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Li LM, Carson A, Dams-O'Connor K. Psychiatric sequelae of traumatic brain injury - future directions in research. Nat Rev Neurol 2023; 19:556-571. [PMID: 37591931 DOI: 10.1038/s41582-023-00853-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2023] [Indexed: 08/19/2023]
Abstract
Despite growing appreciation that traumatic brain injury (TBI) is an important public health burden, our understanding of the psychiatric and behavioural consequences of TBI remains limited. These changes are particularly detrimental to a person's sense of self, their relationships and their participation in the wider community, and they continue to have devastating individual and cumulative effects long after TBI. This Review relates specifically to TBIs that confer objective clinical or biomarker evidence of structural brain injury; symptomatic head injuries without such evidence are outside the scope of this article. Common psychiatric, affective and behavioural sequelae of TBI and their proposed underlying mechanisms are outlined, along with a brief overview of current treatments. Suggestions for how scientists and clinicians can work together in the future to address the chasms in clinical care and knowledge are discussed in depth.
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Affiliation(s)
- Lucia M Li
- Department of Brain Sciences, Imperial College London, London, UK.
| | - Alan Carson
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Kristen Dams-O'Connor
- Brain Injury Research Center, Department of Rehabilitation and Human Performance, Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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2
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Fisher LB, Curtiss JE, Klyce DW, Perrin PB, Juengst SB, Gary KW, Niemeier JP, Hammond FM, Bergquist TF, Wagner AK, Rabinowitz AR, Giacino JT, Zafonte RD. Using Machine Learning to Examine Suicidal Ideation After Traumatic Brain Injury: A Traumatic Brain Injury Model Systems National Database Study. Am J Phys Med Rehabil 2023; 102:137-143. [PMID: 35687765 PMCID: PMC9729434 DOI: 10.1097/phm.0000000000002054] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The aim of the study was to predict suicidal ideation 1 yr after moderate to severe traumatic brain injury. DESIGN This study used a cross-sectional design with data collected through the prospective, longitudinal Traumatic Brain Injury Model Systems network at hospitalization and 1 yr after injury. Participants who completed the Patient Health Questionnaire-9 suicide item at year 1 follow-up ( N = 4328) were included. RESULTS A gradient boosting machine algorithm demonstrated the best performance in predicting suicidal ideation 1 yr after traumatic brain injury. Predictors were Patient Health Questionnaire-9 items (except suicidality), Generalized Anxiety Disorder-7 items, and a measure of heavy drinking. Results of the 10-fold cross-validation gradient boosting machine analysis indicated excellent classification performance with an area under the curve of 0.882. Sensitivity was 0.85 and specificity was 0.77. Accuracy was 0.78 (95% confidence interval, 0.77-0.79). Feature importance analyses revealed that depressed mood and guilt were the most important predictors of suicidal ideation, followed by anhedonia, concentration difficulties, and psychomotor disturbance. CONCLUSIONS Overall, depression symptoms were most predictive of suicidal ideation. Despite the limited clinical impact of the present findings, machine learning has potential to improve prediction of suicidal behavior, leveraging electronic health record data, to identify individuals at greatest risk, thereby facilitating intervention and optimization of long-term outcomes after traumatic brain injury.
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Affiliation(s)
- Lauren B. Fisher
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA; Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Joshua E. Curtiss
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA; Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Daniel W. Klyce
- Central Virginia Veterans Affairs Health Care System, Richmond, VA; Sheltering Arms Institute, Richmond, VA; Virginia Commonwealth University Health System, Richmond, VA
| | - Paul B. Perrin
- Central Virginia Veterans Affairs Health Care System, Richmond, VA; Department of Psychology and Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA
| | - Shannon B. Juengst
- Department of Physical Medicine and Rehabilitation, UT Southwestern Medical Center, Dallas, TX
| | - Kelli W. Gary
- Department of Rehabilitation Counseling, Virginia Commonwealth University, Richmond, VA
| | | | - Flora McConnell Hammond
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, IN; Rehabilitation Hospital of Indiana, Indianapolis, IN
| | | | - Amy K. Wagner
- Departments of Physical Medicine & Rehabilitation and Neuroscience, Center for Neuroscience, Safar Center for Resuscitation Research, Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh PA
| | | | - Joseph T. Giacino
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Ross D. Zafonte
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA; Massachusetts General Hospital, Boston, MA; Brigham and Women’s Hospital, Boston, MA; Harvard Medical School, Boston, MA
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McKee GB, Perrin PB, Rodriguez-Agudelo Y, Plaza SLO, Quijano-Martinez MC, Kuzu D, Ohayagha C, Pugh M, Arango-Lasprilla JC. Suicidal ideation after acute traumatic brain injury: A longitudinal actor-partner interdependence model of patients and caregivers in Latin America. Rehabil Psychol 2021; 66:433-441. [PMID: 34871029 DOI: 10.1037/rep0000395] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
PURPOSE/OBJECTIVE Traumatic brain injury (TBI) is associated with depression, anxiety, and even suicidality in individuals with TBI and in caregivers. Moreover, emotional functioning in individuals with TBI is linked with caregiver functioning. However, no known studies to date have examined linkages in suicidal ideation in individuals with TBI and family caregivers. This is especially important in Latin America, where TBI rates are high, and where cultural norms influence family caregiving. This study examined associations among self-reported suicidal ideation in individuals with TBI and their primary caregivers over time in Mexico and Colombia. Research Method/Design: A total of 109 individuals and their primary caregivers completed measures during hospitalization for TBI and at 2- and 4-months posthospitalization. The primary outcome was Item 9 from the Spanish version of the Patient Health Questionnaire-9, assessing for thoughts of death or suicide in the previous 2 weeks. RESULTS Patients and caregivers reported high levels of suicidal ideation (18.3%-22.4% and 12.4%-15.7%, respectively) at each time point, and suicidal ideation at one time point strongly predicted ideation at the next. When patients endorsed suicidal ideation in the hospital, their caregivers tended to endorse suicidal ideation 2 months later. Although unaccounted for variables could be driving these relationships, they may also provide possible evidence of causal preponderance between patient and caregiver suicidal ideation post-TBI. CONCLUSIONS/IMPLICATIONS Clinicians and rehabilitation specialists can use these findings to inform suicide risk assessment by expanding these practices to caregivers of patients who endorsed suicidal ideation. Interventions after TBI should incorporate caregivers given this study showed significant interdependence of suicidality between patients and caregivers. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Grace B McKee
- Advanced Fellowship Program in Mental Illness Research and Treatment
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4
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McIntire KL, Crawford KM, Perrin PB, Sestak JL, Aman K, Walter LA, Page DB, Wen H, Randolph BO, Brunner RC, Novack TL, Niemeier JP. Factors Increasing Risk of Suicide after Traumatic Brain Injury: A State-of-the-Science Review of Military and Civilian Studies. Brain Inj 2021; 35:151-163. [PMID: 33460350 DOI: 10.1080/02699052.2020.1861656] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Primary Objective: Survey TBI literature to identify evidence of risk for post-injury suicide.Literature Selection: Search terms ((traumatic brain injury OR TBI) AND (suicidality OR suicidal behaviour OR suicidal ideation)) entered in PubMed, OVID Medline, PsychInfo, and Web of Science for papers published in print 01/01/1997 to 06/30/2019.Analysis of Literature: Authors screened abstracts, excluding duplicates and articles not meeting inclusion/exclusion criteria. Full papers were reviewed to make final exclusions. Data were extracted from 40 papers included co- and premorbid disorders, demographics, injury-related and psychological factors.Results: Persons with TBI have a higher risk for suicide than the general population. Reviewed articles reported comorbid depression and/or PTSD as risk factors for post-TBI suicide. Co- or premorbid substance misuse, sex, and sleep disturbance moderate risk. Quality of the literature was limited by sample size, the predominance of male participants, and inconsistency in reporting of findings.Conclusions: Comorbid depression and PTSD are significant post-TBI risk factors for suicide. Several variables combine to moderate or mediate TBI's connection with suicide. Civilian and military clinician cross-talk and consistent reporting of results from reproducible studies of post-TBI suicide risk factors could improve prevention and treatment efforts in veterans and civilians.
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Affiliation(s)
- Kayla L McIntire
- Department of Physical Medicine and Rehabilitation, University of Alabama, Birmingham, Alabama, USA
| | - Kelly M Crawford
- Department of Physical Medicine and Rehabilitation, Carolinas Medical Center (Atrium Health System), Charlotte, North Carolina, USA
| | - Paul B Perrin
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Jordan L Sestak
- Department of Physical Medicine and Rehabilitation, Carolinas Medical Center (Atrium Health System), Charlotte, North Carolina, USA
| | - Kyle Aman
- Department of Physical Medicine and Rehabilitation, Emory University, Atlanta, Georgia, USA
| | - Lauren A Walter
- Department of Physical Medicine and Rehabilitation, University of Alabama, Birmingham, Alabama, USA
| | - David B Page
- Department of Physical Medicine and Rehabilitation, University of Alabama, Birmingham, Alabama, USA
| | - Huacong Wen
- Department of Physical Medicine and Rehabilitation, University of Alabama, Birmingham, Alabama, USA
| | - Brittney O Randolph
- Department of Physical Medicine and Rehabilitation, University of Alabama, Birmingham, Alabama, USA
| | - Robert C Brunner
- Department of Physical Medicine and Rehabilitation, University of Alabama, Birmingham, Alabama, USA
| | - Tom L Novack
- Department of Physical Therapy, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Janet P Niemeier
- Department of Physical Medicine and Rehabilitation, University of Alabama, Birmingham, Alabama, USA
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Shin MK, Vázquez-Rosa E, Cintrón-Pérez CJ, Riegel WA, Harper MM, Ritzel D, Pieper AA. Characterization of the Jet-Flow Overpressure Model of Traumatic Brain Injury in Mice. Neurotrauma Rep 2021; 2:1-13. [PMID: 33748810 PMCID: PMC7962691 DOI: 10.1089/neur.2020.0020] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The jet-flow overpressure chamber (OPC) has been previously reported as a model of blast-mediated traumatic brain injury (bTBI). However, rigorous characterization of the features of this injury apparatus shows that it fails to recapitulate exposure to an isolated blast wave. Through combined experimental and computational modeling analysis of gas-dynamic flow conditions, we show here that the jet-flow OPC produces a collimated high-speed jet flow with extreme dynamic pressure that delivers a severe compressive impulse. Variable rupture dynamics of the diaphragm through which the jet flow originates also generate a weak and infrequent shock front. In addition, there is a component of acceleration-deceleration injury to the head as it is agitated in the headrest. Although not a faithful model of free-field blast exposure, the jet-flow OPC produces a complex multi-modal model of TBI that can be useful in laboratory investigation of putative TBI therapies and fundamental neurophysiological processes after brain injury.
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Affiliation(s)
- Min-Kyoo Shin
- Harrington Discovery Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.,Department of Psychiatry and Department of Neuroscience, Case Western Reserve University, Cleveland, Ohio, USA.,Geriatric Research Education and Clinical Centers, Louis Stokes Cleveland VAMC, Cleveland, Ohio, USA
| | - Edwin Vázquez-Rosa
- Harrington Discovery Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.,Department of Psychiatry and Department of Neuroscience, Case Western Reserve University, Cleveland, Ohio, USA.,Geriatric Research Education and Clinical Centers, Louis Stokes Cleveland VAMC, Cleveland, Ohio, USA
| | - Coral J Cintrón-Pérez
- Harrington Discovery Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.,Department of Psychiatry and Department of Neuroscience, Case Western Reserve University, Cleveland, Ohio, USA.,Geriatric Research Education and Clinical Centers, Louis Stokes Cleveland VAMC, Cleveland, Ohio, USA
| | - William A Riegel
- Stumptown Research and Development, LLC, Black Mountain, North Carolina, USA
| | - Matthew M Harper
- Center for the Prevention and Treatment of Visual Loss, Veterans Affairs Medical Center, Iowa City, Iowa, USA.,Departments of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, USA
| | - David Ritzel
- Dyn-FX Consulting, Ltd., Amherstburg, Ontario, Canada
| | - Andrew A Pieper
- Harrington Discovery Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.,Department of Psychiatry and Department of Neuroscience, Case Western Reserve University, Cleveland, Ohio, USA.,Geriatric Research Education and Clinical Centers, Louis Stokes Cleveland VAMC, Cleveland, Ohio, USA
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Yurgil KA, Barkauskas DA, Baker DG. Deployment and Psychological Correlates of Suicide Ideation: A Prospective, Longitudinal Study of Risk and Resilience Among Combat Veterans. Mil Med 2020; 186:e58-e66. [PMID: 33201239 DOI: 10.1093/milmed/usaa450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/01/2020] [Accepted: 10/13/2020] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Suicide rates among military personnel have risen in part due to war zone deployments. Yet, the degree to which deployment-related stressors, in combination with preexisting and co-occurring psychiatric symptoms and individual resilience factors, contribute to suicide ideation (SI) remains unclear. The current study leverages prospective, longitudinal data to examine both risk and protective factors associated with SI in deployed service members. MATERIALS AND METHODS Participants were 1,805 active duty enlisted Marines and Navy service members assessed before and after a 7-month deployment for SI, preexisting and concurrent symptoms of depression, post-traumatic stress disorder (PTSD), alcohol consumption, as well as prior and deployment-related traumatic brain injury (TBI). Current self-reported psychological resilience and social support were analyzed as potential protective factors. RESULTS Rates of SI were 7.3% and 3.9% before and after deployment, respectively. Of those with post-deployment SI, 68.6% were new-onset cases. Multivariate regression revealed that concurrent mild depression was the strongest risk factor (odds ratio [OR] = 10.03, 95% CI 5.28-19.07). Other significant risk factors included prior SI (OR = 3.36, 95% CI 1.60-7.05), prior subthreshold PTSD (OR = 2.10, 95% CI 1.10-3.99), and deployment TBI (OR = 1.84, 95% CI 1.03-3.28). Controlling for clinical symptoms and TBI, the risk of SI was reduced for those with moderate (OR = 0.50, 95% CI 0.27-0.93) and high psychological resilience scores (OR = 0.25, 95% CI 0.08-0.79) after deployment. CONCLUSIONS Results indicate that even mild symptoms of depression and PTSD may increase the risk of SI. Screening for subthreshold clinical symptoms and TBI while incorporating psychological resilience training would allow for a more multidimensional approach to suicide risk assessment.
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Affiliation(s)
- Kate A Yurgil
- Department of Psychological Sciences, Loyola University New Orleans, New Orleans, LA 70118, USA.,Department of Psychiatry, VA San Diego Healthcare System, San Diego, CA 92161, USA.,Center of Excellence for Stress and Mental Health, San Diego, CA 92161, USA
| | - Donald A Barkauskas
- Department of Preventative Medicine, Keck School of Medicine University of Southern California, Los Angeles, CA 90032, USA
| | - Dewleen G Baker
- Department of Psychiatry, VA San Diego Healthcare System, San Diego, CA 92161, USA.,Center of Excellence for Stress and Mental Health, San Diego, CA 92161, USA.,Department of Psychiatry, University of California San Diego School of Medicine, La Jolla, CA 92093, USA
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Trexler LE, Corrigan JD, Davé S, Hammond FM. Recommendations for Prescribing Opioids for People With Traumatic Brain Injury. Arch Phys Med Rehabil 2020; 101:2033-2040. [PMID: 32771395 DOI: 10.1016/j.apmr.2020.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 07/06/2020] [Indexed: 10/23/2022]
Abstract
Our objective was to make recommendations intended to reduce the rate of opioid misuse and overdose for a particularly high-risk group of people with traumatic brain injury (TBI). A consensus process conducted with TBI researchers and expert practitioners developed practical recommendations to inform prescribing of opioids for people with TBI. After determining key general principles for prescribing opioids for people with TBI, 6 TBI-specific recommendations were developed, 1 for acute pain in the agitated patient with TBI, 3 recommendations to be considered before prescribing an opioid, and 2 for follow-up and use by mental health and substance use disorder providers. While there is much needed research to examine the relationship between opioid misuse and TBI, the present recommendations provide at least some clinical considerations that might serve to prevent further deaths among a high-risk group.
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Affiliation(s)
- Lance E Trexler
- Rehabilitation Hospital of Indiana, Indianapolis, Indiana; Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, Indiana.
| | - John D Corrigan
- Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, Ohio
| | - Shashank Davé
- Rehabilitation Hospital of Indiana, Indianapolis, Indiana; Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, Indiana
| | - Flora M Hammond
- Rehabilitation Hospital of Indiana, Indianapolis, Indiana; Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, Indiana
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Knight E, Norman A, Simpson GK. Living with suicidality following traumatic brain injury: a qualitative study. Brain Inj 2020; 34:1010-1019. [PMID: 32529858 DOI: 10.1080/02699052.2020.1763463] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE Numbers of traumatic brain injury (TBI) are increasing, and with suicidality post-injury presenting at 3-4 times higher than in the general population, understanding this is crucial in reducing a devastating outcome. Given the lack of literature, this study investigated the experiences of living with suicidality after TBI. METHODS Interview data from nineteen participants with TBI from a Brain Injury Rehabilitation Unit (BIRU) in New South Wales (NSW), Australia were collected and thematically analyzed. FINDINGS The participants (predominantly male) sustained extremely severe injuries (median PTA 60 [IQR 81.0] days) and were in the chronic phase post-injury (median 8.0 [IQR 9.0] years). Six main themes were identified; Loss of sense of self, TBI as a hidden disability, Chronic but transient suicidality, Reliance, Protective factors, and Hope. Tentative relationships between themes and subthemes were identified. CONCLUSION Chronic suicidality after TBI was demonstrated consistently regardless of receiving long-term support. However, their engagement with protective factors such as social support, spirituality and positive personal qualities was identified. Implementing these as coping strategies during long-term rehabilitation may reduce the levels of suicidal distress. Implications, methodological considerations and future research were discussed, with the aim of improving experiences of individuals with TBI to reduce suicidality.
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Affiliation(s)
- Ellie Knight
- Department of Psychology, Hywel Dda University Health Board , Wales, UK
| | - Alyson Norman
- School of Psychology, University of Plymouth , Plymouth, UK
| | - Grahame K Simpson
- Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research , Sydney, Australia
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Aleem M, Goswami N, Kumar M, Manda K. Low-pressure fluid percussion minimally adds to the sham craniectomy-induced neurobehavioral changes: Implication for experimental traumatic brain injury model. Exp Neurol 2020; 329:113290. [PMID: 32240659 DOI: 10.1016/j.expneurol.2020.113290] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 03/27/2020] [Accepted: 03/30/2020] [Indexed: 12/21/2022]
Abstract
Modeling experimental traumatic brain injury (TBI) in rodents is necessarily required to understand the pathophysiological and neurobehavioral consequences of neurotrauma. Numerous models have been developed to study experimental TBI. Fluid percussion injury (FPI) is the most extensively used model to represent clinical phenotypes. Nevertheless, the surgical 'sham' procedure (craniectomy), a prerequisite of FPI, is the impeding factor in experimental TBI. We hypothesized that if craniectomy causes substantial structural and functional changes in the brain, it might mimic the mild FPI-induced neurobehavioral dysfunctions. To understand the hypothesis, C57BL/6 mice were exposed to lateral FPI at 1.2 atm pressure and changes in the neuronal architecture, hippocampal neurogenesis, neuroinflammation, and behavioral functions were compared to the sham (craniectomy) and control mice at day 7 post-FPI. We observed that both the craniectomy and FPI significantly augmented the ipsilateral hippocampal neurogenesis as evaluated by DCX and Beta-III tubulin immunoreactivity. Similarly, a significant increase in GFAP and TMEM immunoreactivity in CA1 and CA3 regions showed that craniectomy mimics FPI-induced neuroinflammation. The additive damaging effect of craniectomy with FPI was also reported in the term of axonal and dendritic fragmentation, swelling and neuronal death using silver staining, Fluoro-jade, and MAP-2 immunoreactivity. Sham-exposed mice showed a significant functional decrease in grip strength. Our results indicate that sham craniectomy itself is enough to cause TBI like characteristics, and thus fluid percussion at mild pressure is minimally additive with craniectomy. Considering the method as a mixed (focal & diffused) injury model, the 'net neurotrauma severity' should be compared with naïve control instead of the sham as it is an outcome of cumulative damage due to fluid pressure and craniectomy. Nevertheless, to understand the long term consequences of neurotrauma, the extent of recovery in surgical sham may separately be quantified.
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Affiliation(s)
- Mohd Aleem
- Division of Behavioral Neuroscience, Institute of Nuclear Medicine & Allied Sciences, Delhi 110 054, India
| | - Nidhi Goswami
- Division of Behavioral Neuroscience, Institute of Nuclear Medicine & Allied Sciences, Delhi 110 054, India
| | - Mayank Kumar
- Division of Behavioral Neuroscience, Institute of Nuclear Medicine & Allied Sciences, Delhi 110 054, India
| | - Kailash Manda
- Division of Behavioral Neuroscience, Institute of Nuclear Medicine & Allied Sciences, Delhi 110 054, India.
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Yeh TC, Chien WC, Chung CH, Liang CS, Chang HA, Kao YC, Yeh HW, Yang YJ, Tzeng NS. Psychiatric Disorders After Traumatic Brain Injury: A Nationwide Population-Based Cohort Study and the Effects of Rehabilitation Therapies. Arch Phys Med Rehabil 2020; 101:822-831. [PMID: 31917196 DOI: 10.1016/j.apmr.2019.12.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 11/16/2019] [Accepted: 12/05/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To investigate the risk of psychiatric disorders after traumatic brain injury (TBI), and to clarify whether the post-TBI rehabilitation was associated with a lower risk of developing psychiatric disorders. DESIGN A register-based, retrospective cohort design. SETTING Using data from the National Health Insurance Research Database of Taiwan, we established an exposed cohort with TBI and a nonexposed group without TBI matched by age and year of diagnosis between 2000 and 2015. PARTICIPANTS This study included 231,894 patients with TBI and 695,682 patients without TBI (N=927,576). INTERVENTIONS Rehabilitation therapies in TBI patients. MAIN OUTCOME MEASURES A multivariable Cox proportional hazards regression model was used to compare the risk of developing psychiatric disorders. RESULTS The incidence rate of psychiatric disorders was higher in the TBI group than the control group. Compared with the control group, the risk of psychiatric disorders in the TBI group was twofold (hazard ratio [HR]=2.072; 95% confidence interval [95% CI], 1.955-2.189; P<.001). Among the participants with TBI, 49,270 (21.25%) had received rehabilitation therapy and had a lower risk of psychiatric disorders (HR=0.691; 95% CI, 0.679-0.703; P<.001). In the subgroup analysis, the medium- to high-level intensity rehabilitation therapy was associated with lower risks of psychiatric disorder (HR=0.712 and 0.568, respectively), but there was no significant finding in the low-intensity group. CONCLUSIONS We found that TBI was associated with a high risk for developing psychiatric disorders, and that the post-TBI rehabilitation significantly reduced the risk of psychiatric disorders in a dose-dependent manner.
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Affiliation(s)
- Ta-Chuan Yeh
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China; Department of Psychiatry, Tri-Service General Hospital, Penghu Branch, Penghu, Taiwan, Republic of China
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China; School of Public Health, National Defense Medical Center, Taipei, Taiwan, Republic of China; Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China; School of Public Health, National Defense Medical Center, Taipei, Taiwan, Republic of China; Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan, Republic of China
| | - Chih-Sung Liang
- Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China; Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Hsin-An Chang
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China; Student Counseling Center, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Yu-Chen Kao
- Department of Psychiatry, Tri-Service General Hospital, Song-Shan Branch, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Hui-Wen Yeh
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China; Institute of Bioinformatics and System Biology, National Chiao Tung University, Hsin-Chu, Taiwan, Republic of China; Department of Nursing, Tri-Service General Hospital, School of Nursing, National Defense Medical Center, Taipei, Taiwan, Republic of China; Department of Nursing, Kang Ning University (Taipei Campus), Taipei, Taiwan, Republic of China
| | - Yun-Ju Yang
- Department of Surgery, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Nian-Sheng Tzeng
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China; Student Counseling Center, National Defense Medical Center, Taipei, Taiwan, Republic of China.
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Increased Risks of Suicide Attempt and Suicidal Drug Overdose Following Admission for Head Injury in Patients with Depression. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16193524. [PMID: 31547202 PMCID: PMC6801720 DOI: 10.3390/ijerph16193524] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 09/12/2019] [Accepted: 09/16/2019] [Indexed: 12/11/2022]
Abstract
Aims: To determine the risks of suicide attempt (SA) and suicidal drug overdose (SDO) following the admission for head injury of patients with depression. Design: We analyzed the NHIRD data of patients aged ≥20 years who had received depression diagnoses between 2000 and 2010. They were divided into cohorts of those with admission for head injury (DHI) and those without it (DWI) during the follow-up period and compared against a sex-, age-, comorbidity-, and index-date-matched cohort from the general population. Setting: The Taiwan National Health Insurance Research Database (NHIRD). Participants/Cases: We analyzed the NHIRD data of patients (≥20 years) who had received depression diagnoses between 2000 and 2010. Intervention(s): Regular interventions. Measurements: We calculated the adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) of SA and SDO in these cohorts after adjustment for age, sex, and comorbidities. Findings: Up to the end of 2011, our results revealed extremely high incidences of SA and SDO with 63.3 and 88.6 per 10,000 person-years, respectively, in the DHI cohort. The DHI cohort had a 37.4-times higher risk for SA and a 17.1-times higher risk for SDO compared with the comparison group and had aHRs of 14.4 and 16.3, respectively, for poisoning by medicinal substances and poisoning by tranquilizers compared with patients in the DWI cohort. Patients with DHI aged <50 years, of female sex, with high incomes, living in more urbanized areas, and without other comorbidities had extraordinarily higher risks for SA. Conclusions: The risks of SA and SDO were proportionally increased by head injury in patients with depression in Taiwan. Our findings provide crucial information to implement efficient suicide prevention strategies in the future.
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Sell SL, Boone DR, Weisz HA, Cardenas C, Willey HE, Bolding IJ, Micci MA, Falduto MT, Torres KEO, DeWitt DS, Prough DS, Hellmich HL. MicroRNA profiling identifies a novel compound with antidepressant properties. PLoS One 2019; 14:e0221163. [PMID: 31442236 PMCID: PMC6707633 DOI: 10.1371/journal.pone.0221163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 07/31/2019] [Indexed: 02/07/2023] Open
Abstract
Patients with traumatic brain injury (TBI) are frequently diagnosed with depression. Together, these two leading causes of death and disability significantly contribute to the global burden of healthcare costs. However, there are no drug treatments for TBI and antidepressants are considered off-label for depression in patients with TBI. In molecular profiling studies of rat hippocampus after experimental TBI, we found that TBI altered the expression of a subset of small, non-coding, microRNAs (miRNAs). One known neuroprotective compound (17β-estradiol, E2), and two experimental neuroprotective compounds (JM6 and PMI-006), reversed the effects of TBI on miRNAs. Subsequent in silico analyses revealed that the injury-altered miRNAs were predicted to regulate genes involved in depression. Thus, we hypothesized that drug-induced miRNA profiles can be used to identify compounds with antidepressant properties. To confirm this hypothesis, we examined miRNA expression in hippocampi of injured rats treated with one of three known antidepressants (imipramine, fluoxetine and sertraline). Bioinformatic analyses revealed that TBI, potentially via its effects on multiple regulatory miRNAs, dysregulated transcriptional networks involved in neuroplasticity, neurogenesis, and circadian rhythms- networks known to adversely affect mood, cognition and memory. As did E2, JM6, and PMI-006, all three antidepressants reversed the effects of TBI on multiple injury-altered miRNAs. Furthermore, JM6 reduced TBI-induced inflammation in the hippocampus and depression-like behavior in the forced swim test; these are both properties of classic antidepressant drugs. Our results support the hypothesis that miRNA expression signatures can identify neuroprotective and antidepressant properties of novel compounds and that there is substantial overlap between neuroprotection and antidepressant properties.
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Affiliation(s)
- Stacy L. Sell
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Deborah R. Boone
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Harris A. Weisz
- Graduate School of Biomedical Science, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Cesar Cardenas
- University of Mississippi Medical Center: Psychiatry & Human Behavior, Jackson, Mississippi, United States of America
| | - Hannah E. Willey
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Ian J. Bolding
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Maria-Adelaide Micci
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Michael T. Falduto
- GenUs BioSystems, Northbrook, Illinois, United States of America
- Paradise Genomics, Inc., Northbrook, Illinois, United States of America
| | | | - Douglas S. DeWitt
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Donald S. Prough
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Helen L. Hellmich
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas, United States of America
- * E-mail:
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Madsen T, Erlangsen A, Orlovska S, Mofaddy R, Nordentoft M, Benros ME. Association Between Traumatic Brain Injury and Risk of Suicide. JAMA 2018; 320:580-588. [PMID: 30120477 PMCID: PMC6142987 DOI: 10.1001/jama.2018.10211] [Citation(s) in RCA: 111] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Traumatic brain injuries (TBIs) can have serious long-term consequences, including psychiatric disorders. However, few studies have assessed the association between TBI and risk of suicide. OBJECTIVE To examine the association between TBI and subsequent suicide. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study using nationwide registers covering 7 418 391 individuals (≥10 years) living in Denmark (1980-2014) with 164 265 624 person-years' follow-up; 567 823 (7.6%) had a medical contact for TBI. Data were analyzed using Poisson regression adjusted for relevant covariates, including fractures not involving the skull, psychiatric diagnoses, and deliberate self-harm. EXPOSURE Medical contacts for TBI recorded in the National Patient Register (1977-2014) as mild TBI (concussion), skull fracture without documented TBI, and severe TBI (head injuries with evidence of structural brain injury). MAIN OUTCOMES AND MEASURES Suicide recorded in the Danish Cause of Death register until December 31, 2014. RESULTS Of 34 529 individuals who died by suicide (mean age, 52 years [SD, 18 years]; 32.7% women; absolute rate 21 per 100 000 person-years [95% CI, 20.8-21.2]), 3536 (10.2%) had medical contact: 2701 with mild TBI, 174 with skull fracture without documented TBI, and 661 with severe TBI. The absolute suicide rate was 41 per 100 000 person-years (95% CI, 39.2-41.9) among those with TBI vs 20 per 100 000 person-years (95% CI, 19.7-20.1) among those with no diagnosis of TBI. The adjusted incidence rate ratio (IRR) was 1.90 (95% CI, 1.83-1.97). Compared with those without TBI, severe TBI (absolute rate, 50.8 per 100 000 person-years; 95% CI, 46.9-54.6) was associated with an IRR of 2.38 (95% CI, 2.20-2.58), whereas mild TBI (absolute rate, 38.6 per 100 000 person-years; 95% CI, 37.1-40.0), and skull fracture without documented TBI (absolute rate, 42.4 per 100 000 person-years; 95% CI, 36.1-48.7) had an IRR of 1.81 (95% CI, 1.74-1.88) and an IRR of 2.01 (95% CI, 1.73-2.34), respectively. Suicide risk was associated with number of medical contacts for TBI compared with those with no TBI contacts: 1 TBI contact, absolute rate, 34.3 per 100 000 person-years (95% CI, 33.0-35.7; IRR, 1.75; 95% CI, 1.68-1.83); 2 TBI contacts, absolute rate, 59.8 per 100 000 person-years (95% CI, 55.1-64.6; IRR, 2.31; 95% CI, 2.13-2.51); and 3 or more TBI contacts, absolute rate, 90.6 per 100 000 person-years (95% CI, 82.3-98.9; IRR, 2.59; 95% CI, 2.35-2.85; all P < .001 for the IRR's). Compared with the general population, temporal proximity since the last medical contact for TBI was associated with risk of suicide (P<.001), with an IRR of 3.67 (95% CI, 3.33-4.04) within the first 6 months and an incidence IRR of 1.76 (95% CI, 1.67-1.86) after 7 years. CONCLUSIONS AND RELEVANCE In this nationwide registry-based retrospective cohort study individuals with medical contact for TBI, compared with the general population without TBI, had increased suicide risk.
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Affiliation(s)
- Trine Madsen
- Danish Research Institute of Suicide Prevention, Mental Health Centre Copenhagen, Capital Region of Denmark, Copenhagen, Denmark
- Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Annette Erlangsen
- Danish Research Institute of Suicide Prevention, Mental Health Centre Copenhagen, Capital Region of Denmark, Copenhagen, Denmark
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- iPSYCH – The Lundbeck Foundation Initiative for Integrated Psychiatric Research, Aarhus, Denmark
- Center of Mental Health Research, Australian National University, Canberra, Australia
| | - Sonja Orlovska
- Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ramy Mofaddy
- Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Merete Nordentoft
- Danish Research Institute of Suicide Prevention, Mental Health Centre Copenhagen, Capital Region of Denmark, Copenhagen, Denmark
- Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
- iPSYCH – The Lundbeck Foundation Initiative for Integrated Psychiatric Research, Aarhus, Denmark
| | - Michael E. Benros
- Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
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Juengst SB, Terhorst L, Dicianno BE, Niemeier JP, Wagner AK. Development and content validity of the behavioral assessment screening tool (BAST β). Disabil Rehabil 2018; 41:1200-1206. [PMID: 29303003 DOI: 10.1080/09638288.2017.1423403] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Develop and establish the content validity of the Behavioral Assessment Screening Tool (BASTβ), a self-reported measure of behavioral and emotional symptoms after traumatic brain injury. METHODS This was an assessment development study, including two focus groups of individuals with traumatic brain injury (n = 11) and their family members (n = 10) and an expert panel evaluation of content validity by experts in traumatic brain injury rehabilitation (n = 7). We developed and assessed the Content Validity Index of the BASTβ. RESULTS The BASTβ initial items (n = 77) corresponded with an established conceptual model of behavioral dysregulation after traumatic brain injury. After expert panel evaluation and focus group feedback, the final BASTβ included 66 items (60 primary, 6 branching logic) rated on a three-level ordinal scale (Never, Sometimes, Always) with reference to the past two weeks, and an Environmental Context checklist including recent major life events (n = 23) and four open-ended questions about environmental factors. The BASTβ had a high Content Validity Index of 89.3%. CONCLUSION The BASTβ is a theoretically grounded, multidimensional self-reported assessment of behavioral dysregulation after traumatic brain injury, with good content validity. Future translation into mobile health modalities could improve effectiveness and efficiency of long-term symptom monitoring post-traumatic brain injury. Future work will establish and validate the factor structure, internal consistency reliabilities and other validities of the BAST. Implications for Rehabilitation Behavioral problems after traumatic brain injury is one of the strongest contributing factors to poor mood and community integration outcomes after injury. Behavior is complex and multidimensional, making it a challenge to measure and to monitor long term. The Behavioral Assessment Screening Tool (BAST) is a patient-oriented outcome assessment developed in collaboration with individuals with traumatic brain injury, their care partners, and experts in the field of traumatic brain injury rehabilitation to be relevant and accessible for adults with traumatic brain injuries. The BAST is a long-term monitoring and screening tool for community-dwelling adults with traumatic brain injuries, to improve identification and management of behavioral and emotional sequelae.
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Affiliation(s)
- Shannon B Juengst
- a Department of Physical Medicine and Rehabilitation , University of Texas Southwestern , Dallas , TX , USA.,b Department of Rehabilitation Counseling , University of Texas Southwestern , Dallas , TX , USA
| | - Lauren Terhorst
- c Department of Occupational Therapy , University of Pittsburgh , Pittsburgh , PA , USA.,d Clinical and Translational Science Institute , University of Pittsburgh , Pittsburgh , PA , USA
| | - Brad E Dicianno
- e Department of Physical Medicine and Rehabilitation , University of Pittsburgh , Pittsburgh , PA , USA.,f Department of Rehabilitation Science and Technology , University of Pittsburgh , Pittsburgh , PA , USA
| | - Janet P Niemeier
- g Department of Physical Medicine and Rehabilitation , Carolinas Medical Center , Charlotte , SC , USA
| | - Amy K Wagner
- f Department of Rehabilitation Science and Technology , University of Pittsburgh , Pittsburgh , PA , USA.,h Center for Neuroscience , University of Pittsburgh , Pittsburgh , PA , USA.,i Safar Center for Resuscitation , University of Pittsburgh , Pittsburgh , PA , USA
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Grossbard J, Malte CA, Lapham G, Pagulayan K, Turner AP, Rubinsky AD, Bradley KA, Saxon AJ, Hawkins EJ. Prevalence of Alcohol Misuse and Follow-Up Care in a National Sample of OEF/OIF VA Patients With and Without TBI. Psychiatr Serv 2017; 68:48-55. [PMID: 27476804 PMCID: PMC5704906 DOI: 10.1176/appi.ps.201500290] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Information on prevalence and management of alcohol misuse among Afghanistan and Iraq veterans with traumatic brain injury (TBI) is limited. This study compared rates of alcohol misuse and follow-up care-brief intervention (BI) and addiction treatment-among Afghanistan and Iraq veterans with and without TBI receiving care from the Department of Veterans Affairs (VA). METHODS The sample included veterans ages 18 and older screened with the Alcohol Use Disorders Identification Test alcohol consumption questions (AUDIT-C) in 2012 who received VA health care in the prior year (N=358,417). Overall and age-specific estimates of alcohol misuse (AUDIT-C score ≥5) were compared for men and women with and without TBI by logistic regression. BI and addiction treatment after screening were compared between groups by using multivariable logistic regression. RESULTS Alcohol misuse was higher among men with TBI than among men without TBI (20.3%, 95% confidence interval [CI]=19.9-20.8, versus 16.4%, CI=16.3-16.6) and among women with TBI than among women without TBI (6.8%, CI=5.8-8.1, versus 5.6%, CI=5.4-5.8); younger (age <30) patients with TBI had the highest rates. BI rates did not differ by TBI status (76.4%-80.2%). Addiction treatment rates for those with severe misuse were higher among those with TBI (men, 20.0%, CI=18.4-21.6, versus 15.4%, CI=14.9-15.9; women, 36.6%, CI=21.8-51.3, versus 21.1%, CI=18.2-24.0). CONCLUSIONS Alcohol misuse is common among Iraq and Afghanistan veterans with TBI, particularly young men. BI rates were high and did not vary by TBI status, although addiction treatment rates were higher among patients with TBI than among those without TBI.
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Affiliation(s)
- Joel Grossbard
- Dr. Grossbard, Ms. Malte, Dr. Turner, Dr. Rubinsky, Dr. Saxon, and Dr. Hawkins are with the Department of Veterans Affairs (VA) Center of Excellence in Substance Abuse Treatment and Education, Puget Sound Health Care System, Seattle. Dr. Turner is also with the Department of Rehabilitation Medicine, University of Washington, Seattle. Dr. Saxon and Dr. Hawkins are also with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, where Dr. Pagulayan is affiliated. Dr. Rubinsky is also with the Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA Health Services Research and Development (HSR&D), Seattle. Dr. Lapham and Dr. Bradley are with the Group Health Research Institute, Seattle. Dr. Bradley is also with the Department of Health Services, University of Washington, Seattle. Send correspondence to Dr. Hawkins (e-mail: )
| | - Carol A Malte
- Dr. Grossbard, Ms. Malte, Dr. Turner, Dr. Rubinsky, Dr. Saxon, and Dr. Hawkins are with the Department of Veterans Affairs (VA) Center of Excellence in Substance Abuse Treatment and Education, Puget Sound Health Care System, Seattle. Dr. Turner is also with the Department of Rehabilitation Medicine, University of Washington, Seattle. Dr. Saxon and Dr. Hawkins are also with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, where Dr. Pagulayan is affiliated. Dr. Rubinsky is also with the Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA Health Services Research and Development (HSR&D), Seattle. Dr. Lapham and Dr. Bradley are with the Group Health Research Institute, Seattle. Dr. Bradley is also with the Department of Health Services, University of Washington, Seattle. Send correspondence to Dr. Hawkins (e-mail: )
| | - Gwen Lapham
- Dr. Grossbard, Ms. Malte, Dr. Turner, Dr. Rubinsky, Dr. Saxon, and Dr. Hawkins are with the Department of Veterans Affairs (VA) Center of Excellence in Substance Abuse Treatment and Education, Puget Sound Health Care System, Seattle. Dr. Turner is also with the Department of Rehabilitation Medicine, University of Washington, Seattle. Dr. Saxon and Dr. Hawkins are also with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, where Dr. Pagulayan is affiliated. Dr. Rubinsky is also with the Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA Health Services Research and Development (HSR&D), Seattle. Dr. Lapham and Dr. Bradley are with the Group Health Research Institute, Seattle. Dr. Bradley is also with the Department of Health Services, University of Washington, Seattle. Send correspondence to Dr. Hawkins (e-mail: )
| | - Kathleen Pagulayan
- Dr. Grossbard, Ms. Malte, Dr. Turner, Dr. Rubinsky, Dr. Saxon, and Dr. Hawkins are with the Department of Veterans Affairs (VA) Center of Excellence in Substance Abuse Treatment and Education, Puget Sound Health Care System, Seattle. Dr. Turner is also with the Department of Rehabilitation Medicine, University of Washington, Seattle. Dr. Saxon and Dr. Hawkins are also with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, where Dr. Pagulayan is affiliated. Dr. Rubinsky is also with the Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA Health Services Research and Development (HSR&D), Seattle. Dr. Lapham and Dr. Bradley are with the Group Health Research Institute, Seattle. Dr. Bradley is also with the Department of Health Services, University of Washington, Seattle. Send correspondence to Dr. Hawkins (e-mail: )
| | - Aaron P Turner
- Dr. Grossbard, Ms. Malte, Dr. Turner, Dr. Rubinsky, Dr. Saxon, and Dr. Hawkins are with the Department of Veterans Affairs (VA) Center of Excellence in Substance Abuse Treatment and Education, Puget Sound Health Care System, Seattle. Dr. Turner is also with the Department of Rehabilitation Medicine, University of Washington, Seattle. Dr. Saxon and Dr. Hawkins are also with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, where Dr. Pagulayan is affiliated. Dr. Rubinsky is also with the Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA Health Services Research and Development (HSR&D), Seattle. Dr. Lapham and Dr. Bradley are with the Group Health Research Institute, Seattle. Dr. Bradley is also with the Department of Health Services, University of Washington, Seattle. Send correspondence to Dr. Hawkins (e-mail: )
| | - Anna D Rubinsky
- Dr. Grossbard, Ms. Malte, Dr. Turner, Dr. Rubinsky, Dr. Saxon, and Dr. Hawkins are with the Department of Veterans Affairs (VA) Center of Excellence in Substance Abuse Treatment and Education, Puget Sound Health Care System, Seattle. Dr. Turner is also with the Department of Rehabilitation Medicine, University of Washington, Seattle. Dr. Saxon and Dr. Hawkins are also with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, where Dr. Pagulayan is affiliated. Dr. Rubinsky is also with the Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA Health Services Research and Development (HSR&D), Seattle. Dr. Lapham and Dr. Bradley are with the Group Health Research Institute, Seattle. Dr. Bradley is also with the Department of Health Services, University of Washington, Seattle. Send correspondence to Dr. Hawkins (e-mail: )
| | - Katharine A Bradley
- Dr. Grossbard, Ms. Malte, Dr. Turner, Dr. Rubinsky, Dr. Saxon, and Dr. Hawkins are with the Department of Veterans Affairs (VA) Center of Excellence in Substance Abuse Treatment and Education, Puget Sound Health Care System, Seattle. Dr. Turner is also with the Department of Rehabilitation Medicine, University of Washington, Seattle. Dr. Saxon and Dr. Hawkins are also with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, where Dr. Pagulayan is affiliated. Dr. Rubinsky is also with the Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA Health Services Research and Development (HSR&D), Seattle. Dr. Lapham and Dr. Bradley are with the Group Health Research Institute, Seattle. Dr. Bradley is also with the Department of Health Services, University of Washington, Seattle. Send correspondence to Dr. Hawkins (e-mail: )
| | - Andrew J Saxon
- Dr. Grossbard, Ms. Malte, Dr. Turner, Dr. Rubinsky, Dr. Saxon, and Dr. Hawkins are with the Department of Veterans Affairs (VA) Center of Excellence in Substance Abuse Treatment and Education, Puget Sound Health Care System, Seattle. Dr. Turner is also with the Department of Rehabilitation Medicine, University of Washington, Seattle. Dr. Saxon and Dr. Hawkins are also with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, where Dr. Pagulayan is affiliated. Dr. Rubinsky is also with the Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA Health Services Research and Development (HSR&D), Seattle. Dr. Lapham and Dr. Bradley are with the Group Health Research Institute, Seattle. Dr. Bradley is also with the Department of Health Services, University of Washington, Seattle. Send correspondence to Dr. Hawkins (e-mail: )
| | - Eric J Hawkins
- Dr. Grossbard, Ms. Malte, Dr. Turner, Dr. Rubinsky, Dr. Saxon, and Dr. Hawkins are with the Department of Veterans Affairs (VA) Center of Excellence in Substance Abuse Treatment and Education, Puget Sound Health Care System, Seattle. Dr. Turner is also with the Department of Rehabilitation Medicine, University of Washington, Seattle. Dr. Saxon and Dr. Hawkins are also with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, where Dr. Pagulayan is affiliated. Dr. Rubinsky is also with the Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA Health Services Research and Development (HSR&D), Seattle. Dr. Lapham and Dr. Bradley are with the Group Health Research Institute, Seattle. Dr. Bradley is also with the Department of Health Services, University of Washington, Seattle. Send correspondence to Dr. Hawkins (e-mail: )
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Richard YF, Swaine BR, Sylvestre MP, Lesage A, Zhang X, Feldman DE. The association between traumatic brain injury and suicide: are kids at risk? Am J Epidemiol 2015; 182:177-84. [PMID: 26121988 DOI: 10.1093/aje/kwv014] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 01/16/2015] [Indexed: 11/14/2022] Open
Abstract
Traumatic brain injury (TBI) in late adolescence and adulthood is associated with a higher risk of suicide; however, it is unknown whether this association is also present in people who sustained a TBI during childhood. The purpose of the present study was to determine whether experiencing a TBI during childhood is a risk factor for suicide later in life and to examine whether the risk of suicide differs by sex or injury severity. A cohort of 135,703 children aged 0-17 years was identified from the Quebec population-based physician reimbursement database in 1987, and follow-up was conducted until 2008. Of the children in this cohort, 21,047 had sustained a TBI. Using a survival analysis with time-dependent indicators of TBI, we found a higher risk of suicide for people who sustained a TBI during childhood (hazard ratio (HR) = 1.49, 95% confidence interval (CI): 1.04, 2.14), adolescence (HR = 1.57, 95% CI: 1.09, 2.26), and adulthood (HR = 2.53, 95% CI: 1.79, 3.59). When compared with less severe injuries, such as concussions and cranial fractures, more severe injuries, such as intracranial hemorrhages, were associated with a higher risk of suicide (HR = 2.18 vs. 2.77, respectively). Repeated injuries were associated with higher risks of suicide in all age groups.
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Nowrangi MA, Kortte KB, Rao VA. A Perspectives Approach to Suicide After Traumatic Brain Injury: Case and Review. PSYCHOSOMATICS 2014; 55:430-7. [DOI: 10.1016/j.psym.2013.11.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 11/19/2013] [Accepted: 11/21/2013] [Indexed: 10/26/2022]
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Cocks E, Bulsara C, O'Callaghan A, Netto J, Boaden R. Exploring the experiences of people with the dual diagnosis of acquired brain injury and mental illness. Brain Inj 2014; 28:414-21. [PMID: 24475744 DOI: 10.3109/02699052.2014.880799] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PRIMARY OBJECTIVE People with the dual diagnosis of acquired brain injury and mental illness (ABI/MI) are vulnerable to a range of negative life experiences, which has received limited attention in the literature. The objective of the project described in this paper was to identify and describe these experiences in order to distinguish barriers and facilitators to successful rehabilitation and recovery. RESEARCH DESIGN The project used qualitative methodologies. METHODS AND PROCEDURES The 15 participants were eight people with ABI/MI, two family members and five support workers. Nineteen interviews were conducted. Analysis of these interviews produced a set of five key themes, with each theme elaborated by a set of descriptive issues. MAIN OUTCOMES AND RESULTS The five themes were loss, personal development, occupation, family and services. The experiences of people with ABI/MI were strongly negative. They faced more barriers than facilitators to recovery. Current policies and practices were inadequate. CONCLUSIONS Enhanced stakeholder collaboration and co-ordination and a more individualized, long-term perspective on the needs of people with ABI/MI are recommended to guide future policy and practice. Future research on quality-of-life, wellbeing, community inclusion and participation in ordinary life was recommended.
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Affiliation(s)
- Errol Cocks
- Centre for Research into Disability and Society, School of Occupational Therapy and Social Work, Faculty of Health Sciences, Curtin University , Perth, WA , Australia
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Rapp PE, Rosenberg BM, Keyser DO, Nathan D, Toruno KM, Cellucci CJ, Albano AM, Wylie SA, Gibson D, Gilpin AMK, Bashore TR. Patient Characterization Protocols for Psychophysiological Studies of Traumatic Brain Injury and Post-TBI Psychiatric Disorders. Front Neurol 2013; 4:91. [PMID: 23885250 PMCID: PMC3717660 DOI: 10.3389/fneur.2013.00091] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 06/26/2013] [Indexed: 12/20/2022] Open
Abstract
Psychophysiological investigations of traumatic brain injury (TBI) are being conducted for several reasons, including the objective of learning more about the underlying physiological mechanisms of the pathological processes that can be initiated by a head injury. Additional goals include the development of objective physiologically based measures that can be used to monitor the response to treatment and to identify minimally symptomatic individuals who are at risk of delayed-onset neuropsychiatric disorders following injury. Research programs studying TBI search for relationships between psychophysiological measures, particularly ERP (event-related potential) component properties (e.g., timing, amplitude, scalp distribution), and a participant's clinical condition. Moreover, the complex relationships between brain injury and psychiatric disorders are receiving increased research attention, and ERP technologies are making contributions to this effort. This review has two objectives supporting such research efforts. The first is to review evidence indicating that TBI is a significant risk factor for post-injury neuropsychiatric disorders. The second objective is to introduce ERP researchers who are not familiar with neuropsychiatric assessment to the instruments that are available for characterizing TBI, post-concussion syndrome, and psychiatric disorders. Specific recommendations within this very large literature are made. We have proceeded on the assumption that, as is typically the case in an ERP laboratory, the investigators are not clinically qualified and that they will not have access to participant medical records.
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Affiliation(s)
- Paul E. Rapp
- Department of Military and Emergency Medicine, Uniformed Services UniversityBethesda, MD, USA
| | - Brenna M. Rosenberg
- Department of Military and Emergency Medicine, Uniformed Services UniversityBethesda, MD, USA
| | - David O. Keyser
- Department of Military and Emergency Medicine, Uniformed Services UniversityBethesda, MD, USA
| | - Dominic Nathan
- Department of Military and Emergency Medicine, Uniformed Services UniversityBethesda, MD, USA
| | - Kevin M. Toruno
- Department of Military and Emergency Medicine, Uniformed Services UniversityBethesda, MD, USA
| | | | | | - Scott A. Wylie
- Neurology Department, Vanderbilt UniversityNashville, TN, USA
| | - Douglas Gibson
- Combat Casualty Care Directorate, Army Medical Research and Materiel CommandFort Detrick, MD, USA
| | - Adele M. K. Gilpin
- Arnold and Porter, LLPWashington, DC, USA
- Department of Epidemiology and Preventive Medicine, University of MarylandCollege Park, MD, USA
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Managing behavioral health needs of veterans with traumatic brain injury (TBI) in primary care. J Clin Psychol Med Settings 2013. [PMID: 23184276 DOI: 10.1007/s10880-012-9345-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Traumatic brain injury (TBI) is a frequent occurrence in the United States, and has been given particular attention in the veteran population. Recent accounts have estimated TBI incidence rates as high as 20 % among US veterans who served in Afghanistan or Iraq, and many of these veterans experience a host of co-morbid concerns, including psychiatric complaints (such as depression and post-traumatic stress disorder), sleep disturbance, and substance abuse which may warrant referral to behavioral health specialists working in primary care settings. This paper reviews many common behavioral health concerns co-morbid with TBI, and suggests areas in which behavioral health specialists may assess, intervene, and help to facilitate holistic patient care beyond the acute phase of injury. The primary focus is on sequelae common to mild and moderate TBI which may more readily present in primary care clinics.
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Abstract
Traumatic brain injury (TBI) is prevalent among many populations and existing data suggest that those with TBI are at increased risk for death by suicide. This systematic review serves as an update to a previous review, with the aim of evaluating the current state of evidence regarding prevalence and risk of suicide deaths, post-TBI suicidal ideation and suicide attempts, and treatments to reduce suicide-related outcomes among TBI survivors. Review procedures followed the PRISMA statement guidelines. In all, 1014 abstracts and 83 full-text articles were reviewed to identify 16 studies meeting inclusion criteria. Risk of bias for individual studies ranged from low to high, and very few studies were designed to examine a priori hypotheses related to suicide outcomes of interest. Overall, findings from this systematic review supported an increased risk of suicide among TBI survivors compared to those with no history of TBI. Evidence pertaining to suicidal thoughts and attempts was less clear, mainly due to heterogeneity of methodological quality across studies. One small randomised controlled trial was identified that targeted suicide prevention in TBI survivors. Further research is needed to identify the prevalence of post-TBI ideation and attempts, and to establish evidence-based suicide prevention practices among TBI survivors.
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Abstract
Psychosis following traumatic brain injury (PFTBI) has received modest empirical investigation, and is subsequently poorly understood, identified and treated. The current article reports on consistencies in PFTBI phenomenology according to the existing peer-reviewed literature. The potential for psychotic symptoms post TBI, aetiological propositions, prevalence, significance of onset latency and injury severity, clinical and cognitive neuropsychological presentation and injury localisation/neuroimaging data are reviewed. Substantial methodological limitations associated with the majority of publications informing this work are also discussed. Despite controversies in the literature, psychosis following TBI appears to be three times more prevalent than psychotic disorders in the general population, and comparable in presentation to other idiopathic psychotic spectrum disorders, including schizophrenia.
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Abstract
Objective: Review the literature to evaluate the evidence for effective treatment to mitigate substance misuse and substance use disorders (SUD) following traumatic brain injury (TBI).Design: Systematic review.Data source: Scopus.Study eligibility criteria: A study was considered eligible for review if (a) the intended population specifically included persons with TBI; (b) the experimental intervention targeted misuse of alcohol, illegal drugs or prescription drugs; (c) the intervention was compared to the standard of care, control or another intervention; (d) the outcomes under study included substance use or misuse; and (e) the study design was a controlled trial.Results: Six studies were identified that met the inclusion criteria. Three studies were conducted during the acute phase of recovery using brief interventions, while the remaining three were conducted with individuals in the post-acute phase (usually several years post-injury) using more intensive treatment. All studies were found to be vulnerable to bias due to methodological weaknesses.Conclusions: While firm conclusions could not be drawn from the results of the studies, each study provided important information about the challenges to conducting SUD intervention trials with persons with TBI. The choices researchers will have to make to address these challenges are delineated.
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Assessing Suicide Ideation in Patients With Traumatic Brain Injury (TBI) by Using Depression Scales. J Head Trauma Rehabil 2013; 28:149-50. [DOI: 10.1097/htr.0b013e3182527138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rezaei S, Asgari K, Yousefzadeh S, Moosavi HA, Kazemnejad E. Effects of neurosurgical treatment and severity of head injury on cognitive functioning, general health and incidence of mental disorders in patients with traumatic brain injury. ARCHIVES OF TRAUMA RESEARCH 2012; 1:93-100. [PMID: 24396755 PMCID: PMC3876538 DOI: 10.5812/atr.6546] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Revised: 08/14/2012] [Accepted: 09/05/2012] [Indexed: 11/16/2022]
Abstract
Background Neurosurgical treatment and the severity of head injury (HI) can have remarkable effect on patients’ neuropsychiatric outcomes. Objectives This research aimed to study the effect of these factors on cognitive functioning, general health and incidence of mental disorders in patients with a traumatic brain injury (TBI). Patients and Methods In this descriptive, longitudinal study, 206 TBI patients entered the study by consecutive sampling; they were then compared according to neurosurgery status and severity of their HI. Both groups underwent neurosurgical and psychological examinations. The mini mental state examination (MMSE) and general health questionnaire–28 items (GHQ-28) were administered to the study participants. At follow-up, four months later, the groups underwent a structured clinical interview by a psychiatrist based on the diagnostic and statistical manual of mental disorders, fourth edition (DSM-IV) diagnostic criteria regarding the presence of mental disorders. Results Analysis of covariance (ANCOVA) and multivariate analysis of covariance (MANCOVA) were performed and adjusted for the effect of confounding variables (age, gender, Glasgow outcome scale (GOS) , and level of education). The severity of HI had the most significant effect for the following variables; cognitive functioning and physical symptoms (P < 0.05). The effect of the neurosurgical treatment factor was not significant; however, the interaction effect of the two variables on social dysfunction, and total score of the GHQ-28 questionnaire appeared to be significant (P < 0.05). Fisher's exact test indicated that after a four month follow-up period, no significant differences were seen between the two groups (with or without neurosurgery) in the incidence of mental disorders, while χ2 Test showed that having a more severe HI is significantly correlated with the incidence of mental disorders (P < 0.01). Conclusions The implications of this study should be discussed with an emphasis on negative, effective factors on the cognitive – behavioral and neuropsychiatric outcomes of a TBI.
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Affiliation(s)
- Sajjad Rezaei
- Guilan Road Trauma Research Center, Department of Psychology, University of Isfahan, Isfahan, IR Iran
- Corresponding author: Sajjad Rezaei, Guilan Road Trauma Research Center and Department of Psychology, University of Isfahan, Isfahan, IR Iran. Tel.: +98-9113390785, Fax: +98-1313238373, E-mail:
| | - Karim Asgari
- Department of Psychology, University of Isfahan, Isfahan, IR Iran
| | - Shahrokh Yousefzadeh
- Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, IR Iran
| | | | - Ehsan Kazemnejad
- Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, IR Iran
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Hsieh MY, Ponsford J, Wong D, Schönberger M, Taffe J, McKay A. Motivational interviewing and cognitive behaviour therapy for anxiety following traumatic brain injury: a pilot randomised controlled trial. Neuropsychol Rehabil 2012; 22:585-608. [PMID: 22632385 DOI: 10.1080/09602011.2012.678860] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Although cognitive-behavioural therapy (CBT) is the treatment of choice for anxiety, its delivery needs to be adapted for individuals with traumatic brain injury (TBI). It also requires clients' active engagement for maximum benefit. This study was a pilot randomised controlled trial involving an anxiety treatment programme adapted for people with TBI, based on CBT and motivational interviewing (MI). Twenty-seven participants with moderate/severe TBI (aged 21-73 years, 78% males) recruited from a brain injury rehabilitation hospital were randomly allocated to receive MI + CBT (n = 9), non-directive counselling (NDC) + CBT (n = 10) and treatment-as-usual (TAU) (n = 8). CBT and MI were manualised and delivered in 12 weekly individual sessions. Primary outcome was self-reported anxiety symptoms assessed at baseline, at the end of NDC/MI and immediately following CBT. Assessment was conducted by assessors blinded to group assignment. Intention-to-treat analyses showed that the two active treatment groups demonstrated significantly greater anxiety reduction than TAU. Participants receiving MI showed greater response to CBT, in terms of reduction in anxiety, stress and non-productive coping, compared to participants who received NDC. The results provided preliminary support for the adapted CBT programme, and the potential utility of MI as treatment prelude. Longer follow-up data are required to evaluate the maintenance of treatment effects.
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Affiliation(s)
- Ming-Yun Hsieh
- School of Psychology and Psychiatry, Monash University, Melbourne, Victoria, Australia
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Tyson BT, Pham MT, Brown NT, Mayer TR. Patient safety considerations in the rehabilitation of the individual with cognitive impairment. Phys Med Rehabil Clin N Am 2012; 23:315-34. [PMID: 22537695 DOI: 10.1016/j.pmr.2012.02.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Deficits in cognitive functioning are associated with many safety concerns, including difficulties performing activities of daily living, medication errors, motor vehicle accidents, impaired awareness of deficits, decision-making capacity, falls, and travel away from home. Preventing adverse safety outcomes is particularly relevant in rehabilitation patients. Integration of information and recommendations stemming from allied disciplines, such as rehabilitation medicine, physical therapy, occupational therapy, speech therapy, and neuropsychology, is the most effective way to limit poor outcomes. Education and prevention counseling by health care professionals is an important approach in limiting adverse safety outcomes in patients with cognitive impairment.
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Affiliation(s)
- Brad T Tyson
- Traumatic Brain Injury and Coma Recovery Unit, Department of Physical Medicine and Rehabilitation, Kingsbrook Jewish Medical Center, Kingsbrook Rehabilitation Institute, 585 Schenectady Avenue, Brooklyn, NY 11203, USA
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Reeves RR, Laizer JT. Traumatic Brain Injury and Suicide. J Psychosoc Nurs Ment Health Serv 2012; 50:32-8. [DOI: 10.3928/02793695-20120207-02] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Accepted: 01/12/2012] [Indexed: 11/20/2022]
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Adams RS, Corrigan JD, Larson MJ. Alcohol Use after Combat-Acquired Traumatic Brain Injury: What We Know and Don't Know. JOURNAL OF SOCIAL WORK PRACTICE IN THE ADDICTIONS 2012; 12:28-51. [PMID: 22485074 PMCID: PMC3319372 DOI: 10.1080/1533256x.2012.647580] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Military personnel engage in unhealthy alcohol use at rates higher than their same age, civilian peers, resulting in negative consequences for the individual and jeopardized force readiness for the armed services. Among those returning from combat deployment, unhealthy drinking may be exacerbated by acute stress reactions and injury, including traumatic brain injury (TBI). Combat-acquired TBI is common among personnel in the current conflicts. Although research suggests that impairments due to TBI leads to an increased risk for unhealthy drinking and consequences among civilians, there has been little research to examine whether TBI influences drinking behaviors among military personnel. This article examines TBI and drinking in both civilian and military populations and discusses implications for clinical care and policy.
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Affiliation(s)
- Rachel Sayko Adams
- Brandeis University, Heller School, Institute for Behavioral Health, Waltham, MA, USA
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Abstract
It is important for clinicians to recognize major depression following traumatic brain injury (TBI) because of its association with poor global and psychosocial outcome, postconcussive symptoms and cognitive deficits. The purpose of this review is to provide an up-to-date selective review of the current understanding of epidemiology, risk factors and management of major depression following TBI. Many studies of prevalence of depression following TBI have not used accepted structured criteria for the diagnoses, but those that did found wide ranges of rates, from 17% to 61%. The risk factors for development of depression following TBI are poorly understood, but past psychiatric history, frontal lesions and atrophy, and family dysfunction have been shown in more than one study to play important roles. There are few controlled trials of the treatment of major depression in patients with TBI using accepted diagnostic criteria for major depression, as well as defined criteria for response and remission. As such, it is important for clinicians to use best practice guidelines for the treatment of major depression in the absence of TBI.
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Affiliation(s)
- Mark J Rapoport
- Sunnybrook Health Sciences Centre, Geriatric Traumatic Brain Injury Clinic, Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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A Guide for the Assessment and Treatment of Suicidal Patients With Traumatic Brain Injuries. J Head Trauma Rehabil 2011; 26:244-56. [DOI: 10.1097/htr.0b013e3182225528] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Himanen L, Portin R, Hämäläinen P, Hurme S, Hiekkanen H, Tenovuo O. Risk factors for reduced survival after traumatic brain injury: a 30-year follow-up study. Brain Inj 2011; 25:443-52. [PMID: 21401369 DOI: 10.3109/02699052.2011.556580] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PRIMARY OBJECTIVE To evaluate risk factors for reduced survival in subjects with traumatic brain injury (TBI). PARTICIPANTS AND METHODS A retrospective follow-up of three decades included 192 subjects with TBI. Cognitive testing was carried out on average 2 years after the injury (at mean age of 39.0 years), during the years 1966-1972. Cox's regression and logistic regression analyses were used and the survival of the subjects was compared with the general population using the standardized mortality ratio (SMR). RESULTS Reduced survival was significantly associated with age at injury (p < 0.001) and vocational outcome (p = 0.003). Vocational outcome in turn was associated with age (p = 0.010), TBI severity (p < 0.001), cognitive impairment (p = 0.010), later TBIs (p = 0.007) and alcohol abuse (p = 0.015). Mortality in the younger patient group (age at death <40 years) was higher than in the general population (SMR 4.50, 95% CI = 2.02-10.01). CONCLUSIONS A reduced working ability, influenced by age-, injury- and lifestyle-related factors, is associated with long-term survival after TBI. The mortality among younger patients is high, a finding which should be considered when planning the care after TBI.
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Affiliation(s)
- Leena Himanen
- Department of Neurology, Turku University Hospital, Turku, Finland.
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Breshears RE, Brenner LA, Harwood JEF, Gutierrez PM. Predicting Suicidal Behavior in Veterans With Traumatic Brain Injury: The Utility of the Personality Assessment Inventory. J Pers Assess 2010; 92:349-55. [DOI: 10.1080/00223891.2010.482011] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Blair JC. Prevalence, natural history and consequences of posttraumatic hypopituitarism: A case for endocrine surveillance. Br J Neurosurg 2010; 24:10-7. [DOI: 10.3109/02688690903536637] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Wasserman L, Shaw T, Vu M, Ko C, Bollegala D, Bhalerao S. An overview of traumatic brain injury and suicide. Brain Inj 2009; 22:811-9. [DOI: 10.1080/02699050802372166] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Schwarzbold M, Diaz A, Martins ET, Rufino A, Amante LN, Thais ME, Quevedo J, Hohl A, Linhares MN, Walz R. Psychiatric disorders and traumatic brain injury. Neuropsychiatr Dis Treat 2008; 4:797-816. [PMID: 19043523 PMCID: PMC2536546 DOI: 10.2147/ndt.s2653] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Psychiatric disorders after traumatic brain injury (TBI) are frequent. Researches in this area are important for the patients' care and they may provide hints for the comprehension of primary psychiatric disorders. Here we approach epidemiology, diagnosis, associated factors and treatment of the main psychiatric disorders after TBI. Finally, the present situation of the knowledge in this field is discussed.
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Affiliation(s)
- Marcelo Schwarzbold
- Núcleo de Pesquisas em Neurologia Clínica e Experimental (NUPNEC), Departamento de Clínica Médica, Hospital Universitário, UFSC Florianópolis, SC, Brazil.
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