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Effects of “Diagnosis Threat” on Cognitive and Affective Functioning Long After Mild Head Injury

  • Lana J. Ozen (a1) and Myra A. Fernandes (a1)


Persistent cognitive complaints are common following a mild head injury (MHI), but deficits are rarely detected on neuropsychological tests. Our objective was to examine the effect of symptom expectation on self-report and cognitive performance measures in MHI individuals. Prior research suggests that when MHI participants are informed they may experience cognitive difficulties, they perform worse on neuropsychological tests compared to MHI participants who are uninformed. In this study, undergraduate students with and without a prior MHI were either informed that the study's purpose was to investigate the effects of MHI on cognitive functioning (“diagnosis threat” condition) or merely informed that their cognitive functioning was being examined, with no mention of status (“neutral” condition). “Diagnosis threat” MHIs self-reported more attention failures compared to “diagnosis threat” controls and “neutral” MHIs, and more memory failures compared to “diagnosis threat” controls. In the “neutral” condition, MHIs reported higher anxiety levels compared to controls and compared to “diagnosis threat” MHIs. Regardless of condition, MHIs performed worse on only one neuropsychological test of attention span. “Diagnosis threat” may contribute to the prevalence and persistence of cognitive complaints made by MHI individuals found in the literature, but may not have as strong of an effect on neuropsychological measures. (JINS, 2011, 17, 219–229)


Corresponding author

Correspondence and reprint requests to: Lana Ozen, Department of Psychology, 200 University Ave. W., University of Waterloo, Waterloo, Ontario, N2L 3G1, Canada. E-mail:


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Beck, A.T., Steer, R.A., Brown, G.K. (1996). Manual for the Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation.
Belanger, H.G., Curtiss, G., Demery, J.A., Lebowitz, B.K., Vanderploeg, R.D. (2005). Factors moderating neuropsychological outcomes following mild traumatic brain injury: A meta-analysis. Journal of the International Neuropsychological Society, 11, 215227.
Bernstein, D.M. (2002). Information processing difficulty long after self-reported concussion. Journal of the International Neuropsychological Society, 8, 673682.
Binder, L.M., Rohling, M. (1996). Money matters: A meta-analytic review of the effects of financial incentives on recovery after closed-head injury. American Journal of Psychiatry, 153, 710.
Binder, L.M., Rohling, M.L., Larrabee, G.J. (1997). A review of mild head trauma. Part I. Meta-analytic review of neuropsychological studies. Journal of Clinical and Experimental Neuropsychology, 19, 421431.
Broadbent, D.E., Cooper, P.F., FitzGerald, P., Parkes, K.R. (1982). The cognitive failures questionnaire (CFQ) and its correlates. British Journal of Clinical Psychology, 21, 116.
Carriere, J.S.A., Cheyne, J., Smilek, D. (2008). Everyday attention lapses and memory failures: The affective consequences of mindlessness. Consciousness and Cognition, 17, 835847.
Chan, R.C.K. (2002). Attention deficits in patients with persisting postconcussive complaints: A general deficit or specific component deficit? Journal of Clinical and Experimental Neuropsychology, 24, 10811093.
Cicerone, K.D. (1996). Attention deficits and dual task demands after mild traumatic brain injury. Brain Injury, 10, 7989.
Davis, C.H. (2002). Self-perception in mild traumatic brain injury. American Journal of Physiological Medicine Rehabilitation, 81, 609621.
Delis, D.C., Kramer, J.H., Kaplan, E., Ober, B.A. (1987). The California Verbal Learning Test. San Antonio, TX: The Psychological Corporation.
Dischinger, P.C., Ryb, G.E., Kufera, J.A., Auman, K.M. (2009). Early predictors of postconcussive syndrome in a population of trauma patients with mild traumatic brain injury. The Journal of Trauma, 66, 289297.
Edna, T.H., Cappelen, J. (1987). Return to work and social adjustment after traumatic head injury. Acta Neurochirurgica, 85, 4043.
Fann, J.R., Uomoto, J.M., Katon, W.J. (2001). Cognitive improvement with treatment of depression following mild traumatic brain injury. Psychosomatics, 42, 4854.
Gunstad, J., Suhr, J.A. (2001). “Expectation as etiology” versus “the good old days”: Post-concussion syndrome symptom reporting in athletes, headache sufferers, and depressed individuals. Journal of International Neuropsychological Society, 7, 323333.
Gunstad, J., Suhr, J.A. (2004). Cognitive factors in post-concussion syndrome symptom report. Archives of Clinical Neuropsychology, 19, 391405.
Iverson, G.L., Lange, R.T., Brooks, B.L., Rennison, A. (2010). ‘Good old day’ bias following mild traumatic brain injury. The Clinical Neuropsychologist, 24, 1737.
Iverson, G.L., Zasler, N.D., Lange, R.T. (2007). Post-concussive disorder. In Zasler, N.D., Katz, D.I., Zafonte, R.D. (Eds.), Brain injury medicine: Principles and practice (pp. 373403). New York: Demos Medical Publishing.
Kay, T., Harrington, D.E., Adams, R., Anderson, T., Berrol, S., Cicerone, K. (1993). Report of the mild traumatic brain injury committee of the head injury interdisciplinary special interest group of the american congress of rehabilitation medicine: Definition of mild traumatic injury. Journal of Head Trauma Rehabilitation, 8, 8687.
Lange, R.T., Iverson, G.L., Rose, A. (2010). Post-concussion symptom reporting and the “good-old-days” bias following mild traumatic brain injury. Archives of Clinical Neuropsychology, 25, 442450.
McAllister, T.W., Saykin, A.J., Flashman, L.A., Sparling, M.B., Johnson, S.C., Guerin, S.J., Yanofsky, N. (1999). Brain activation during working memory 1 month after mild traumatic brain injury: A functional MRI study. Neurology, 53, 13001311.
McAllister, T.W., Sparling, M.B., Flashman, L.A., Guerin, S.J., Mamourian, A.C., Saykin, A.J. (2001). Differential working memory load effects after mild traumatic brain injury. Neuroimaging, 14, 10041012.
Messe, A., Caplain, S., Paradot, G., Garrigue, D., Mineo, J., Ares, G.S., Lehericy, S. (2010). Diffusion tensor imaging and white matter lesions at the subacute stage in mild traumatic brain injury with persistent neurobehavioral impairment. Human Brain Mapping, [Epub ahead of print].
Middleboe, T., Andersen, H.S., Birket-Smith, M., Friis, M.L. (1992). Minor head injury: Impact on general health after 1 year. A prospective follow-up study. Acta Neurologica Scandinavica, 85, 59.
Mittenberg, W., DiGiulio, D.V., Perrin, S., Bass, A.E. (1992). Symptoms following mild head injury: Expectation as aetiology. Journal of Neurology, Neurosurgery, and Psychiatry, 55, 200204.
Mooney, G., Speed, J. (2001). The association between mild traumatic brain injury and psychiatric conditions. Brain Injury, 15, 865877.
Niogi, S.N., Mukherjee, P. (2008). Diffusion tensor imaging of mild traumatic brain injury. Journal of Head Trauma Rehabilitation, 25, 241255.
Pare, N., Rabin, L.A., Fogel, J., Pepin, M. (2008). Mild traumatic brain injury and its sequelae: Characterisation of divided attention deficits. Neuropsychological Rehabilitation, 19, 110137.
Ponsford, J., Willmott, C., Rothwell, A., Cameron, P., Kelly, A., Nelms, R., Ng, K. (2000). Factors influencing outcome following mild traumatic brain injury in adults. Journal of International Neuropsychological Society, 6, 568579.
Potter, D.D., Jory, S.H., Bassett, M.R., Barrett, K., Mychalkiw, W. (2002). Effect of mild head injury on event-related potential correlates of stroop task performance. Journal of the International Neuropsychological Society, 8, 828837.
Rapoport, M.J., McCullagh, S., Shammi, P., Feinstein, A. (2005). Cognitive impairment associated with major depression following mild and moderate traumatic brain injury. The Journal of Neuropsychiatry and Clinical Neurosciences, 17, 6165.
Reason, J.T., Mycielska, K. (1982). Absent-minded? The psychology of mental lapses and everyday errors. Englewood Cliffs, NJ: Prentice-Hall.
Reitan, R.M., Wolfson, D. (1985). The Halstead-Reitan neuropsychological test battery. Tucson, AZ: Neuropsychological Press.
Rutherford, W.H., Merrett, J.D., McDonald, J.R. (1979). Symptoms at one year following concussion from minor head injuries. Injury, 10, 25230.
Smits, M., Dippel, D.W.J., Houston, G.C., Wielopolski, P.A., Koudstaal, P.J., Hunink, M.G.M., Lugt, A. (2009). Postconcussion syndrome after minor head injury: Brain activation of working memory and attention. Human Brain Mapping, 30, 27892803.
Solbakk, A., Reinvang, I., Neilsen, C., Sundet, K. (1999). ERP indicators of disturbed attention in mild closed head injury: A frontal lobe syndrome? Psychophysiology, 36, 802817.
Sosin, D.M., Sniezek, J.E., Thurman, D.J. (1996). Incidence of mild and moderate brain injury in the United States, 1991. Brain Injury, 10, 4754.
Spencer, S.J., Steele, C.M., Quinn, D.M. (1999). Stereotype threat and women's math performance. Journal of Experimental and Social Psychology, 35, 428.
Spiegel, H. (1997). Nocebo: The power of suggestibility. Preventive Medicine, 26, 616621.
Spielberger, C.D., Gorsuch, R.L., Lushene, R.E. (1970). Manual for the State-Trait Anxiety Inventory. Palo Alto, CA: Consulting Psychologists Press.
Stein, M.B., McAllister, T.W. (2009). Exploring the convergence of posttraumatic stress disorder and mild traumatic brain injury. The American Journal of Psychiatry, 166, 768776.
Stulemeijer, M., Vos, P.E., Bleijenberg, G., van der Werf, S.P. (2007). Cognitive complaints after mild traumatic brain injury: Things are not always what they seem. Journal of Psychosomatic Research, 63, 637645.
Suhr, J.A., Gunstad, J. (2002). “Diagnosis threat”: The effect of negative expectations on cognitive performance in head injury. Journal of Clinical and Experimental Neuropsychology, 24, 448457.
Suhr, J.A., Gunstad, J. (2005). Further exploration of the effect of “diagnosis threat” on cognitive performance in individuals with mild head injury. Journal of the International Neuropsychological Society, 11, 2329.
Thurman, D.J. (2001). The epidemiology and economics of head trauma. In Miller, L., Hayes, R. (Eds.), Head trauma: Basic, preclinical, and clinical directions (pp. 327348). New York: John Wiley & Sons.
Tsanadis, J., Montoya, E., Hanks, R.A., Millis, S.R., Fichtenberg, N.L. (2008). Brain injury severity, litigation status, and self-report of postconcussive symptoms. The Clinical Neuropsychologist, 22, 10801092.
Vanderploeg, R.D., Belanger, H.G., Curtiss, G. (2009). Mild traumatic brain injury and posttraumatic stress disorder and their associations with healthy symptoms. Archives of Physical Medicine and Rehabilitation, 90, 10841092.
Vanderploeg, R.D., Curtiss, G., Belanger, H.G. (2005). Long-term neuropsychological outcomes following mild traumatic brain injury. The International Neuropsychological Society, 11, 228236.
Vanderploeg, R.D., Curtiss, G., Luis, C.A., Salazar, A.M. (2007). Long-term morbidities following self-reported mild traumatic brain injury. Journal of Clinical and Experimental Neuropsychology, 29, 585598.
Wechsler, D. (1997). Wechsler adult intelligence scale (3rd ed.). New York: The Psychological Corporation.
Westcott, M.C., Alfano, D.P. (2005). The symptom checklist-90-revised and mild traumatic brain injury. Brain Injury, 20, 12611267.
Wheeler, S.C., Petty, R.E. (2001). The effects of stereotype activation on behavior: A review of possible mechanisms. Psychological Bulletin, 127, 797826.
Zhang, K., Johnson, B., Pennell, D., Ray, W. (2010). Are functional deficits in concussed individuals consistent with white matter structural alterations: Combined fMRI and DTI study. Experimental Brain Research, 204, 5770.


Effects of “Diagnosis Threat” on Cognitive and Affective Functioning Long After Mild Head Injury

  • Lana J. Ozen (a1) and Myra A. Fernandes (a1)


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