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Financial Incentives Influence Recovery after Mild Head Trauma

Psychiatrists often see patients who claim to have cognitive and emotional dysfunction following head injury, some of whom may have financial incentives for making disability or insurance claims. This meta-analysis evaluated the importance of financial incentives on the persistence of symptoms and disability after closed-head injury.

Researchers reviewed 17 reports on closed-head injuries, involving 18 study groups. The studies reported financial incentives, neuropsychological test results, symptoms, and problems rated by relatives or clinicians. Of 2353 subjects, about 30% received compensation.

The weighted average effect size of 0.47 suggested an overall association between financial incentives and symptoms. However, symptoms were less likely to have an organic basis in patients with financial incentives; patients with incentives were more likely to have late-onset symptoms and short post-traumatic amnesia (which are less likely to be organically-based than early-onset symptoms or longer-lasting amnesia). When researchers rated severity of brain injury from neurologic data, they found that patients who received compensation were more likely to have mild injuries than moderate or severe ones.

Comment: Although frank malingering is thought to be rare, this study found that patients with less severe injuries were more likely to seek monetary compensation, and patients with financial incentives were less likely to have an organic basis for their symptoms. The authors estimate that the elimination of financial incentives would reduce symptoms of disability by 23%. Since mild closed-head injury usually has a good outcome, clinicians should pay particular attention to the motivations of patients who persistently complain after such injury.

— J Yager

Published in Journal Watch Psychiatry March 1, 1996

Citation(s):

Binder LM; Rohling ML. Money matters: a meta-analytic review of the effects of financial incentives on recovery after closed-head injury. Am J Psychiatry 1996 Jan 153 7-10.

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