Somatization in adolescents with persistent post-concussive symptoms : a retrospective chart review

Background: Approximately 30% of adolescents who sustain a concussion experience related symptoms that persist beyond one month post-injury, affecting everyday functioning, developmental achievements, and quality of life. Somatization, the process whereby psychological distress is expressed as unintentionally produced physical symptoms, may relate to and maintain persistent post-concussive symptoms in some adolescents. However, effectively identifying somatization in adolescents with persistent post-concussive symptoms is challenging due to ambiguity about factors that specifically characterize the issue, such as symptoms, impairment levels, premorbid experiences, mental health and medical service use. Objectives: To describe the characteristics of somatization in adolescents with persistent post- concussive symptoms and compare outcomes in adolescents with persistent post-concussive symptoms unaffected by somatization. Methods: This study involved a review of medical records of adolescents referred to a tertiary care interdisciplinary concussion clinic between January 2016 and May 2018. Information on demographics and injury characteristics, post-concussive symptoms, mental health, medical service use, and school attendance was extracted from charts. Those with physician-identified somatization were compared to those without physician-identified somatization. Results: Compared to those unaffected by somatization, adolescents with somatization reported more severe and unusual post-concussive symptoms, demonstrated that they had more post-injury impairment in school attendance, were more likely to have a history of premorbid chronic pain or medically unexplained symptoms, obtained more neuroimaging after injury, and obtained more health care after injury. Conclusions: Adolescents with persistent post-concussive symptoms affected by somatization differed in their experience of post-concussive symptoms, illness behaviours, and pre-morbid history compared to those unaffected by somatization. These findings should help improve clinical identification of somatization in youth following a concussion, and subsequently the referral of affected youth to effective mental health services.Medicine, Faculty ofExperimental Medicine, Division ofMedicine, Department ofGraduat