of the existential and psychosocial aftermath of the concussion. Objective: The present study investigates the existential and psychosocial changes that can be caused by long-lasting symptoms. In addition, the aim is to compose a set of recommendations for a psychosocial rehabilitative intervention for this target group. These recommendations are based on an insider perspective as well as on input from relatives to people with long-lasting symptoms. Method: Using a qualitative approach, we explored the challenges that people with long-lasting symptoms can experience. Nine semi-structured interviews were conducted: five with individuals with long-lasting symptoms (i.e. the insider perspective) and four with individuals who are relatives of people with long-lasting symptoms. Participants were found through Facebook and interviews were conducted through Zoom. Thematic analysis was carried out on the empirical data. Results: Two meta-themes with six themes each were developed. The first meta-theme, Existential and psychosocial changes, consisted of six themes: 1) Life disruption, 2) Uncertainty, 3) Psychological consequences, 4) Invisibility, 5) Social impact, and 6) Positive life changes. Likewise, the second meta-theme, Encounter with the system and desires for a psychosocial intervention, comprised six themes: 1) Lack of precedent for the treatment of concussions, 2) Encounter with the system, 3) Outreach efforts, 4) Psychological interventions, 5) Involvement of relatives in a psychosocial intervention, and 6) The need for a supportive intervention for relatives. Conclusions: This study concludes that a concussion and long-lasting symptoms can entail a life disruption causing changes in identity and a reduced quality of life while requiring a reconsideration of priorities. Moreover, uncertainty can follow the life disruption as it is uncertain if the condition will ever improve. Additionally, social relations can change, for example due to a lack of understanding from friends and family. The long-lasting symptoms can also bring about psychological consequences such as frustration, lack of energy, grief, anxiety, depression, stress, thoughts of suicide, and a feeling of being inadequate or a nuisance. The invisible nature of the condition can be a contributing factor to the existential and psychosocial changes. It is also concluded that these long-term symptoms can lead to positive changes in life. Furthermore, it is concluded that the participants wish for help to be offered early following the injury and that the psychosocial intervention is part of a coordinated interdisciplinary treatment, follows a plan, and comprises concrete advice and guidance. The participants also describe that the intervention should address the new life circumstances, and that they want to be able to unload on, be supported by, and discuss existential subjects with a psychologist. The participants wish for the psychologist to be understanding, help deal with worries, instill hope, and normalize psychological reactions, and for the psychologist to have a coaching approach. Other than that, the participants like the option of a group intervention but they have some caveats for this related to lack of energy and social comparison. Similarly, the participants have caveats regarding the involvement of their relatives in the psychosocial intervention, but those that do find this beneficial wish for their relatives to be part of the therapy or to be helped to gain more knowledge about and thus a better understanding of the condition. Additionally, we conclude that the target group will benefit from receiving recognition at both the micro and macro levels. In a psychosocial intervention, this means the psychologist should approach the group with an understanding of their challenges. Moreover, we recommend seeing the target group’s identity challenges from a narrative perspective. We also consider Acceptance and Commitment Therapy helpful in enhancing the well-being of the target group. In addition to these recommendations, the target group should have access to public support groups. Implications: More research is needed. The practical implications of the presented recommendations are dependent on funds being allocated to this area of health care.

A master thesis from Aalborg University

En livsrystelse: En kvalitativ undersøgelse af eksistentielle og psykosociale følger efter hjernerystelse og anbefalinger til en psykosocial rehabiliteringsindsats

[A Qualitative Study on Existential and Psychosocial Consequences following a Concussion and Recommendations for Psychosocial Rehabilitation]