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Pediatric Brain Injury

Mental Health Impacts of TBI

The Mental Health Impacts of Traumatic Brain Injury

6 December 2023   |   Gyrus Group

Traumatic brain injury (TBI) presents a substantial risk of precipitating a range of psychiatric and behavioural issues, extending the consequences of the injury beyond the initial physical trauma (Reekum et al., 2000). This article provides a brief overview of the mental health impacts associated with TBI.

In the immediate aftermath of a TBI, patients commonly experience cognitive disturbances. This can range from confusion and difficulty maintaining attention in mild TBI (e.g., concussion) to profound amnesia for events surrounding and following the injury in more severe TBI (Tsai et al., 2021). Immediate cognitive disturbance is a useful marker of injury severity. Cognitive disturbances typically improve linearly in the months following a TBI (Christensen et al., 2008). Alongside cognitive disturbance, patients who are otherwise placid may show unusual aggression, agitation, and irritability in the acute stages of a brain injury (Stéfan et al., 2016). These symptoms are likely to subside over time, but may persist as a lasting personality change, depending on the nature of the injury (Prigatano, 1992).

Beyond cognitive complaints, psychiatric consequences of TBI may not emerge until the post-acute (longer term) phase of recovery. A review by Vaishnavi et al. (2009) outlined the prevalence psychiatric diagnoses following TBI, with more prevalent conditions including cognitive impairment (25% – 70%), insomnia (30% – 70%), anxiety (10% to 70%), and major depression (25% – 50%). Less prevalent psychiatric conditions following TBI included aggression (30%), apathy (10%), mania (1% – 10%), and psychosis (3% – 8%). Further compounding psychiatric and physical recovery following brain injury, TBI is associated with increased risk of substance misuse and the development of a substance use disorder (Olsen & Corrigan, 2022), and an increased risk of suicidality (suicidal ideation and/or behaviour; Simpson & Tate, 2007). Alongside having significant impact on the patient’s quality of life, psychiatric disorder following TBI can have lasting implications for the patient’s psychosocial functioning(McLean et al., 1993), and can cause difficulties in the patient’s relationships with their friends and families (Chan et al., 2009).

Neurorehabilitation following TBI often focuses on physical recovery, including physical therapy, speech and language therapy, and occupational therapy. Given the risk for psychiatric disturbance as a consequence of TBI, rehabilitation efforts should also incorporate psychiatric support. Research has indicated that medium- and high-intensity therapeutic rehabilitation is beneficial in reducing risk of psychiatric disorder following TBI (Yeh et al., 2020) and that Gradient Exposure Therapy (GET) may reduce harm-avoidance behaviour associated with anxiety and post-traumatic stress disorder following TBI (Silverberg et al., 2022). Currently, Cognitive Behavioural Therapy (CBT) remains among the most widely-used approach to reducing psychiatric disturbance following brain injury (Gómez-De-Regil et al., 2019), and is the most widely available therapeutic approach within the UK, via the NHS.

References

Chan, J., Parmenter, T., & Stancliffe, R. (2009). The impact of traumatic brain injury on the mental health outcomes of individuals and their family carers. Australian E-Journal for the Advancement of Mental Health, 8(2), 155–164. https://doi.org/10.5172/JAMH.8.2.155

Christensen, B. K., Colella, B., Inness, E., Hebert, D., Monette, G., Bayley, M., & Green, R. E. (2008). Recovery of Cognitive Function After Traumatic Brain Injury: A Multilevel Modeling Analysis of Canadian Outcomes. Archives of Physical Medicine and Rehabilitation, 89(12), S3–S15. https://doi.org/10.1016/J.APMR.2008.10.002

Gómez-De-Regil, L., Estrella-Castillo, D. F., & Vega-Cauich, J. (2019). Psychological Intervention in Traumatic Brain Injury Patients. Behavioural Neurology, 2019. https://doi.org/10.1155/2019/6937832

McLean, A., Dikmen, S. S., & Temkin, N. R. (1993). Psychosocial recovery after head injury. Archives of Physical Medicine and Rehabilitation, 74(10), 1041–1046. https://doi.org/10.1016/0003-9993(93)90059-J

Olsen, C. M., & Corrigan, J. D. (2022). Does Traumatic Brain Injury Cause Risky Substance Use or Substance Use Disorder? Biological Psychiatry, 91(5), 421–437. https://doi.org/10.1016/J.BIOPSYCH.2021.07.013

Prigatano, G. P. (1992). Personality Disturbances Associated With Traumatic Brain Injury. Journal of Consulting and Clinical Psychology, 60(3), 360–368. https://doi.org/10.1037/0022-006X.60.3.360

Reekum, van, van Reekum, R., Tammy Cohen, F., & Jenny Wong, B. (2000). Can Traumatic Brain Injury Cause Psychiatric Disorders? The Journal of Neuropsychiatry and Clinical Neurosciences, 12, 316–327. https://doi.org/10.1176/JNP.12.3.316

Silverberg, N. D., Cairncross, M., Brasher, P. M. A., Vranceanu, A. M., Snell, D. L., Yeates, K. O., Panenka, W. J., Iverson, G. L., Debert, C. T., Bayley, M. T., Hunt, C., Baker, A., & Burke, M. J. (2022). Feasibility of Concussion Rehabilitation Approaches Tailored to Psychological Coping Styles: A Randomized Controlled Trial. Archives of Physical Medicine and Rehabilitation, 103(8), 1565-1573.e2. https://doi.org/10.1016/J.APMR.2021.12.005

Simpson, G. K., & Tate, R. L. (2007). Suicidality in people surviving a traumatic brain injury: Prevalence, risk factors and implications for clinical management. Brain Injury, 21(13–14), 1335–1351. https://doi.org/10.1080/02699050701785542

Stéfan, A., Mathé, J. F., Dhenain, M., Blanchard, P., Blondet, E., Mathé, J. F., Dumond, J. J., Guillermou, E., Mazaux, J. M., Onillon, M., Pascale, P. D., Luauté, J., Hamonet, J., Plantier, D., Angélique, S., Wiart, L., Annabelle, A., Aubert, S., Beis, J. M., … Zerbib, Y. (2016). What are the disruptive symptoms of behavioral disorders after traumatic brain injury? A systematic review leading to recommendations for good practices. Annals of Physical and Rehabilitation Medicine, 59(1), 5–17. https://doi.org/10.1016/J.REHAB.2015.11.002

Tsai, Y. C., Liu, C. J., Huang, H. C., Lin, J. H., Chen, P. Y., Su, Y. K., Chen, C. T., & Chiu, H. Y. (2021). A Meta-analysis of Dynamic Prevalence of Cognitive Deficits in the Acute, Subacute, and Chronic Phases After Traumatic Brain Injury. The Journal of Neuroscience Nursing : Journal of the American Association of Neuroscience Nurses, 53(2), 63–68. https://doi.org/10.1097/JNN.0000000000000570

Vaishnavi, S., Rao, V., & Fann, J. R. (2009). Neuropsychiatric Problems After Traumatic Brain Injury: Unraveling the Silent Epidemic. Psychosomatics, 50(3), 198–205. https://doi.org/10.1176/APPI.PSY.50.3.198

Yeh, T. C., Chien, W. C., Chung, C. H., Liang, C. S., Chang, H. A., Kao, Y. C., Yeh, H. W., Yang, Y. J., & Tzeng, N. S. (2020). Psychiatric Disorders After Traumatic Brain Injury: A Nationwide Population-Based Cohort Study and the Effects of Rehabilitation Therapies. Archives of Physical Medicine and Rehabilitation, 101(5), 822–831. https://doi.org/10.1016/J.APMR.2019.12.005

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Executive Summary

Traumatic brain injury (TBI) increases the risk of developing new or worsening existing psychiatric conditions. Cognitive impairment and mood disorders (such as depression and anxiety) are among the more common psychiatric consequences of TBI, which may lead to ongoing psychosocial difficulties. Managing psychiatric outcomes of TBI is an important part of rehabilitation following brain injury.

About the Author

Dr. Alfred White, Consultant Neuropsychiatrist.