Social determinants of health associated with psychological distress stratified by lifetime traumatic brain injury status and sex: Cross-sectional evidence from a population sample of adults in Ontario, Canada

Abstract

This study identified the social determinants of health (SDoH) associated with psychological distress in adults with and without a self-reported history of traumatic brain injury (TBI), stratified by sex. Data from the 2014–2017 cycles of the Centre for Addiction and Mental Health Monitor Survey, a representative survey of adults ≥18 years in Ontario, Canada, were analyzed (N = 7,214). The six-item version of the Kessler Psychological Distress Scale was used to determine moderate to severe psychological distress. Self-reported lifetime TBI was defined as a head injury resulting in a loss of consciousness for ≥5 minutes or at least one-night stay in the hospital (16.4%). Among individuals reporting a history of TBI, 30.2% of males and 40.1% of females reported psychological distress (p = 0.0109). Among individuals who did not report a history of TBI, 17.9% of males and 23.5% of females reported psychological distress (p<0.0001). Multivariable logistic regression analyses showed that the SDoH significantly associated with elevated psychological distress were similar between individuals with and without a history of TBI. This included unemployment, student, or ‘other’ employment status among both males and females; income below the provincial median and age 65+ among males; and rural residence among females. This study highlighted opportunities for targeted population-level interventions, namely accessible and affordable mental health supports for individuals with lower income. Notably, this study presented evidence suggesting adaptations to existing services to accommodate challenges associated with TBI should be explored, given the finite and competing demands for mental health care and resources.

Exploring the Social Determinants of Health and Health Disparities in Traumatic Brain Injury: A Scoping Review

“…A person's SDoH can impact their overall health and well-being, and play a role in the potential health disparities, access to care, and treatment post injury that a person faces [9]. Despite the SDoH generally being related to non-medical factors, they have been noted to both positively and negatively influence the health outcomes [7,10,11]. In recent years, the amount of research on this topic has increased, specifically related to social factors [9,12].…”

“…In recent years, the amount of research on this topic has increased, specifically related to social factors [9,12]. An in-depth examination and clear understanding of an individual's SDoH in conjunction with planning for health services and providing support to available resources is vital for better public health achievement, promoting access to care, and preventing health inequalities [11,12]. Chan and colleagues write that influences on health outcomes can impact a given individual or a population and are important factors that may impact health and healthcare-related services [11].…”

Rehabilitation access for individuals with cognitive‐communication challenges after traumatic brain injury: A co‐design study with persons with lived experience

“…Barriers to accessing rehabilitation services have been reported internationally, including delays or lack of referral to services; failure of referring providers to detect or address subtle cognitive, communication, or emotional sequelae; lack of knowledge on the part of referral sources; service system complexities and navigation difficulties; limitations in funding or resources; and insufficient frequency or duration of services (Andelic et al., 2021; Chan et al., 2022; Knollman‐Porter et al., 2021; Shiner et al., 2022). These challenges in rehabilitation access appear to apply to most healthcare contexts and can be grouped according to three themes: system navigation and referral processes, funding and resource allocation and healthcare communications.…”

“…Services may be fragmented, individuals may require multiple types of rehabilitation services offered in different locations and systems, and those with TBI may be unfamiliar with healthcare systems and funding processes (Andelic et al., 2021; Fuentes et al., 2018), especially in regions without case coordination. Referral patterns also suggest a tendency for providers to prioritise physical concerns and activities of daily living over more subtle but frequent and debilitating emotional, cognitive and communication concerns (Andelic et al., 2021; Chan et al., 2022; Knollman‐Porter et al., 2021).…”

Financial Capability and Financial Well-Being Challenges and Vulnerabilities of Adults Living With Acquired Brain Injury: A Pilot Survey

“… 24 , 25 Concerningly, declines in or lower FWB after ABI are associated with threats to goal-attainment, recovery, stability in social relationships, community and social participation, health, and general well-being after ABI. 2 , 13 , 26 , 27 , 28 , 29 , 30 …”