Traumatic Brain Injury History Among Individuals Using Mental Health and Addictions Services: A Scoping Review

Abstract

Objective: Traumatic brain injury (TBI) has been increasingly linked in population research to psychiatric problems as well as substance use and related harms, suggesting that individuals with TBI may also present more frequently to mental health and addictions (MHA) services. Little is known, however, about TBI history among MHA service users. The objectives of this review were to understand (i) the prevalence of TBI history among MHA service users; (ii) how TBI history is identified in MHA service settings; and (iii) predictors or outcomes of TBI that have been reported in MHA service users. Methods: A scoping review was conducted in accordance with PRISMA Scoping Review Extension guidelines. A search for relevant literature was conducted in MEDLINE, PsycINFO, SPORTDiscus, CINAHL, and Embase as well as various gray literature sources. Results: Twenty-eight relevant studies were identified. TBI was defined and operationalized heterogeneously between studies, and TBI history prevalence rates ranged considerably among the study samples. The included studies used varied methods to identify TBI history in MHA settings, such as clinical chart audits, single-item questions, or structured questionnaires (eg, Brain Injury Screening Questionnaire or Ohio State University TBI Identification Method). TBI history was most consistently associated with indicators of more severe substance use problems and mental health symptoms as well as increased aggression or risk to others. Studies reported less consistent findings regarding the relationship of TBI to physical health, cognitive impairment, functioning, risk to self, and type of psychiatric diagnosis. Conclusion: Screening for TBI history in MHA settings may contribute important information for risk assessment and care planning. However, to be clinically useful, assessment of TBI history will require consistent operationalization of TBI as well as use of validated screening methods.

Implementing traumatic brain injury screening in behavioral health treatment settings: results of an explanatory sequential mixed-methods investigation

“…However, identifying, testing, and specifying the mechanisms through which these implementation strategies operate on EBP adoption are necessary to reduce implementation costs and expedite the public health benefit of EBPs through more precise implementation approaches. Nonetheless, given that over half of clients in behavioral healthcare settings have a lifetime exposure to TBI that affects their ability to fully engage in and benefit from treatment [ 3 , 74 ], tailored training and educational strategies are important first steps to changing the treatment landscape.…”

“…Translating this screening method from research into practice is particularly challenging because TBI is often viewed as a medical condition to be identified and addressed by medical professionals. Although TBI does sometimes require intensive medical intervention to address the physical effects of the injury (i.e., neuroendocrine dysfunction or subdural hematoma, for example), vast evidence has demonstrated that TBI can result in chronic cognitive, behavioral, and psychiatric conditions over the life course [ 84 , 85 ], which disproportionately affects individuals who seek care in behavioral health settings [ 3 ]. Despite how common TBI is in these settings, behavioral health providers often do not receive any formal education on TBI and hence enter the workforce unaware about the presence of TBI among clients or their roles in addressing these clients’ needs.…”

“…Traumatic brain injury (TBI) is an example of a common, yet under-identified chronic condition among individuals who seek treatment for substance use or mental health problems in behavioral healthcare settings [ 2 ]. An estimated 60% of individuals in these settings have a lifetime exposure to TBI that affects their ability to fully engage in and benefit from treatment [ 3 , 4 ]. Implementing universal screening for lifetime exposure to TBI is critical to preventing misdiagnoses and/or mislabeling clients as poorly motivated or “non-compliant” with treatment due to chronic cognitive and behavioral problems resulting from TBI [ 4 ].…”

Acute stress modulates the outcome of traumatic brain injury‐associated gene expression and behavioral responses

“…70%–90%), TBI is considered mild (mTBI) with a Glasgow Coma Scale score of 13–15 2,3 . Following TBI, patients frequently present neuropsychiatric problems (e.g., depression, anxiety) and substance abuse as a post‐TBI sequel 4,5 . In turn, previous mental health problems or substance abuse elevate a person's risk of experiencing TBI 6–8 …”

“…2,3 Following TBI, patients frequently present neuropsychiatric problems (e.g., depression, anxiety) and substance abuse as a post-TBI sequel. 4,5 In turn, previous mental health problems or substance abuse elevate a person's risk of experiencing TBI. [6][7][8] So far, the impact of a patient's stress load before TBI has been largely neglected when predicting outcomes following mTBI.…”