H - 30 California Surveillance of Mental Health Disparities in Survivors of Traumatic Brain Injury (TBI): a Randomized & Representative Sample.

Abstract

Traumatic Brain Injury (TBI) is a silent public health epidemic that begins as a medical condition ("neurometabolic cascade") that may develop into significant psychiatric symptoms that negatively impact community reintegration for survivors following injury ("neuropsychosocial cascade"). However, survivors may not seek medical attention for a variety of reasons (e.g., anosognosia, fear of retaliation, no insurance). Therefore, medical incidence does not necessarily reflect the community prevalence of TBI. The California Department of Rehabilitation, the Department of Public Health, and the State Survey Panel collected data from a randomized and representative sample of Californians (N = 1057) using three probability-based techniques, such that every Californian registered with the United States postal service had a non-zero chance of being selected. Respondents were evaluated using psychometrically established methods for screening history and symptoms of TBI. California rates of community prevalence ranged between 15% (estimated 4.2 million Californians) and 42%, depending on the definition of TBI used, highlighting significant disparities in operationalization. These rates were compared to the annual medical rates (< 1%) derived from the California Department of Public Health (2016-2020). This study revealed significantly higher rates of depression, anxiety, and neurocognitive disorders over three decades, on average, relative to the general California population: illustrating a disease process. Neuropsychiatric disparities were associated with dysfunctional community reintegration (e.g., home insecurity, justice system involvements, employment instability).