This is the only study to our knowledge that has investigated gender differences on self reported symptoms and symptom impact on daily living many years post injury. We found several similarities on self reported symptoms between men and women but also significant differences. These differences can provide information to health care providers for the planning and delivery of care for individuals with a TBI.
Four of the five most reported symptoms were the same for men and women, highlighting similarities in symptoms experienced after TBI. These symptoms include being forgetful, irritability, poor balance, and word finding difficulties. This finding is consistent with previous studies of symptom prevalence [19
]. Poor balance was the third most reported symptom for men and women after TBI which has safety implications, particularly since the main cause of brain injury in older adults is falls [2
]. The diversity of self-reported symptoms reported in the chronic stage of recovery indicates the need for ongoing services to provide programming which includes cognitive, physical, psychosocial components in order to facilitate successful integration into community life.
Significantly more women reported headaches and dizziness than men. This difference is supported by previous studies with TBI survivors [19
] as well as in the general population [30
]. Therefore, the distinction found in our study may not be directly related to the injury, but rather reflect what is found in the general population. Why women comprise a larger proportion of individuals reporting these symptoms is not clear, although there is some evidence of neurophysiological factors [21
Additionally, headaches can be attributed to soft tissue injury of the neck and upper body; women may be more susceptible to trauma of soft tissue during acceleration-deceleration injuries due to higher head to body mass ratio compared to men [33
]. Regardless, headaches and dizziness are associated with difficulty performing daily activities [19
] and vocational tasks [36
]. As such, these symptoms should be a priority for treatment intervention, pharmacological and educational, along the continuum of care.
Men reported hearing/noise difficulties and sleep disturbances as significantly more problematic than women. Several studies have found sensitivity to noise as a prominent sequelae of TBI [20
] and a factor in poor functional outcome [19
]. The meta-analysis by Farace and Alves [6
] found significantly more men than women reported hearing related problems. Noise sensitivity may impact social and vocational involvement and success, known areas of difficulty post TBI [3
]. Clinicians may need to incorporate environmental assessments into discharge and return to work planning to detect possible noise/hearing irritants that could impact effective community integration.
Sleep disturbances are prevalent in both men and women post TBI [41
] and can complicate recovery [44
]. Sleep disturbances are also associated with depression, anxiety, and poor outcome on cognitive measures [44
]. Self-report of sleep disturbances makes it difficult to determine whether the issue relates to the TBI itself or to secondary complications such as depression, stress or pain [48
]. In our study men reported sleep disturbances as significantly more problematic for daily living compared to women. One explanation may be the effect of sleep deprivation on paid work as more men in our study were working outside the home than women. The literature is inconclusive regarding gender differences and subsequent causes of sleep disturbances [41
]. Vigilance to the pervasive impact of sleep disturbances for individuals with TBI is imperative. The complex interrelationship between TBI, cognitive and psychological symptoms and sleep disturbances further supports the need for comprehensive assessment and treatment programs.
Self-report measures such as the one used in this study can capture the socio-medical perspective of health such as social influence on illness and health reporting behaviours, which may account for some of our results [51
]. The fact that significantly more men reported high sex drive than women may be due to social acceptance and willingness to report rather than an organic brain disturbance caused by the injury. In addition, women reported needing supervision as significantly more problematic than men. Again, this may reflect the social pressure of sustaining care-taker and home-maker roles without feeling able to ask for assistance. Additionally, environmental constraints may affect a woman's ability to perform and balance home and community activities, thus the need for assistance [5