TBI in Mental Health & Substance Use Service Settings (Research Summary)

Brain injury, mental health, and substance use are interconnected, yet brain injury is frequently left out of the conversation. A research team from the University of Toronto published a research study in The Journal of Head Trauma Rehabilitation exploring traumatic brain injury history among individuals accessing mental health and substance use services.

What do we already know?

A growing body of research shows that existing mental health and substance use (MHSU) problems increase a person’s risk of sustaining a traumatic brain injury (TBI)

• And vice versa: TBI increases a person’s risk of developing a MHSU problem

TBI may be underrecognized in MHSU settings due to:

• Overlap in TBI and MHSU symptoms
• Gaps in care-seeking and follow-up for TBIs
• Poor integration between TBI and MHSU sectors

Identifying prior TBI can help MHSU clinicians make care plans and better understand the person’s behaviours & symptoms

What did they want to know?

The researchers wanted to understand:

(1) The prevalence of TBI history among individuals accessing MHSU services

• How many people are affected by TBI and MHSU?

(2) How TBI history has been identified within MHSU service settings

• What tools/measures are used to identify/diagnose TBI?

(3) What predictors or outcomes of TBI have been reported in these service settings.

• Is TBI connected to factors like mental health symptoms, gender, substance use, physical health concerns, or aggression?

What did they do?

Conducted a scoping review

• Follows a step-by-step process
• A method for synthesizing (bringing together) evidence from many research studies
• Goal: Identify the scope and extent of existing research on a topic (what do we already know, what are the gaps in our knowledge)

Searched a research database using keywords related to TBI, MHSU, and screening + gray literature search (targeted Google search to find additional relevant documents)

• Sorted to find relevant research papers
• Extracted data from each paper (e.g., study design, who the participants were, TBI screening tool used) and compared findings

What did they find?

#1: How many people are affected by TBI and MHSU?

• Most studies found >25% of people accessing MHSU services had history of TBI
• Half of these studies found TBI rates >50%

#2: What tools/measures are used to identify/diagnose TBI?

Variety of tools used to identify TBI

• Including: self-report (asking the person questions about their TBI history), prior medical documentation, report from family/friend

Self-report identified the most TBIs

#3: Is TBI connected to factors like mental health symptoms, gender, substance use, physical health concerns, or aggression?

For people accessing MHSU services, history of a TBI was associated with:

• More severe mental health symptoms
• Greater likelihood of having a personality disorder diagnosis
• More severe substance use (e.g., recent SU, longer SU, use of multiple substances)
• More physical health concerns (e.g., headaches)
• Deteriorating or ongoing unstable functioning (ability to meet personal care, social, or occupational functioning)
• Male gender (i.e., men had higher rates of TBI)
• Increased hostility and aggression

Some studies found TBI related to cognitive difficulties, whereas other studies found no association

What does this mean?

MHSU service users more likely to have TBI than general population

• TBI and MHSU service providers need to work together to provide effective support
• Providing TBI-specific support (e.g., CBT with memory strategies) may improve intervention effectiveness and health outcomes

Structured self-report questionnaires to assess TBI history is best practice

• Relying on medical documentation alone may underreport injuries
• MHSU clinicians should screen for brain injury in their initial assessment

Recommendations for future research:

• Longitudinal MHSU studies that assess for TBI at beginning – will provide info on TBI and MHSU symptoms and service use over time
• Studies on TBI and MHSU in youth – onset of most mental illnesses occurs in adolescence/young adulthood

Source: Davies, J., Dinyarian, C., Wheeler, A. L., Dale, C. M., & Cleverley, K. (2023). Traumatic Brain Injury History Among Individuals Using Mental Health and Addictions Services: A Scoping Review. The Journal of Head Trauma Rehabilitation, 38(1), E18-E32.

doi: 10.1097/HTR.0000000000000780

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