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Biased reporting of past self-injurious thoughts and behaviors: A literature review. J Affect Disord 2022; 308:596-606. [PMID: 35429538 DOI: 10.1016/j.jad.2022.04.073] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 03/03/2022] [Accepted: 04/10/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Accurate assessment of suicide risk is critical for clinical practice, empirical advances, and informing public policy. In this narrative review of the literature, we compiled evidence from longitudinal studies that identify reporting bias of past self-injurious thoughts and behaviors (SITB) and examined possible correlates of inconsistent reporting. METHOD We conducted an extensive literature search, including 19 longitudinal samples or subsamples who reported the presence of current or past SITB at an initial but not at a subsequent assessment (yes/no inconsistent reports). RESULTS The median was 33%, and the weighted mean was 39% (95% CI, 37%-41%) for the prevalence of inconsistent reporting of SITB across the longitudinal samples. Importantly, inconsistent reports were linked with less internalizing psychopathology and more adaptive functioning. The type of sample recruited and assessment interval may also be relevant factors to consider. LIMITATIONS Variability of sample characteristics and methodology made it challenging to draw firm conclusions across studies but provide information about critical sources of bias. CONCLUSIONS Results suggest considerable caution for clinical, empirical, and policy decision-making based on lifetime reports of suicide and encourage a continued consideration for identifying potential reporting biases for SITB.
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Gilmore CS, Lim KO, Garvin MK, Wang JK, Ledolter J, Fenske AL, Gentz CL, Nellis J, Armstrong MT, Kardon RH. Association of Optical Coherence Tomography With Longitudinal Neurodegeneration in Veterans With Chronic Mild Traumatic Brain Injury. JAMA Netw Open 2020; 3:e2030824. [PMID: 33351088 PMCID: PMC7756235 DOI: 10.1001/jamanetworkopen.2020.30824] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
IMPORTANCE Mild traumatic brain injury (TBI) may predispose individuals to progressive neurodegeneration. OBJECTIVE To identify evidence of neurodegeneration through longitudinal evaluation of changes in retinal layer thickness using optical coherence tomography in veterans with a history of mild TBI. DESIGN, SETTING, AND PARTICIPANTS This longitudinal cohort study evaluated veterans who were receiving services at the Minneapolis Veterans Affairs Health Care System. Symptomatic or mild TBI was diagnosed according to the Mayo TBI Severity Classification System. Participants in the age-matched control group had no history of TBI. Participants with any history or evidence of retinal or optic nerve disease that could affect retinal thickness were excluded. Data analysis was performed from July 2019 to February 2020. EXPOSURES The presence and severity of mild TBI were determined through consensus review of self-report responses during the Minnesota Blast Exposure Screening Tool semistructured interview. MAIN OUTCOMES AND MEASURES Change over time of retinal nerve fiber layer (RNFL) thickness. RESULTS A total of 139 veterans (117 men [84%]; mean [SD] age, 49.9 [11.1] years) were included in the study, 69 in the TBI group and 70 in the control group. Veterans with mild TBI showed significantly greater RNFL thinning compared with controls (mean [SE] RNFL slope, -1.47 [0.24] μm/y vs -0.31 [0.32] μm/y; F1,122 = 8.42; P = .004; Cohen d = 0.52). Functionally, veterans with mild TBI showed greater declines in visual field mean deviation (mean [SE] slope, -0.09 [0.14] dB/y vs 0.46 [0.23] dB/y; F1,122 = 4.08; P = .046; Cohen d = 0.36) and pattern standard deviation (mean [SE] slope, 0.09 [0.06] dB/y vs -0.10 [0.07] dB/y; F1,122 = 4.78; P = .03; Cohen d = 0.39) and high spatial frequency (12 cycles/degree) contrast sensitivity compared with controls. Cognitively, there was a significantly greater decrease in the number of errors over time during the Groton Maze Learning Test (GMLT) in controls compared with veterans with mild TBI (mean [SE] slope, -9.30 [1.48] errors/y vs -5.23 [1.24] errors/y; F1,127 = 4.43; P = .04; Cohen d = 0.37). RNFL tissue loss was significantly correlated with both worsening performance on the GMLT over time (Spearman ρ = -0.20; P = .03) and mild TBI severity (Spearman ρ = -0.25; P = .006). The more severe the mild TBI (larger Minnesota Blast Exposure Screening Tool severity score), the faster the reduction in RNFL thickness (ie, the more negative the slope) across time. CONCLUSIONS AND RELEVANCE This cohort study found longitudinal evidence for significant, progressive neural degeneration over time in veterans with mild TBI, as indicated by greater RNFL tissue loss in patients with mild TBI vs controls, as well as measures of function. These results suggest that these longitudinal measures may be useful biomarkers of neurodegeneration. Changes in this biomarker may provide early detection of subsequent cognitive and functional deficits that may impact veterans' independence and need for care.
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Affiliation(s)
- Casey S. Gilmore
- Minneapolis VA Healthcare System, Minneapolis, Minnesota
- Defense and Veterans Brain Injury Center, Minneapolis, Minnesota
| | - Kelvin O. Lim
- Minneapolis VA Healthcare System, Minneapolis, Minnesota
- Defense and Veterans Brain Injury Center, Minneapolis, Minnesota
- Department of Psychiatry, University of Minnesota, Minneapolis
| | - Mona K. Garvin
- Center for the Prevention and Treatment of Visual Loss, Iowa City VA Healthcare System, Iowa City, Iowa
- Department of Electrical and Computer Engineering, University of Iowa, Iowa City
| | - Jui-Kai Wang
- Center for the Prevention and Treatment of Visual Loss, Iowa City VA Healthcare System, Iowa City, Iowa
- Department of Electrical and Computer Engineering, University of Iowa, Iowa City
| | - Johannes Ledolter
- Department of Electrical and Computer Engineering, University of Iowa, Iowa City
- Department of Business Analytics and Department of Statistics and Actuarial Science, University of Iowa, Iowa City
| | - Alicia L. Fenske
- Minneapolis VA Healthcare System, Minneapolis, Minnesota
- Defense and Veterans Brain Injury Center, Minneapolis, Minnesota
| | - Carolyn L. Gentz
- Minneapolis VA Healthcare System, Minneapolis, Minnesota
- Defense and Veterans Brain Injury Center, Minneapolis, Minnesota
| | - Julie Nellis
- Center for the Prevention and Treatment of Visual Loss, Iowa City VA Healthcare System, Iowa City, Iowa
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City
| | - Michael T. Armstrong
- Minneapolis VA Healthcare System, Minneapolis, Minnesota
- Defense and Veterans Brain Injury Center, Minneapolis, Minnesota
| | - Randy H. Kardon
- Center for the Prevention and Treatment of Visual Loss, Iowa City VA Healthcare System, Iowa City, Iowa
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City
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Challenges of Conducting Research With Young Offenders With Traumatic Brain Injury. J Head Trauma Rehabil 2019; 33:378-381. [PMID: 29863611 DOI: 10.1097/htr.0000000000000392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The purpose of this commentary is to highlight the challenges encountered when conducting research with young offenders. This is drawn from the first-hand experience of 3 researchers working on separate projects within this environment. Young offenders present as a complex clinical population with high levels of illiteracy, substance abuse, and mental health issues. Significant planning is therefore required before working with this group. Consideration must be given to the heterogeneity of prison populations alongside the potential limitations of datacollection methods, in particular, reliance on self-report. The capacity of young offenders to comprehend and effectively engage with research is also of concern, posing issues of both a practical and ethical nature. The absence of a consistent "research culture" within prison environments poses further practical challenges, potentially also placing significant burden on both researchers and prison resources. The challenges discussed in this article may help inform future studies in the area and emphasize the need for greater critical reflection among researchers conducting work of this type.
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Anxiety Disorders in Adults With Childhood Traumatic Brain Injury: Evidence of Difficulties More Than 10 Years Postinjury. J Head Trauma Rehabil 2019; 33:191-199. [PMID: 28520662 DOI: 10.1097/htr.0000000000000312] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To explore long-term psychiatric outcomes in individuals with a history of childhood traumatic brain injury (TBI) or orthopedic injury (OI). SETTING Hospital emergency department, medical admission records and outpatient settings. PARTICIPANTS There were 95 males (M = 22.78 years, SD = 3.44 years) and 74 females (M = 22.27 years, SD = 3.09 years), 65 with mild TBI (M = 23.25 years, SD = 3.58 years), 61 with moderate-severe TBI (M = 22.34 years, SD = 2.79 years), and 43 with OI (M = 21.81 years, SD = 3.36 years). DESIGN Longitudinal, between-subjects, cross-sectional design using retrospective and current data. MAIN MEASURES Semistructured interview to obtain psychiatric diagnoses and background information, and medical records for identification of TBI. RESULTS Group with moderate-severe TBI presented with significantly higher rates of any anxiety disorder (χ2 = 6.81, P = .03) and comorbid anxiety disorder (χ2 = 6.12, P < .05). Group with overall TBI presented with significantly higher rates of any anxiety disorder (χ1 = 5.36, P = .02), panic attacks (χ1 = 4.43, P = .04), specific phobias (χ1 = 4.17, P = .04), and depression (χ1 = 3.98, P < .05). Prediction analysis revealed a statistically significant model (χ7 = 41.84, P < .001) explaining 23% to 37% of the variance in having any anxiety disorder, with significant predictors being group (TBI) and gender (female). CONCLUSIONS Children who have sustained a TBI may be vulnerable to persistent anxiety, panic attacks, specific phobias, and depression, even 13 years after the injury event.
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McKinlay A, Lin A, Than M. A comparison of emergency department medical records to parental self-reporting of traumatic brain injury symptoms. Concussion 2018; 3:CNC52. [PMID: 30202594 PMCID: PMC6093711 DOI: 10.2217/cnc-2017-0017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 12/14/2017] [Indexed: 11/29/2022] Open
Abstract
Aim: Studies have shown Emergency Department (ED) recording of traumatic brain injury (TBI) cases to be poor. Methods: Parents of children aged 2–12 who attended an ED with injury to the head completed a concussion checklist which was compared with medical records. Results: ED medical records commonly used head injury (HI), concussion, minor-HI and mild-HI without distinction between TBI and superficial HI. Recalled symptoms included vomiting, blurred vision and headaches versus headaches, fatigue and feeling sick from parents who reported more concussive symptoms. More cases of TBI were identifiable from parental recall compared with medical records, which recorded fewer symptoms for diagnosis, prognosis and statistical reporting of TBI. Conclusion: Clear guidelines need to be implemented to improve retrospective diagnosis for incidence gathering and future clinical use.
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Affiliation(s)
- Audrey McKinlay
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria 3010, Australia.,Department of Psychology, University of Canterbury, Christchurch, New Zealand.,Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria 3010, Australia.,Department of Psychology, University of Canterbury, Christchurch, New Zealand
| | - Alanah Lin
- School of Medicine, Christchurch Campus, University of Otago, Christchurch, New Zealand.,School of Medicine, Christchurch Campus, University of Otago, Christchurch, New Zealand
| | - Martin Than
- Department of Emergency Medicine, Christchurch Hospital, Christchurch, New Zealand.,Department of Emergency Medicine, Christchurch Hospital, Christchurch, New Zealand
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Lifetime History of Traumatic Brain Injury and Current Disability Among Ohio Adults. J Head Trauma Rehabil 2018; 33:E24-E32. [DOI: 10.1097/htr.0000000000000352] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Childhood Trauma and Lifetime Traumatic Brain Injury Among Individuals Who Are Homeless. J Head Trauma Rehabil 2018; 33:185-190. [DOI: 10.1097/htr.0000000000000310] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ma Z, Bayley MT, Perrier L, Dhir P, Dépatie L, Comper P, Ruttan L, Lay C, Munce SEP. The association between adverse childhood experiences and adult traumatic brain injury/concussion: a scoping review. Disabil Rehabil 2018; 41:1360-1366. [DOI: 10.1080/09638288.2018.1424957] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Zechen Ma
- Hull-Ellis Concussion Research Centre, Toronto Rehabilitation Institute, Toronto, Canada
| | - Mark T. Bayley
- Hull-Ellis Concussion Research Centre, Toronto Rehabilitation Institute, Toronto, Canada
| | - Laure Perrier
- Gerstein Science Information Centre, University of Toronto, Toronto, Canada
| | - Priya Dhir
- Faculty of Medicine, University of Toronto, Toronto, Canada
- The Hospital for Sick Children, Toronto, Canada
| | | | - Paul Comper
- Hull-Ellis Concussion Research Centre, Toronto Rehabilitation Institute, Toronto, Canada
| | - Lesley Ruttan
- Hull-Ellis Concussion Research Centre, Toronto Rehabilitation Institute, Toronto, Canada
| | - Christine Lay
- Centre for Headache, Women’s College Hospital, Toronto, Canada
| | - Sarah E. P. Munce
- Hull-Ellis Concussion Research Centre, Toronto Rehabilitation Institute, Toronto, Canada
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Albicini M, Eggleston M, McKinlay A. The prevalence of traumatic brain injury, comorbid anxiety and other psychiatric disorders in an outpatient child and adolescent mental health service. J Ment Health 2017; 29:439-445. [DOI: 10.1080/09638237.2017.1385733] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Michelle Albicini
- Faculty of Medicine Nursing and Health Sciences, School of Psychological Sciences, Monash University, Clayton, Australia,
- School of Psychological Sciences, University of Melbourne, Melbourne, Australia, and
| | - Matthew Eggleston
- Child and Family Specialty Service, Canterbury District Health Board, Christchurch, New Zealand
| | - Audrey McKinlay
- School of Psychological Sciences, University of Melbourne, Melbourne, Australia, and
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10
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Bernstein J, Calamia M. Characteristics of a Mild Traumatic Brain Injury Sample Recruited Using Amazon's Mechanical Turk. PM R 2017. [DOI: 10.1016/j.pmrj.2017.06.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Gardner RC, Langa KM, Yaffe K. Subjective and objective cognitive function among older adults with a history of traumatic brain injury: A population-based cohort study. PLoS Med 2017; 14:e1002246. [PMID: 28267747 PMCID: PMC5340352 DOI: 10.1371/journal.pmed.1002246] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 01/25/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Traumatic brain injury (TBI) is extremely common across the lifespan and is an established risk factor for dementia. The cognitive profile of the large and growing population of older adults with prior TBI who do not have a diagnosis of dementia, however, has not been well described. Our aim was to describe the cognitive profile associated with prior TBI exposure among community-dwelling older adults without dementia-an understudied but potentially vulnerable population. METHODS AND FINDINGS In this population-based cohort study, we studied 984 community-dwelling older adults (age 51 y and older and their spouses) without dementia who had been randomly selected from respondents to the 2014 wave of the Health and Retirement Study to participate in a comprehensive TBI survey and who either reported no prior TBI (n = 737) or prior symptomatic TBI resulting in treatment in a hospital (n = 247). Mean time since first TBI was 38 ± 19 y. Outcomes assessed included measures of global cognitive function, verbal episodic memory, semantic fluency, and calculation as well as a measure of subjective memory ("How would you rate your memory at the present time?"). We compared outcomes between the two TBI groups using regression models adjusting for demographics, medical comorbidities, and depression. Sensitivity analyses were performed stratified by TBI severity (no TBI, TBI without loss of consciousness [LOC], and TBI with LOC). Respondents with TBI were younger (mean age 64 ± 10 y versus 68 ± 11 y), were less likely to be female, and had higher prevalence of medical comorbidities and depression than respondents without TBI. Respondents with TBI did not perform significantly differently from respondents without TBI on any measure of objective cognitive function in either raw or adjusted models (fully adjusted: global cognitive function score 15.4 versus 15.2, p = 0.68; verbal episodic memory score 4.4 versus 4.3, p = 0.79; semantic fluency score 15.7 versus 14.0, p = 0.21; calculation impairment 22% versus 26%, risk ratio [RR] [95% CI] = 0.86 [0.67-1.11], p = 0.24). Sensitivity analyses stratified by TBI severity produced similar results. TBI was associated with significantly increased risk for subjective memory impairment in models adjusted for demographics and medical comorbidities (29% versus 24%; RR [95% CI]: 1.26 [1.02-1.57], p = 0.036). After further adjustment for active depression, however, risk for subjective memory impairment was no longer significant (RR [95% CI]: 1.18 [0.95-1.47], p = 0.13). Sensitivity analyses revealed that risk of subjective memory impairment was increased only among respondents with TBI with LOC and not among those with TBI without LOC. Furthermore, the risk of subjective memory impairment was significantly greater among those with TBI with LOC versus those without TBI even after adjustment for depression (RR [95% CI]: partially adjusted, 1.38 [1.09-1.74], p = 0.008; fully adjusted, 1.28 [1.01-1.61], p = 0.039). CONCLUSIONS In this population-based study of community-dwelling older adults without dementia, those with prior TBI with LOC were more likely to report subjective memory impairment compared to those without TBI even after adjustment for demographics, medical comorbidities, and active depression. Lack of greater objective cognitive impairment among those with versus without TBI may be due to poor sensitivity of the cognitive battery or survival bias, or may suggest that post-TBI cognitive impairment primarily affects executive function and processing speed, which were not rigorously assessed in this study. Our findings show that among community-dwelling non-demented older adults, history of TBI is common but may not preferentially impact cognitive domains of episodic memory, attention, working memory, verbal semantic fluency, or calculation.
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Affiliation(s)
- Raquel C. Gardner
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, California, United States of America
- San Francisco Veterans Affairs Medical Center, San Francisco, California, United States of America
- * E-mail:
| | - Kenneth M. Langa
- Division of General Medicine, University of Michigan Health System, Ann Arbor, Michigan, United States of America
- Veterans Affairs Center for Practice Management and Outcomes Research, Ann Arbor, Michigan, United States of America
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan, United States of America
- Institute of Gerontology, University of Michigan, Ann Arbor, Michigan, United States of America
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Kristine Yaffe
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, California, United States of America
- San Francisco Veterans Affairs Medical Center, San Francisco, California, United States of America
- Department of Psychiatry, University of California San Francisco, San Francisco, California, United States of America
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California, United States of America
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McKinlay A, Albicini M. Prevalence of traumatic brain injury and mental health problems among individuals within the criminal justice system. ACTA ACUST UNITED AC 2016; 1:CNC25. [PMID: 30202566 PMCID: PMC6093757 DOI: 10.2217/cnc-2016-0011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 10/26/2016] [Indexed: 11/21/2022]
Abstract
Traumatic brain injury (TBI) is associated with increased aggression and antisocial behavior. This review examined existing literature regarding TBI prevalence and associated adverse mental health among individuals within the criminal justice system. TBI prevalence varied between 12 and 82% for youths, and 23 and 87% for adults. TBI was associated with a range of negative outcomes, particularly substance abuse. However, confounding factors, including differing control groups, lack of information for timing and severity of TBI, and use of self-report measures for TBI history made it difficult to determine whether TBI was a risk factor. Future research should eliminate or counter for these confounds, to provide accurate prevalence rates of TBI and the direction of association between TBI and offending behaviors.
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Affiliation(s)
- Audrey McKinlay
- Melbourne School of Psychological Science, The University of Melbourne, Melbourne, Australia.,Melbourne School of Psychological Science, The University of Melbourne, Melbourne, Australia
| | - Michelle Albicini
- School of Psychological Sciences, Monash University, Melbourne, Australia.,School of Psychological Sciences, Monash University, Melbourne, Australia
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Accuracy of Self-report as a Method of Screening for Lifetime Occurrence of Traumatic Brain Injury Events that Resulted in Hospitalization. J Int Neuropsychol Soc 2016; 22:717-23. [PMID: 27265159 DOI: 10.1017/s1355617716000497] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Traumatic brain injury (TBI) occurs frequently during child and early adulthood, and is associated with negative outcomes including increased risk of drug abuse, mental health disorders and criminal offending. Identification of previous TBI for at-risk populations in clinical settings often relies on self-report, despite little information regarding self-report accuracy. This study examines the accuracy of adult self-report of hospitalized TBI events and the factors that enhance recall. METHODS The Christchurch Health and Development Study is a birth cohort of 1265 children born in Christchurch, New Zealand, in 1977. A history of TBI events was prospectively gathered at each follow-up (yearly intervals 0-16, 18, 21, 25 years) using parental/self-report, verified using hospital records. RESULTS At 25 years, 1003 cohort members were available, with 59/101 of all hospitalized TBI events being recalled. Recall varied depending on the age at injury and injury severity, with 10/11 of moderate/severe TBI being recalled. Logistic regression analysis indicated that a model using recorded loss of consciousness, age at injury, and injury severity, could accurately classify whether or not TBI would be reported in over 74% of cases. CONCLUSIONS This research demonstrates that, even when individuals are carefully cued, many instances of TBI will not recalled in adulthood despite the injury having required a period of hospitalization. Therefore, screening for TBI may require a combination of self-report and review of hospital files to ensure that all cases are identified. (JINS, 2016, 22, 717-723).
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