Prevalence of Self-Reported Head Injury in the United States

Head Injury and Risk of Incident Ischemic Stroke in Community-Dwelling Adults

BACKGROUND

While stroke is a recognized short-term sequela of traumatic brain injury, evidence about long-term ischemic stroke risk after traumatic brain injury remains limited.

METHODS

The Atherosclerosis Risk in Communities Study is an ongoing prospective cohort comprised of US community-dwelling adults enrolled in 1987 to 1989 followed through 2019. Head injury was defined using self-report and hospital-based diagnostic codes and was analyzed as a time-varying exposure. Incident ischemic stroke events were physician-adjudicated. We used Cox regression adjusted for sociodemographic and cardiovascular risk factors to estimate the hazard of ischemic stroke as a function of head injury. Secondary analyses explored the number and severity of head injuries; the mechanism and severity of incident ischemic stroke; and heterogeneity within subgroups defined by race, sex, and age.

RESULTS

Our analysis included 12 813 participants with no prior head injury or stroke. The median follow-up age was 27.1 years (25th-75th percentile=21.1-30.5). Participants were of median age 54 years (25th-75th percentile=49-59) at baseline; 57.7% were female and 27.8% were Black. There were 2158 (16.8%) participants with at least 1 head injury and 1141 (8.9%) participants with an incident ischemic stroke during follow-up. For those with head injuries, the median age to ischemic stroke was 7.5 years (25th-75th percentile=2.2-14.0). In adjusted models, head injury was associated with an increased hazard of incident ischemic stroke (hazard ratio [HR], 1.34 [95% CI, 1.12-1.60]). We observed evidence of dose-response for the number of head injuries (1: HR, 1.16 [95% CI, 0.97-1.40]; ≥2: HR, 1.94 [95% CI, 1.39-2.71]) but not for injury severity. We observed evidence of stronger associations between head injury and more severe stroke (National Institutes of Health Stroke Scale score ≤5: HR, 1.31 [95% CI, 1.04-1.64]; National Institutes of Health Stroke Scale score 6-10: HR, 1.64 [95% CI, 1.06-2.52]; National Institutes of Health Stroke Scale score ≥11: HR, 1.80 [95% CI, 1.18-2.76]). Results were similar across stroke mechanism and within strata of race, sex, and age.

CONCLUSIONS

In this community-based cohort, head injury was associated with subsequent ischemic stroke. These results suggest the importance of public health interventions aimed at preventing head injuries and primary stroke prevention among individuals with prior traumatic brain injuries.

Cross validation of the response bias scale and the response bias scale-19 in active-duty personnel: use on the MMPI-2-RF and MMPI-3

The Response Bias Scale (RBS) is the central measure of cognitive over-reporting in the MMPI-family of instruments. Relative to other clinical populations, the research evaluating the detection of over-reporting is more limited in Veteran and Active-Duty personnel, which has produced some psychometric variability across studies. Some have suggested that the original scale construction methods resulted in items which negatively impact classification accuracy and in response crafted an abbreviated version of the RBS (RBS-19; Ratcliffe et al., 2022; Spencer et al., 2022). In addition, the most recent edition of the MMPI is based on new normative data, which impacts the ability to use existing literature to determine effective cut-scores for the RBS (despite all items having been retained across MMPI versions). To date, no published research exists for the MMPI-3 RBS. The current study examined the utility of the RBS and the RBS-19 in a sample of Active-Duty personnel (n = 186) referred for neuropsychological evaluation. Using performance validity tests as the study criterion, we found that the RBS-19 was generally equitably to RBS in classification. Correlations with other MMPI-2-RF over- and under-reporting symptom validity tests were slightly stronger for RBS-19. Implications and directions for research and practice with RBS/RBS-19 are discussed, along with implications for neuropsychological assessment and response validity theory.

Associations of Microvascular Injury-Related Biomarkers With Traumatic Brain Injury Severity and Outcomes: A Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) Pilot Study

Traumatic brain injury (TBI) is characterized by heterogeneity in terms of injury severity, mechanism, outcome, and pathophysiology. A single biomarker alone is unlikely to capture the heterogeneity of even one injury subtype, necessitating the use of panels of biomarkers. Herein, we focus on traumatic cerebrovascular injury and investigate associations of a panel of 16 vascular injury-related biomarkers with indices of TBI severity and outcomes using data from 159 participants in the Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) Pilot Study. Associations of individual biomarkers and clusters of biomarkers identified using non-linear principal components analysis with TBI severity and outcomes were assessed using logistic regression models and Spearman's correlations. As individual biomarkers, higher levels of thrombomodulin, angiopoietin (Ang)-2, von Willebrand factor, and P-selectin were associated with more severe injury; higher levels of Ang-1, Tie2, vascular endothelial growth factor (VEGF)-C, and basic fibroblast growth factor (bFGF) were associated with less severe injury (all p < 0.05 in age-adjusted models). After false discovery rate correction for multiple comparisons, higher levels of Ang-2 remained associated with more severe injury and higher levels of Ang-1, Tie2, and bFGF remained associated with less severe injury at a p < 0.05 level. In principal components analysis, principal component (PC)1, comprised of Ang1, bFGF, P-selectin, VEGF-C, VEGF-A, and Tie2, was associated with less severe injury (age-adjusted odds ratio [OR]: 0.63, 95% confidence interval [CI]: 0.44-0.88 for head computer tomography [CT] positive vs. negative) and PC2 (Ang-2, E-selectin, Flt-1, placental growth factor, thrombomodulin, and vascular cell adhesion protein 1) was associated with greater injury severity (age-adjusted OR: 2.29, 95% CI: 1.49-3.69 for Glasgow Coma Scale [GCS] 3-12 vs. 13-15 and age-adjusted OR 1.59, 95% CI: 1.11-2.32 for head CT positive vs. negative). Neither individual biomarkers nor PCs were associated with outcomes in adjusted models (all p > 0.05). In conclusion, in this trauma-center based population of acute TBI patients, biomarkers of microvascular injury were associated with TBI severity.

Traumatic Brain Injury and Long-Term Risk of Stroke Among US Military Veterans

BACKGROUND

Traumatic brain injury (TBI) is associated with significant morbidity, but the association of TBI with long-term stroke risk in diverse populations remains less clear. Our objective was to examine the long-term associations of TBI with stroke and to investigate potential differences by age, sex, race and ethnicity, and time since TBI diagnosis.

METHODS

Retrospective cohort study of US military veterans aged 18+ years receiving healthcare in the Veterans Health Administration system between October 1, 2002 and September 30, 2019. Veterans with TBI were matched 1:1 to veterans without TBI on age, sex, race and ethnicity, and index date, yielding 306 796 veterans with TBI and 306 796 veterans without TBI included in the study. In primary analyses, Fine-Gray proportional hazards models adjusted for sociodemographics and medical/psychiatric comorbidities were used to estimate the association between TBI and stroke risk, accounting for the competing risk of mortality.

RESULTS

Participants were a mean age of 50 years, 9% were female, and 25% were of non-White race and ethnicity. Overall, 4.7% of veterans developed a stroke over a median follow-up of 5.2 years. Veterans with TBI had 1.69 times (95% CI, 1.64-1.73) increased risk of any stroke (ischemic or hemorrhagic) compared to veterans without TBI. This increased risk was highest in the first-year post-TBI diagnosis (hazard ratio [HR], 2.16 [95% CI, 2.03-2.29]) but remained elevated for 10+ years. Similar patterns were observed for secondary outcomes, with associations of TBI with hemorrhagic stroke (HR, 3.92 [95% CI, 3.59-4.29]) being stronger than with ischemic stroke (HR, 1.56 [95% CI, 1.52-1.61]). Veterans with both mild (HR, 1.47 [95% CI, 1.43-1.52]) and moderate/severe/penetrating injury (HR, 2.02 [95% CI, 1.96-2.09]) had increased risk of stroke compared to veterans without TBI. Associations of TBI with stroke were stronger among older compared to younger individuals (P interaction-by-age<0.001) and were weaker among Black veterans compared to other race and ethnicities (P interaction-by-race<0.001).

CONCLUSIONS

Veterans with prior TBI are at increased long-term risk for stroke, suggesting they may be an important population to target for primary stroke prevention measures.

Head Trauma in Refugees and Asylum Seekers: A Systematic Review

BACKGROUND AND OBJECTIVES

Refugees and asylum seekers are at risk of head trauma. They endure blows to the head due to exigent circumstances necessitating resettlement (e.g., torture, war, interpersonal violence) and during their dangerous journeys to refuge. Our objective was to assess the global prevalence of head trauma in refugees and asylum seekers and describe its clinical characteristics in this population.

METHODS

The protocol was registered in the PROSPERO International Prospective Register of Systematic Reviews (CRD42020173534). PubMed/MEDLINE, PsycInfo, Web of Science, Embase, and Google Scholar databases were searched for relevant studies. We included all studies in English that comprised refugees or asylum seekers of any age and examined the prevalence or characteristics of head trauma. We excluded studies that were not peer-reviewed original research. Information was recorded on the prevalence of head trauma, method of ascertaining head trauma, severity, mechanism of injury, other trauma exposures, and comorbidities. Descriptive analyses and narrative syntheses were performed.

RESULTS

A total of 22 studies were included, of which 13 with 6,038 refugees and asylum seekers reported head trauma prevalence. Prevalence estimates ranged from 9% to 78%. Heterogeneity among studies precluded meta-analysis. Most studies were US based (n = 9, 41%), followed by the Middle East (n = 5, 23%). Most refugees or asylum seekers were from the Middle East (n = 9, 41%), with those from Latin America least represented (n = 3, 14%). Studies disproportionately involved younger (pooled mean age = 29 years) adult samples composed of men. Recruitment settings were predominantly hospitals/clinics (n = 14, 64%), followed by refugee camps (n = 3, 14%). The most common mechanism of injury was direct impact through a beating or blow to the head. Studies varied greatly in how head trauma was defined and ascertained; no study used a validated traumatic brain injury (TBI)-specific screening tool. Similarly, TBI severity was not uniformly assessed, although hospital-based samples captured more moderate-to-severe head injuries. Mental health comorbidities were more frequently documented rather than physical health ones. Only 2 studies included a comparison with local populations.

DISCUSSION

Refugees and asylum seekers are vulnerable to head trauma, but studies using systematic approaches to screening are lacking. Increased attention to head trauma in displaced populations will allow for optimizing equitable care for this growing vulnerable population.

Associations of Preexisting Vascular Risk Factors With Outcomes After Traumatic Brain Injury: A TRACK-TBI Study

OBJECTIVE

To evaluate associations of preinjury vascular risk factors with traumatic brain injury (TBI) outcomes.

SETTING

The level 1 trauma center-based T ransforming R esearch a nd C linical K nowledge in TBI (TRACK-TBI) Study.

PARTICIPANTS

A total of 2361 acute TBI patients 18 years or older who presented to the emergency department within 24 hours of head trauma warranting clinical evaluation with a noncontrast head CT between February 26, 2014, and August 8, 2018.

DESIGN

A multicenter prospective cohort study.

MAIN MEASURES

Vascular risk factors (hypertension, diabetes, hyperlipidemia, and smoking) were assessed at baseline by self- or proxy-report and chart review. The primary outcome was the 6-month Glasgow Outcome Scale-Extended TBI version (GOSE-TBI). Secondary 6-month outcomes included the Rivermead Post-Concussion Symptoms Questionnaire (RPQ), the Satisfaction with Life Scale (SWLS), and the 18-item Brief Symptom Inventory Global Severity Index (BSI-18-GSI).

RESULTS

Mean age of participants was 42 years, 31% were women, and 16% were Black. Current smoking was the most common vascular risk factor (29%), followed by hypertension (17%), diabetes (8%), and hyperlipidemia (6%). Smoking was the only risk factor associated with worse scores on all 4 outcome indices. Hypertension and diabetes were associated with worse RPQ scores, and hypertension was associated with worse BSI-18-GSI scores (all P < .05). Compared with individuals with no vascular risk factors, individuals with 1 but not 2 or more vascular risk factors had significantly worse GOSE-TBI and SWLS scores, while a higher burden of vascular risk factors was significantly associated with worse RPQ and BSI-18-GSI scores.

CONCLUSION

Our study found that preinjury vascular risk factors, especially smoking, are associated with worse outcomes after TBI. Aggressive postinjury treatment of vascular risk factors may be a promising strategy to improve TBI outcomes.

Head Injury and Long-term Mortality Risk in Community-Dwelling Adults

Importance

Head injury is associated with significant short-term morbidity and mortality. Research regarding the implications of head injury for long-term survival in community-dwelling adults remains limited.

Objective

To evaluate the association of head injury with long-term all-cause mortality risk among community-dwelling adults, with consideration of head injury frequency and severity.

Design, Setting, and Participants

This cohort study included participants with and without head injury in the Atherosclerosis Risk in Communities (ARIC) study, an ongoing prospective cohort study with follow-up from 1987 through 2019 in 4 US communities in Minnesota, Maryland, North Carolina, and Mississippi. Of 15 792 ARIC participants initially enrolled, 1957 were ineligible due to self-reported head injury at baseline; 103 participants not of Black or White race and Black participants at the Minnesota and Maryland field centers were excluded due to race-site aliasing; and an additional 695 participants with missing head injury date or covariate data were excluded, resulting in 13 037 eligible participants.

Exposures

Head injury frequency and severity, as defined via self-report in response to interview questions and via hospital-based International Classification of Diseases diagnostic codes (with head injury severity defined in the subset of head injury cases identified using these codes). Head injury was analyzed as a time-varying exposure.

Main Outcomes and Measures

All-cause mortality was ascertained via linkage to the National Death Index. Data were analyzed between August 5, 2021, and October 23, 2022.

Results

More than one-half of participants were female (57.7%; 42.3% men), 27.9% were Black (72.1% White), and the median age at baseline was 54 years (IQR, 49-59 years). Median follow-up time was 27.0 years (IQR, 17.6-30.5 years). Head injuries occurred among 2402 participants (18.4%), most of which were classified as mild. The hazard ratio (HR) for all-cause mortality among individuals with head injury was 1.99 (95% CI, 1.88-2.11) compared with those with no head injury, with evidence of a dose-dependent association with head injury frequency (1 head injury: HR, 1.66 [95% CI, 1.56-1.77]; 2 or more head injuries: HR, 2.11 [95% CI, 1.89-2.37]) and severity (mild: HR, 2.16 [95% CI, 2.01-2.31]; moderate, severe, or penetrating: HR, 2.87 [95% CI, 2.55-3.22]). Estimates were similar by sex and race, with attenuated associations among individuals aged 54 years or older at baseline.

Conclusions and Relevance

In this community-based cohort with more than 3 decades of longitudinal follow-up, head injury was associated with decreased long-term survival time in a dose-dependent manner, underscoring the importance of measures aimed at prevention and clinical interventions to reduce morbidity and mortality due to head injury.

Aging-Associated Thyroid Dysfunction Contributes to Oxidative Stress and Worsened Functional Outcomes Following Traumatic Brain Injury

The incidence of traumatic brain injury (TBI) increases dramatically with advanced age and accumulating evidence indicates that age is one of the important predictors of an unfavorable prognosis after brain trauma. Unfortunately, thus far, evidence-based effective therapeutics for geriatric TBI is limited. By using middle-aged animals, we first confirm that there is an age-related change in TBI susceptibility manifested by increased inflammatory events, neuronal death and impaired functional outcomes in motor and cognitive behaviors. Since thyroid hormones function as endogenous regulators of oxidative stress, we postulate that age-related thyroid dysfunction could be a crucial pathology in the increased TBI severity. By surgically removing the thyroid glands, which recapitulates the age-related increase in TBI-susceptible phenotypes, we provide direct evidence showing that endogenous thyroid hormone-dependent compensatory regulation of antioxidant events modulates individual TBI susceptibility, which is abolished in aged or thyroidectomized individuals. The antioxidant capacity of melatonin is well-known, and we found acute melatonin treatment but not liothyronine (T3) supplementation improved the TBI-susceptible phenotypes of oxidative stress, excitotoxic neuronal loss and promotes functional recovery in the aged individuals with thyroid dysfunction. Our study suggests that monitoring thyroid function and acute administration of melatonin could be feasible therapeutics in the management of geriatric-TBI in clinic.

Evaluating Personality Assessment Inventory Response Patterns in Active-Duty Personnel With Head Injury Using a Latent Class Approach

OBJECTIVE

Previous research has found that among those with brain injury, individuals have a variety of different potential symptom sets, which will be seen on the Personality Assessment Inventory (PAI). The number of different groups and what they measure have varied depending on the study.

METHOD

In active-duty personnel with a remote history of mild traumatic brain injury (n = 384) who were evaluated at a neuropsychology clinic, we used a retrospective database to examine if there are different groups of individuals who have distinct sets of symptoms as measured on the PAI. We examined the potential of distinct groups of respondents by conducting a latent class analysis of the clinical scales. Post hoc testing of group structures was conducted on concurrently administered cognitive testing, performance validity tests, and the PAI subscales.

RESULTS

Findings indicate a pattern of broad symptom severity as the most probable reason for multiple groups of respondents, suggesting that there are no distinct symptom sets observed within this population. Pathology levels were the most elevated on internalizing and thought disorder scales across the various class solutions.

CONCLUSION

Findings indicate that among active-duty service members with remote brain injury, there are no distinct groups of respondents with different sets of symptom types as has been found in prior work with other neuropsychology samples. We conclude that the groups found are likely a function of general psychopathology present in the population/sample rather than bona fide differences.

Defining Acute Traumatic Encephalopathy: Methods of the "HEAD Injury Serum Markers and Multi-Modalities for Assessing Response to Trauma" (HeadSMART II) Study

Despite an estimated 2.8 million annual ED visits, traumatic brain injury (TBI) is a syndromic diagnosis largely based on report of loss of consciousness, post-traumatic amnesia, and/or confusion, without readily available objective diagnostic tests at the time of presentation, nor an ability to identify a patient's prognosis at the time of injury. The recognition that “mild” forms of TBI and even sub-clinical impacts can result in persistent neuropsychiatric consequences, particularly when repetitive, highlights the need for objective assessments that can complement the clinical diagnosis and provide prognostic information about long-term outcomes. Biomarkers and neurocognitive testing can identify brain injured patients and those likely to have post-concussive symptoms, regardless of imaging testing results, thus providing a physiologic basis for a diagnosis of acute traumatic encephalopathy (ATE). The goal of the HeadSMART II (HEAD injury Serum markers and Multi-modalities for Assessing Response to Trauma) clinical study is to develop an in-vitro diagnostic test for ATE. The BRAINBox TBI Test will be developed in the current clinical study to serve as an aid in evaluation of patients with ATE by incorporating blood protein biomarkers, clinical assessments, and tools to measure, identify, and define associated pathologic evidence and neurocognitive impairments. This protocol proposes to collect data on TBI subjects by a multi-modality approach that includes serum biomarkers, clinical assessments, neurocognitive performance, and neuropsychological characteristics, to determine the accuracy of the BRAINBox TBI test as an aid to the diagnosis of ATE, defined herein, and to objectively determine a patient's risk of developing post-concussive symptoms.

The prevalence, characteristics, and psychiatric correlates of traumatic brain injury in incarcerated individuals: an examination in two independent samples

PRIMARY OBJECTIVE

Identify the prevalence, characteristics, and psychological correlates of traumatic brain injury (TBI) among incarcerated individuals.

RESEARCH DESIGN

Three aims: (1) Determine the prevalence and characteristics of TBI in 1469 adults incarcerated in Wisconsin state prisons (1064 men, 405 women); (2) Characterize the relationship between mild TBI and mental illness in a sub-sample of men and women; (3) Reproduce the findings from Aim 1 and Aim 2 in an independent sample of 1015 adults incarcerated in New Mexico state prisons (600 men, 415 women).

METHODS AND PROCEDURES

Standardized TBI assessment with structured clinical interviews and self-report questionnaires.

MAIN OUTCOMES AND RESULTS

Rates of TBI were approximately five times greater than the general population, with a substantially higher rate of TBI caused by assault. In the Wisconsin sample, mild TBI was associated with greater levels of post-traumatic stress disorder (PTSD) among women (but not among men). In the New Mexico sample, TBI of any severity was associated with greater levels of major depressive disorder (MDD) among women (but not among men).

CONCLUSIONS

This study thus provides novel data on TBI and its correlates among individuals incarcerated in state prisons, and highlights a specific treatment need within the prison population.

Traumatic Brain Injury and Risk of Dementia and Alzheimer's Disease: A Systematic Review and Meta-Analysis

INTRODUCTION

Previous studies have investigated the potential role of traumatic brain injury (TBI) in subsequent development of dementia and Alzheimer's disease (AD) but reported inconsistent results. We aim to determine the association between TBI and subsequent occurrence of dementia and AD.

METHODS

We performed a systematic search in PubMed and Web of Science for studies that quantitatively investigated the association between TBI and risk of dementia and AD and were published on or before September 21, 2021. A random-effect model was used to combine the estimates.

RESULTS

Twenty-five eligible articles were included in this meta-analysis. The results suggested that TBI was associated with an increased risk of dementia (pooled odds ratio [OR] = 1.81, 95% confidence interval [CI] = 1.53 - 2.14). However, no association was observed between TBI and Alzheimer's disease (pooled OR = 1.02, 95% CI = 0.91 - 1.15). In the subgroup analysis, TBI with loss of consciousness was not associated with risk of dementia (pooled OR = 0.96, 95% CI = 0.84 - 1.09). Besides, Asian ethnicity, male gender, and mean age of the participants less than 65 were associated with a higher risk of dementia.

CONCLUSION

Our study suggests an increased risk of dementia among individuals with TBI, highlighting the need for more intensive medical monitoring and health education in individuals with TBI. Biological mechanisms linking TBI and the development of dementia are needed in future studies.

Head injury and 25-year risk of dementia

INTRODUCTION

Head injury is associated with significant morbidity and mortality. Long-term associations of head injury with dementia in community-based populations are less clear.

METHODS

Prospective cohort study of 14,376 participants (mean age 54 years at baseline, 56% female, 27% Black, 24% with head injury) enrolled in the Atherosclerosis Risk in Communities (ARIC) Study. Head injury was defined using self-report and International Classification of Diseases, Ninth/Tenth Revision (ICD-9/10) codes. Dementia was defined using cognitive assessments, informant interviews, and ICD-9/10 and death certificate codes.

RESULTS

Head injury was associated with risk of dementia (hazard ratio [HR] = 1.44, 95% confidence interval [CI] = 1.3-1.57), with evidence of dose-response (1 head injury: HR = 1.25, 95% CI = 1.13-1.39, 2+ head injuries: HR = 2.14, 95% CI = 1.86-2.46). There was evidence for stronger associations among female participants (HR = 1.69, 95% CI = 1.51-1.90) versus male participants (HR = 1.15, 95% CI = 1.00-1.32), P-for-interaction < .001, and among White participants (HR = 1.55, 95% CI = 1.40-1.72) versus Black participants (HR = 1.22, 95% CI = 1.02-1.45), P-for-interaction = .008.

DISCUSSION

In this community-based cohort with 25-year follow-up, head injury was associated with increased dementia risk in a dose-dependent manner, with stronger associations among female participants and White participants.

Prevalence of Disability Associated With Head Injury With Loss of Consciousness in Adults in the United States: A Population-Based Study

OBJECTIVE

To provide nationally representative prevalence estimates of disability associated with prior head injury with loss of consciousness in the United States and to examine associations between prior head injury and disability.

METHODS

This was a cross-sectional analysis of 7,390 participants ≥40 years of age in the 2011-2014 National Health and Nutrition Examination Surveys (NHANES). Head injury with loss of consciousness was assessed by self-report. Domains of disability were assessed with a standardized structured questionnaire and measured grip strength. Logistic and linear regression models adjusted for demographic, socioeconomic/behavioral, and medical comorbidity variables were used. Multiple imputation was used to account for missing covariate data.

RESULTS

Mean age of participants was 58 years; 53% were female; 71% were non-Hispanic White; and 16% had a history of head injury with loss of consciousness. Overall, participants with a history of head injury had higher prevalence of disability in at least 1 domain of functioning compared to individuals without head injury (47.4% vs 38.6%, p < 0.001), with the highest prevalence of disability in the domains of mobility and work productivity. In fully adjusted models, head injury was significantly positively associated with disability in all domains assessed on the standardized questionnaire (all p < 0.05). Participants with head injury had greater grip strength (all p < 0.05).

CONCLUSIONS

We found that 47.4% of individuals ≥40 years of age in the United States with a history of head injury are living with disability in at least 1 domain of functioning, corresponding to 11.4 million affected individuals. This significant burden of disability suggests that efforts are needed to improve functioning among individuals with head injury.

Mental Health Service Utilization among Adults with Head Injury with Loss of Consciousness: Implications for Social Work

The purpose of this study was to identify factors associated with mental health service utilization among adults with head injury with loss of consciousness (LOC) using Andersen's model of health. This secondary data analysis used the 2011-2014 National Health and Nutrition Examination Survey with data collected from 7,399 adults. Binary logistic regression was conducted to determine odds associated with predisposing, enabling, and needs factors on head injury with LOC and mental health service utilization. A total of  948 (12.8 percent) adults 40 years and older self-reported head injury with LOC. Head injury with LOC was higher among men and people with lower income, illicit drug use history, and moderate to severe depression. Mental health service utilization for people with head injury with LOC was lower among older-age adults and those with no health insurance. However, utilization was higher among adults with military service, history of drug use, and moderate to severe depression. Social workers in health care settings play critical roles serving adults with traumatic brain injury (TBI) through mental health and substance use disorder treatment and bridging gaps in service access. Social workers should recognize the complex needs of clients with TBI and factors affecting mental health service use.

Traumatic brain injury and forensic evaluations: Three case studies of U.S. asylum-seekers

Traumatic brain injuries are common among refugees and asylum-seekers and can result from a range of etiologies, including intimate partner violence, gang violence, war-related trauma, and torture. Regardless of the cause, these injuries often result in a host of neuropsychiatric and other symptoms that may complicate individuals' subsequent health outcomes. For asylum-seekers, documenting prior head trauma is essential to the legal process, since traumatic brain injuries and their subsequent effects on memory and cognition may affect the ability to provide thorough testimony. Using three case vignettes, we explore how to approach the forensic evaluation of asylum-seekers with a history of traumatic brain injury, illustrating the range of etiologies and sequelae of traumatic brain injury in this complex population.

A brief report of the prevalence of chronic and acute health conditions among blind American adults

BACKGROUND

Prior research demonstrates disparities in the prevalence of certain chronic and acute health conditions among persons who are blind (PWB) compared to non-blind persons, such as diabetes and infectious diseases. However, a comprehensive understanding of the prevalence of chronic and acute health conditions among PWB is currently lacking.

OBJECTIVE

The present study addressed this gap by examining the prevalence of chronic and acute conditions among blind persons, and examining differences by gender.

METHODS

The present study surveyed 410 PWB residing in the U.S. about their health conditions and activities. Lifetime prevalence for eight chronic and six acute health conditions were estimated separately for men and women. Engagement in physical activity, regular use of medication, and satisfaction with health were also estimated.

RESULTS

We found that men more often reported their health conditions interfered with daily activities compared to women, as well as higher prevalence of stroke and arthritis compared to women.

CONCLUSION

The current study contributes information that is vital to understanding the burden of specific health conditions on this population and necessary to understand the extent to which this burden disproportionately affects PWB.