University Traumatic Brain Injury Identification Research Articles

The prevalence of traumatic brain injury, comorbid anxiety and other psychiatric disorders in an outpatient child and adolescent mental health service

Background: A history of traumatic brain injury (TBI) is prevalent in children and adolescents within the health system, which may be accompanied with higher rates of poor mental health outcomes including anxiety and other psychiatric disorders.Aims: To explore rates of TBI and associated anxiety and other psychiatric diagnoses in children and adolescents aged 5–18 years within the mental health system.Methods: Participants were recruited from an outpatient mental health service in Canterbury, New Zealand. The Ohio State University TBI Identification method was utilised to ascertain TBI history. Anxiety and other diagnoses were identified by a mental health file review.Results: Over 28% of children in this study reported a history of TBI, the majority of which were mild. Review of mental health files revealed no significant differences between participants with and without TBI for anxiety and psychiatric diagnoses.Conclusions: A proportionately high number of children and adolescents within the mental health system reported a previous TBI. However, anxiety and other psychiatric problems were not over-represented in this group. Further research is essential for examining the characteristics of children and adolescents with TBI within the mental health system, particularly those with more severe injuries, who may present a subgroup.

Characteristics of a Mild Traumatic Brain Injury Sample Recruited Using Amazon’s Mechanical Turk

BackgroundSeveral barriers exist in the recruitment of individuals with a history of mild traumatic brain injury (mTBI). The current study is the first to examine whether crowdsourcing, which has been used in other clinical populations, is useful in the recruitment of those with mTBI. ObjectiveTo examine whether Amazon’s Mechanical Turk (MTurk), an online crowdsourcing platform, is a useful tool in the recruitment of individuals with a history of mTBI and to examine the injury and psychological characteristics of individuals who report a history of mTBI. DesignRetrospective, cross-sectional study. SettingOnline. ParticipantsA total of 468 MTurk workers (215 who reported mTBI history on the screener, 253 who did not). MethodsComparison of MTurk participants (“workers”) who report a history of mTBI on a one-item screener and/or a more comprehensive mTBI assessment tool (ie, the Ohio State University Traumatic Brain Injury Identification Method [OSU TBI-ID]) with workers who do not report mTBI history. Main Outcome MeasuresPrevalence rates of mTBI in the MTurk sample (one-item screener and/or OSU TBI-ID), associations between self-reported mTBI with history of psychological disorders and current psychological symptoms (ie, selected Patient-Reported Outcomes Measurement Information System scales). ResultsOf workers who reported a history of mTBI on the screener, 169 (79%) met mTBI criteria on the OSU TBI-ID. Compared with those who denied history of mTBI on both the screener and OSU TBI-ID, workers who reported a history of mTBI on both measures were more likely to have a history of diagnosed depression (P = .008), anxiety (P = .007) or attention deficit-hyperactivity disorder (P = .04), and were more likely to currently experience cognitive (P = .01) and sleep disorder symptoms (P = .003). ConclusionsWorkers recruited via MTurk with history of mTBI show similar rates of psychological disorder history and current symptoms to samples recruited via noncrowdsourcing methods in previous studies. MTurk may be a useful recruitment tool in the mTBI population and should be used in future studies of outcomes after mTBI. Level of EvidenceIII

The Prevalence of Traumatic Brain Injury Among People With Co-Occurring Mental Health and Substance Use Disorders.

To estimate the rate and severity of traumatic brain injury (TBI) among people with co-occurring mental health and substance use disorders and to compare demographic, diagnostic, and institutionalization differences between those who screen positive or negative. Outpatient community mental health center in Washington, District of Columbia. A total of 295 people with co-occurring mental health and substance use disorders enrolled in a prospective study of integrated treatment of substance abuse. Cross-sectional baseline assessment. The Ohio State University TBI Identification Method. Standardized measures assessed psychiatric diagnoses, symptom severity, current and lifetime substance use, and history of institutionalization. Eighty percent screened positive for TBI, and 25% reported at least 1 moderate or severe TBI. TBI was associated with current alcohol use and psychiatric symptom severity and with lifetime institutionalization and homelessness. It was more common among participants with posttraumatic stress disorder, borderline personality disorder, and antisocial personality disorder. Men (vs women) and participants with psychotic disorders (vs those with mood disorders) had an earlier age of first TBI with loss of consciousness. TBI is common among people with co-occurring mental health and substance use disorders. Repeated and serious TBIs are common in this population. Failure to detect TBI in people with co-occurring disorders who are seeking integrated treatment could lead to misdiagnosis and inappropriately targeted treatment and rehabilitation.

Epidemiology and prognosis of mild traumatic brain injury in returning soldiers: A cohort study.

Mild traumatic brain injury (mTBI; concussion) is common in returning service members yet limited definitive evidence exists on its prognosis. Almost 25,000 non-medically evacuated soldiers returning from Afghanistan or Iraq to 2 military bases between 2009 and 2014 were screened for mTBI. We invited a random sample to participate in the present study, oversampling those screening positive, resulting in 557 mTBI cases and 1,010 controls, of whom 366 cases and 599 controls completed 3-month follow-up evaluations. The criterion measure of screened mTBI was the Ohio State University Traumatic Brain Injury Identification Method. Postconcussive symptoms (PCS) were measured at follow-up with the Neurobehavioral Symptom Inventory. Symptoms reported at a severe or very severe level were considered clinically relevant. About half (47%) of soldiers who had sustained an mTBI during this latest deployment reported PCS at 3-month follow-up vs 25% of controls: adjusted odds ratio 2.4 (1.8-3.2). The most commonly reported symptoms (cases vs controls) were sleep problems (30% vs 14%), forgetfulness (21% vs 9%), irritability (17% vs 8%), and headaches (15% vs 5%). mTBI cases were about twice as likely as controls to report receiving rehabilitative services and fair or poor health. Other predictors of PCS included posttraumatic stress, combat exposure, and noncephalic pain. A majority of both cases and controls reported traumatic brain injuries predating this latest deployment. In this nonclinical population of recently deployed soldiers, a substantial proportion of those who had sustained an mTBI were symptomatic 3 months postdeployment. Future studies need to include longer follow-up to measure symptom resolution. NCT01847040.

Traumatic Brain Injury and Recidivism Among Returning Inmates

In recent years, there has been a surge in research that examines the relationship between traumatic brain injury (TBI) and involvement in the criminal justice system. However, the bulk of this research has been largely retrospective and descriptive, comparing rates of TBI in the offending population with the rates of TBI in the general population. Although findings from these studies indicate a higher prevalence of TBI in the offending population, virtually no studies have examined whether those with TBI are more likely to recidivate. To address this gap, the present study examined rearrest post release from prison among a cohort sample of Indiana inmates who were screened using the Ohio State University Traumatic Brain Injury Identification (OSU-TBI-ID) instrument. Findings indicate that, net of control variables, those with TBI were more likely to recidivate sooner than those without TBI. Policy implications and directions for future research are discussed.

Brain Injury in Persons With Serious Mental Illness Who Have a History of Chronic Homelessness: Could This Impact How Services Are Delivered?

Clinicians completed interviews using the Ohio State University Traumatic Brain Injury Identification Method (TBI-ID) and sections of the Addiction Severity Index (ASI-Lite) with clients who were homeless and receiving community mental health services. Fifty-six percent of clients screened positive for TBI. Clients with a history of TBI were more likely to be using multiple substances, and were more likely to have, and be bothered by, family and emotional problems than clients without TBI. Homeless clients receiving mental health services may have undiagnosed TBI that could affect their ability to benefit from treatment. Such clients may require services that compensate for their cognitive deficits.

The Reliability of a Computer-Assisted Telephone Interview Version of the Ohio State University Traumatic Brain Injury Identification Method.

Provide test-retest reliability (>5 months) of the Ohio State University Traumatic Brain Injury Identification Method modified for use as a computer-assisted telephone interview (CATI) to capture traumatic brain injury (TBI) and other substantial bodily injuries among a representative sample of noninstitutionalized adults living in Colorado. Four subsamples of 50 individuals, including people with no major lifetime injury, a major lifetime injury but no TBI, TBI with no loss of consciousness, and TBI with loss of consciousness, were interviewed using the CATI Ohio State University Traumatic Brain Injury Identification Method between 6 and 18 months after an initial interview. Stratified random sample of Coloradans (n = 200) selected from a larger study of TBI. Cumulative, Severity and Age-related indices were assessed for long-term reliability. Cumulative indices were those that summed the total number of specific TBI severities across the lifetime; Severity indices included measures of the most severe type of injury incurred throughout the lifetime; and Age-related indices assessed the timing of specific injury types across the lifespan. Test-retest reliabilities ranged from poor to excellent. The indices demonstrating the greatest reliability were Severity measures, with intraclass correlations for ordinal indices ranging from 0.62 to 0.78 and Cohen κ ranging from 0.50 to 0.62. One Cumulative outcome demonstrated high reliability (0.70 for number of TBIs with loss of consciousness ≥30 minutes), while the remaining Cumulative outcomes demonstrated low reliability, ranging from 0.06 to 0.21. Age-related test-retest reliabilities were fair to poor, with intraclass correlations of 0.38 to 0.49 and Cohen κ of 0.32 and 0.34. The CATI-modified Ohio State University Traumatic Brain Injury Identification Method used in this study is an effective measure for evaluating the maximum TBI severity incurred throughout the lifetime within a general population survey. The CATI measure is not recommended for use in determining cumulative counts of lifetime incidence of TBI.

Prevalence of Self-Reported Lifetime History of Traumatic Brain Injury and Associated Disability: A Statewide Population-Based Survey.

To investigate the prevalence of all severities of traumatic brain injury (TBI), regardless of treatment setting, and their associated negative outcomes. A total of 2701 adult Coloradoans. A statewide, population-based, random digit-dialed telephone survey. The lifetime history of TBI was assessed by a modification of the Ohio State University TBI Identification Method; activity limitation and life satisfaction were also assessed. The distribution of self-reported lifetime injury was as follows: 19.8%, no injury; 37.7%, injury but no TBI; 36.4%, mild TBI; and 6.0%, moderate-severe TBI. Of those reporting a TBI, 23.1% were hospitalized, 38.5% were treated in an emergency department, 9.8% were treated in a physician's office, and 27.5% did not seek medical care. A clear gradient of activity limitations and low life satisfaction was seen, with the highest proportions of these negative outcomes occurring in people reporting more severe TBI and the lowest proportions in those not reporting a TBI. Approximately twice as many people reported activity limitations and low life satisfaction after nonhospitalized TBI compared with hospitalized TBI. This investigation highlights the seriousness of TBI as a public health problem and the importance of including all severities of TBI, no matter where, or if treated, in estimating the prevalence of disability co-occurring with TBI.

Risk of Negative Outcomes After Traumatic Brain Injury: A Statewide Population-Based Survey.

To investigate the rates of negative outcomes associated with all severities of traumatic brain injury (TBI), treated in all settings or not treated at all, in comparison to the general population. Coloradoans without injury, with injury but no TBI, with mild TBI but no loss of consciousness (LOC), mild TBI with LOC, moderate TBI, or severe TBI. Statewide population-based survey. Computer-assisted, modified Ohio State University TBI Identification Method; Behavioral Risk Factor Surveillance System and National Health Interview Survey questions; Satisfaction with Life Scale; and postconcussive symptoms. Up to 42.5% of participants reported a lifetime history of at least 1 TBI. Multiple negative outcomes were found to increase in prevalence in a stepwise fashion in association with greater TBI severity, with the clearest patterns observed for disability, poor life satisfaction, and impaired memory. Traumatic brain injury was found to be associated with disability and other negative outcomes in a general population survey. This study does not allow us to examine the proximate causes of disability, but it suggests that TBI may serve to both cause disability directly and exacerbate the influence of other etiologies. These relations should be examined in subsequent studies.

Pilot study of traumatic brain injury and alcohol misuse among service members

Objective: Explore relationships among traumatic brain injury (TBI), substance misuse and other mental health disorders in US service members and to identify risk factors for substance misuse.Participants: Service members (n = 93 in final sample) injured while deployed to Operation Enduring Freedom or Operation Iraqi Freedom.Methods and materials: Longitudinal survey at 6 and 12 months post-intake. The following measures were used: problem substance use, Alcohol Expectancies Questionnaire-III, MINI International Neuropsychiatric Interview Substance Abuse Modules, Ohio State University TBI Identification Method, Neurobehavioural Symptom Inventory, Rivermead Post-Concussion Symptoms Questionnaire, Buss-Perry Aggression Questionnaire, Post-Traumatic Stress Disorder Checklist-Civilian Version, Beck Depression Inventory-II, Beck Anxiety Inventory.Results: More severe TBI and post-traumatic stress disorder (PTSD) symptoms at 6 months post-enrolment were associated with decreased odds of substance misuse 12 months after study enrolment. Alcohol expectancies and incurring a TBI at a younger age increased the odds of substance misuse.Conclusions: While the ability to generalize the current findings to a larger population is limited, the results provide direction for future studies on the prevention and treatment of substance misuse following TBI. The unexpected protective effect of more severe TBI may result from prospective attention to the injury and its consequences. Greater preventive benefit may result from identifying more service members with elevated risk. Lifetime history of TBI and alcohol expectancies may be candidate indicators for greater attention.

Traumatic Brain Injury among Indiana State Prisoners

Research on traumatic brain injury among inmates has focused on comparing the rate of traumatic brain injury among offenders to the general population, but also how best to screen for traumatic brain injury among this population. This study administered the short version of the Ohio State University Traumatic Brain Injury Identification Method to all male inmates admitted into Indiana state prisons were screened for a month (N=831). Results indicate that 35.7% of the inmates reported experiencing a traumatic brain injury during their lifetime and that these inmates were more likely to have a psychiatric disorder and a prior period of incarceration than those without. Logistic regression analysis finds that a traumatic brain injury predicts the likelihood of prior incarceration net of age, race, education, and psychiatric disorder. This study suggests that brief instruments can be successfully implemented into prison screenings to help divert inmates into needed treatment.

The lifetime history of traumatic Brain injury and associated outcomes: a state-wide population-based survey

BackgroundThe number of non-hospitalised cases of traumatic brain injury (TBI) exceeds hospitalised cases, and the extent of disability following non-hospitalised TBI is unknown.Aims/Objectives/PurposeDocument the lifetime history of TBI in a...

Prevalence of Traumatic Brain Injury Among Prisoners in South Carolina

To determine lifetime prevalence of traumatic brain injury (TBI) in a statewide sample of prisoners. Retrospective and cross-sectional cohort study. Stratified random sample of prisoners scheduled to be released by release type for each gender (275 men and 267 women with completed sentences and 19 men and 15 women granted parole) and a random sample of prisoners by gender with lifetime or death sentences (26 men and 34 women). PRIMARY MEASURE: Weighted prevalence of TBI. In-person interviews ascertained history of TBI using a customized version of the Ohio State University TBI Identification Method. Sixty-five percent of male releases and nonreleases, and 72% and 73% of female releases and nonreleases, reported at least 1 TBI with an alteration of consciousness. Forty-two percent of male releases and 50% of nonreleases, and 50% of female releases and 33% of nonreleases, reported at least 1 TBI with loss of consciousness. Thirty-five percent of male releases and 42% of nonreleases, and 55% of female releases and 58% of nonreleases, reported ongoing symptoms from TBI. A substantial proportion of prisoners reported having experienced a TBI during their lifetime. The ongoing TBI symptoms reported by prisoners may impact their success on release.

Traumatic Brain Injury and Psychiatric Diagnoses in Veterans Seeking Outpatient Substance Abuse Treatment

Explore the incidence of traumatic brain injury (TBI) in veterans seeking outpatient substance abuse treatment and the association between TBI and psychiatric diagnoses. The Ohio State University TBI identification method (OSU TBI-ID) was administered to veterans with positive TBI-4 screens; substance-related and psychiatric diagnoses were extracted from the medical record. : Over an 18-month period, 247 veterans completed the TBI-4. Of the 136 who screened positive, 70 were administered the OSU TBI-ID. On the basis of the TBI-4, 55% (95% CI: 49%-61%) of veterans screened positive for a history of TBI. The OSU TBI-ID was used to confirm screening results. Those who completed the OSU TBI-ID sustained an average of 3.4 lifetime TBIs. For each additional TBI sustained, after initial injury, there was an estimated 9% increase in the number of psychiatric diagnoses documented (99% CI: 1%-17%). For each additional documented psychiatric diagnosis, there was an estimated increase of 11% in the number of injuries sustained (99% CI: 1%-22%). Also, 54% (38/70) had a positive history of TBI prior to adulthood. These results emphasize the need for TBI screening in this vulnerable population, as well as the importance of increasing brain injury awareness among those abusing substances and their care providers. These findings also highlight the need for specialized services for those with TBI and co-occurring substance misuse aimed at decreased future TBIs or negative psychiatric outcomes or both. Further study is needed to clarify best practices.

Initial Reliability and Validity of the Ohio State University TBI Identification Method

Evaluate the psychometric properties of indices of a lifetime history of traumatic brain injury (TBI). Convenience samples recruited from 2 treatment programs for persons with substance use disorders: N = 119 (study 1) and N = 103 (study 2) Test interrater reliability (study 1) and predictive validity (Study 2). Summary indices of the number, severity, timing, and effects of lifetime TBIs calculated from data elicited via a structured interview. Interrater reliability was high. Factor analysis showed indices could be characterized by severity weighted counts of the number of injuries, both lifetime and in childhood, number of symptoms persisting, worst injury, time since last TBI with loss of consciousness, and age at first TBI with loss of consciousness. Age at injury and symptoms persisting contributed independently to the prediction of common cognitive and behavioral consequences of TBI. These results provide preliminary support for the reliability and validity of summary indices of lifetime history of TBI elicited via a structured interview.