Traumatic Brain Injury and Justice-Involved Youth

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. 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. 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. 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.

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.

Posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) are common consequences of combat exposure, significantly affecting both mental and physical health of military personnel. Identifying reliable biomarkers for these conditions is critical for timely diagnosis, monitoring of treatment effectiveness, and prediction of the disease course. The results of recent studies suggesting potential role of PACAP and BDNF in peripheral blood as biomarkers for PTSD have been yet unconclusive. In this study we analyzed the level of pituitary adenylate cyclase-activating polypeptide and brain-derived neurotrophic factor in the blood plasma of 450 soldiers of the Armed Forces of Ukraine divided into six groups based on their diagnosis: controls, PTSD, PTSD with TBI, TBI, complex PTSD (CPTSD), CPTSD with TBI. PTSD and CPTSD were diagnosed using the International Trauma Interview, and TBI using the Ohio State University TBI Identification Method. PACAP and BDNF levels were analyzed in the the fasting blood samples using ELISA. PACAP and BDNF levels in blood plasma in control group were 2.10 ± 0.26 and 5.13 ± 0.50 ng/ml, respectively. The study findings revealed no statistically significant differences in PACAP and BDNF levels among the study groups. The results obtained indicate potential limitations of using these biomarkers for stress disorders and TBI diagnosing in combat-exposed military populations and highlight the need for further research to identify reliable biomarkers with objective diagnostic value and prognostic significance. Keywords: adenylate cyclase-activating­ polypeptide, biomarkers, brain-derived neurotrophic factor, posttraumatic stress disorder, traumatic brain injury

Women and transgender women sex workers have similar experiences of housing instability, childhood trauma, and victimization to populations with high rates of traumatic brain injury (TBI), such as people experiencing homelessness and incarceration; yet, there is little research on TBI among sex workers. We conducted a mixed method study using qualitative interviews and the Ohio State University TBI Identification Method to understand experiences of violence and head injury with 10 participants recruited from Elizabeth Fry Toronto. Head injuries which resulted in loss of consciousness, or a change in conscious state, a report of feeling dazed or a gap in memory, were classified as traumatic brain injuries. All other injuries to the head which did not meet these criteria were classified as head injuries. Ninety percent of participants reported at least one lifetime TBI, and all participants reported at least one head injury related to violence in sex work. Findings indicate the need to educate sex workers on the seriousness of head injuries and the importance of treatment. Participants spoke of widespread stigma and discrimination as barriers to care, which may be mitigated by enhanced training with an anti-oppressive framework in the health care sector and in law enforcement. Participants felt that peer support workers could best deliver education and create awareness of TBI among people involved in sex work. The magnitude of violence and TBI in this population indicates the need for future research to determine actual prevalence of TBI and appropriate screening tools combined with educational programs.

Traumatic brain injury (TBI) is common among individuals seeking treatment for substance use disorders in behavioral healthcare settings, but evidence-based TBI screening methods are underutilized. We investigated provider perceptions of the acceptability, feasibility, and appropriateness of TBI screening, and whether these perceptions influenced the relationships between screening intentions and behaviors. Understanding how these implementation outcomes are interrelated can help clarify the temporal sequencing of implementation processes and lead to more precise and cost-effective dissemination and implementation (D&I) strategies. In Phase 1 of this explanatory sequential mixed methods study, 215 behavioral healthcare providers completed an electronic survey assessing their intentions to screen for TBI using the Ohio State University TBI Identification Method (OSU TBI-ID). After 1-month, a second survey assessed the number of screens conducted, and perceptions of the acceptability, feasibility, and appropriateness of the OSU TBI-ID. Binary logistic regressions were used to examine whether acceptability, feasibility, and appropriateness moderated the relationship between screening intentions and behaviors. In Phase 2, 20 providers participated in an interview to contextualize the quantitative results. Qualitative data were analyzed thematically and integrated with the quantitative results. The mean acceptability, feasibility, and appropriateness scores were 4.12, 4.02, and 3.69, respectively. Acceptability (OR = 0.80, p = .29), feasibility (OR = 0.93, p = .88), and appropriateness (OR = 0.97, p = .65) of TBI screening did not moderate the relationship between intentions and behaviors. Providers endorsed the OSU TBI-ID as easy to use and integrate into practice, relevant to clients, and helpful in guiding referrals and treatment decision-making. Positive perceptions of an intervention are important but insufficient for shaping the transition from intentions to behavior. This study begins to disentangle interrelationships between early-phase implementation outcomes, which can help guide more precise D&I strategy development to enhance implementation efficiency and effectiveness.

ObjectiveThis study describes the association between history of lifetime traumatic brain injury (TBI) and current disabling functional restrictions among Ontario adults.Setting and designA two-stage rolling cross-sectional sample of 6,048 adults aged 18 to 93 were interviewed by computer assisted telephone interviewing between 2011–2013 regarding their mental health and substance use in Ontario, Canada. TBI criteria were defined by loss of consciousness for minimum five minutes or at least one overnight hospitalization. Dimensions of functionality restrictions in the last 30 days were measured with the WHO Disability Assessment Schedule (WHODAS).ResultsThe estimated mean for global disability in this sample of Ontario adults was 2.75 (SD = 5.4, range 0–40). The estimated means of global disability for individuals who reported a history of lifetime TBI was 4.16 (SD = 7.12) and compared with 2.46 (SD = 4.98) for individuals who never had a TBI (p < 0.001). Adults with a history of lifetime TBI had greater odds of global and item disability including restricted cognition, decreased self-care, difficulties with social relationships, fewer life activities and reduced participation in society compared to adults without a history of TBI (p < 0.001), even after adjusting for values of age, sex, marital status, household income and education.ConclusionThe co-occurrence of history of lifetime TBI with self-reported disability within the past 30 days provide evidence that careful consideration, planning and understanding of short and long term health needs of TBI survivors are critical.

Traumatic brain injury, driver aggression and motor vehicle collisions in Canadian adults

Objective:History of traumatic brain injury (TBI) is associated with increased risk of dementia, but few studies have evaluated whether TBI history alters the course of neurocognitive decline, and existing literature on this topic is limited to short follow-up and smaller samples. The primary aim of this study was to evaluate whether a history of TBI (TBI+) influences neurocognitive decline later-in-life among older adults with or without cognitive impairment [i.e., normally aging, Mild Cognitive Impairment (MCI), or dementia].Participants and Methods:Participants included individuals from the National Alzheimer’s Coordinating Center (NACC) who were at least 50 years old and with 3 to 6 visits (M number of visits = 4.43). Participants with any self-reported history of TBI (n = 1,467) were matched 1:1 to individuals with no reported history of TBI (TBI-) from a sample of approximately 45,000 participants using case-control matching based on age (+/- 2 years), sex, education, race, ethnicity, cognitive diagnosis [cognitively normal (CN), MCI, or all-cause dementia], etiology of cognitive impairment, functional decline (Clinical Dementia Rating Scale, CDR), number of Apolipoprotein E4 (APOE ε4) alleles, and number of annual visits (3 to 6). Mixed linear models were used to assess longitudinal neuropsychological test composites (using NACC normative data) of executive functioning/attention/speed (EFAS), language, and memory in TBI+ and TBI- participants. Interactions between TBI and demographics, APOE ε4 status, and cognitive diagnosis were also examined.Results:Following matching procedures, TBI+ (n=1467) and TBI- (n=1467) groups were nearly identical in age (TBI+ M = 71.59, SD = 8.49; TBI- M = 71.63, SD = 8.44), education (TBI+ M = 16.12, SD = 2.59; TBI- M = 16.10, SD = 2.52), sex (both 55% male), race (both 90% White), ethnicity (both 98% non-Hispanic), APOE ε4 alleles (both 0 = 62%, 1 = 33%, 2 = 5%), baseline cognitive diagnoses (both CN = 60%, MCI = 18%, dementia = 12%), and global CDR (TBI+ M = 0.30, SD = 0.38, TBI- M = 0.30, SD = 0.38). At baseline, groups had similar Z-scores of in EFAS (TBI+ Mefas = -0.02, SD = 1.21; TBI- Mefas = -0.04, SD = 1.27), language (TBI+ MLanguage = -0.48, SD = 0.98; TBI- MLanguage = -0.55, SD = 1.05), and memory (TBI+ MMemory = -0.45, SD = 1.28; TBI- MMemory = -0.45, SD =1.28). The course of change in neuropsychological functioning worsened longitudinally, but did not differ between TBI groups (p’s &gt; .110). There were no significant interactions between TBI history and age, sex, education, race/ethnicity, number of APOE ε4 status, or cognitive diagnosis (all p’s &gt; .027).Conclusions:In this matched case-control design, our findings suggest that a history of TBI, regardless of demographic factors, APOE ε4 status, and cognitive diagnosis, does not significantly alter the course of neurocognitive functioning later-in-life in older adults with and without cognitive impairment. Future clinicopathological longitudinal studies with well characterized TBI histories and the associated clinical course are needed to help clarify the mechanism by which TBI may increase dementia risk for some individuals, without affecting course of decline.

Sleep is often disrupted in traumatic brain injury (TBI) and may be related to persistent behaviour problems; however, little is known about this relationship in young adults. This study explored associations between TBI, behavioural problems and sleep disturbances in 247 university students (197 non-TBI, 47 mild TBI, two moderate TBI, one severe TBI) aged 18-25 years, who completed validated measures for behaviour, sleep quality and history of TBI. Because of small group numbers, participants reporting moderate to severe TBI were excluded from the analyses. Results indicated that students with mild TBI reported higher levels of daytime dysfunction, somatic complaints, withdrawal, other behavioural complaints and internalizing behaviours compared with students with no TBI history. A correlational analysis indicated a moderate relationship between the above significant variables. Our results suggest that university students with a history of mild TBI are more likely to experience certain ongoing daytime behavioural problems, which are likely to negatively influence their academic functioning in tertiary education. This study highlights the importance of research on long-term problems following mild TBI in young adults aged 18-25 years--an age group often overlooked within the literature.

Treatment for posttraumatic stress disorder in patients with a history of traumatic brain injury: A systematic review

Journal of NeurotraumaVol. 37, No. 1 Short CommunicationOpioid Use among Individuals with Traumatic Brain Injury: A Perfect Storm?Rachel Sayko Adams, John D. Corrigan, and Kristen Dams-O'ConnorRachel Sayko AdamsInstitute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts.VHA Rocky Mountain Mental Illness Research Education and Clinical Center, Aurora, Colorado.Search for more papers by this author, John D. CorriganDepartment of Physical Medicine and Rehabilitation, The Ohio State University Wexner Medical Center, Columbus, Ohio.Search for more papers by this author, and Kristen Dams-O'ConnorAddress correspondence to: Kristen Dams-O'Connor, PhD, Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1163, New York, NY 10029 E-mail Address: Kristen.Dams-O'Connor@mountsinai.orgDepartment of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York.Search for more papers by this authorPublished Online:11 Dec 2019https://doi.org/10.1089/neu.2019.6451AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View articleFiguresReferencesRelatedDetailsCited byCaring again: Support for parent caregivers of wounded, ill, and/or injured adult children veteransNeuroRehabilitation, Vol. 52, No. 1Associations between early sleep-disordered breathing following moderate-to-severe traumatic brain injury and long-term chronic pain status: a Traumatic Brain Injury Model Systems studyJournal of Clinical Sleep Medicine, Vol. 19, No. 1Association between traumatic brain injury and suicidality using a mediation approach and MarketScan5 December 2022 | Injury Prevention, Vol. 26Association of pre-admission opioid abuse and/or dependence on major complications in traumatic brain injury (TBI) patientsJournal of Clinical Anesthesia, Vol. 79Peer Support at the Intersection of Disability and Opioid (Mis)Use: Key Stakeholders Provide Essential Considerations5 August 2022 | International Journal of Environmental Research and Public Health, Vol. 19, No. 15Preinjury Health Status of Adults With Traumatic Brain Injury: A Preliminary Matched Case-Control Study15 June 2021 | Journal of Head Trauma Rehabilitation, Vol. 37, No. 3Repeated blast mild traumatic brain injury and oxycodone self‐administration produce interactive effects on neuroimaging outcomes18 January 2022 | Addiction Biology, Vol. 27, No. 2Impact of opioid use disorder on resource utilization and readmissions after operative traumaSurgery, Vol. 171, No. 2Pregnancy, Fetal, and Neonatal Outcomes Among Women With Traumatic Brain Injury14 October 2022 | Journal of Head Trauma Rehabilitation, Vol. Publish Ahead of PrintExamining differences in prescription opioid use behaviors among U.S. adults with and without disabilitiesPreventive Medicine, Vol. 153Reported History of Traumatic Brain Injury Among Suicide Decedents: National Violent Death Reporting System, 2003–2017American Journal of Preventive Medicine, Vol. 61, No. 4When triggers become tigers: taming the autonomic nervous system via sensory support system modulation7 September 2021 | Journal of Social Work Practice in the Addictions, Vol. 37Risk Factors Associated With the Prescription of Opioids Among Service Members Following a First Mild Traumatic Brain InjuryJournal of Head Trauma Rehabilitation, Vol. 36, No. 5Opioid and Sedative-Hypnotic Prescriptions Among Post-9/11 Veteran VA Users Nationwide With Traumatic Brain Injury, 2012-2020Journal of Head Trauma Rehabilitation, Vol. 36, No. 5Scoping Review of Opioid Use After Traumatic Brain InjuryJournal of Head Trauma Rehabilitation, Vol. 36, No. 5Receipt of Concurrent VA and Non-VA Opioid and Sedative-Hypnotic Prescriptions Among Post-9/11 Veterans With Traumatic Brain InjuryJournal of Head Trauma Rehabilitation, Vol. 36, No. 5Association of Lifetime History of Traumatic Brain Injury With Prescription Opioid Use and Misuse Among AdultsJournal of Head Trauma Rehabilitation, Vol. 36, No. 5Traumatic Brain Injury and Opioid Use: Additional Evidence Supporting the “Perfect Storm” of Cascading VulnerabilitiesJournal of Head Trauma Rehabilitation, Vol. 36, No. 5Association between Lifetime History of Traumatic Brain Injury, Prescription Opioid Use, and Persistent Pain: A Nationally Representative Study Raj G. Kumar, Katherine A. Ornstein, John D. Corrigan, Rachel Sayko Adams, and Kristen Dams-O'Connor26 July 2021 | Journal of Neurotrauma, Vol. 38, No. 16Addressing Pain for a Proper Rehabilitation Process in Patients With Severe Disorders of Consciousness17 February 2021 | Frontiers in Pharmacology, Vol. 12 Volume 37Issue 1Jan 2020 InformationCopyright 2020, Mary Ann Liebert, Inc., publishersTo cite this article:Rachel Sayko Adams, John D. Corrigan, and Kristen Dams-O'Connor.Opioid Use among Individuals with Traumatic Brain Injury: A Perfect Storm?.Journal of Neurotrauma.Jan 2020.211-216.http://doi.org/10.1089/neu.2019.6451Published in Volume: 37 Issue 1: December 11, 2019Online Ahead of Print:August 16, 2019Online Ahead of Editing: July 23, 2019PDF download

Background: Traumatic brain injury (TBI) is a major health problem in childhood. Estonia and other Baltic states have the highest trauma-related mortality in the European Union. There are no data on the incidence and causes of TBI for children in Estonia. The aim of this study was to estimate the incidence, structure and main causes of TBI in Tartu and Tartu County. Methods: The study was carried out at Tartu University Hospital, between January 1, 2001, and December 31, 2005. For inclusion in the study the following criteria had to be fulfilled: age 0–14 years, documented brain trauma and neurological symptoms and residency in Tartu or Tartu County. Over the study period the inclusion criteria were fulfilled in 478 cases [272 boys (57%) and 206 girls (43%)]. Results: The incidence of TBI in childhood in Tartu and Tartu County was 369:100,000 (405:100,000 for boys, 330:100,000 for girls). The incidence was highest among children from 0 to 4 years of age – 566:100,000. The main cause of TBI in all age groups was falling – 63.6%. According to severity, 82% of the cases were mild and 18% were moderate and severe. Conclusions: There is an urgent need for governmental prevention programs for TBI in children in Estonia.

Traumatic brain injury (TBI) afflicts 70 million people worldwide annually and is the 3rd overall risk factor for developing Alzheimer's disease (AD), behind genetics and aging. In patients with AD, a history of TBI is associated with a 3-4 year earlier onset of cognitive impairment. TBI and AD share many pathologies, including blood brain barrier dysfunction, neuroinflammation, and protein aggregation. Yet, the underlying mechanism of this relationship is not understood, and there are no treatments that protect patients from accelerated AD after TBI. We recently reported that tau, a microtubule binding protein essential for neuronal health, is acetylated after TBI. Acetylation impairs tau binding to microtubules, leading to its mis-localization into the cell soma and pathological aggregation. Acetylated tau is also elevated early in AD, and acetylated tau was significantly more elevated in the brains of human AD subjects with a history of TBI, compared to AD alone and healthy controls. Therefore, we hypothesize that TBI-induced tau acetylation drives the acceleration of AD. To study this phenomenon, we developed a mouse model of TBI that accelerates AD-like pathology and cognitive impairment in 5xFAD mice, and amyloid-driven AD model. Our unique model of multimodal TBI produces a complex and reproducible brain injury with neurodegeneration and neurobehavioral impairment, beginning with acute axonal degeneration and persisting chronically with blood-brain barrier degradation and nerve cell death. This model of TBI also produces the same systemic metabolic alterations that are reported in TBI patients. TBI causes learning deficits in young 5xFAD mice that are not seen in either sham-injured 5xFAD mice or in wild type littermates subjected to TBI. TBI also accelerates amyloid deposition in 5xFAD mice. We hypothesize that TBI will also worsen blood brain barrier function in 5xFAD mice. Importantly, 5xFAD mice show greater elevation of acetylated tau after TBI, compared to WT mice. Preliminary data suggests that treatment with the FDA-approved non-steroidal inflammatory drug diflunisal, which inhibits the enzyme that acetylates tau, reduces acetylated tau and rescues behavior deficits after TBI in 5xFAD mice.

Does neuroinflammation drive the relationship between tau hyperphosphorylation and dementia development following traumatic brain injury?

Primary objective: To investigate the association between reported past traumatic brain injury (TBI) and demographic, neuropsychiatric and criminographic parameters among individuals recently received into custody.Research design: A random sample of men recently received into the New South Wales (Australia) criminal justice system were screened for a history of TBI and the details of up to five separate TBI episodes were obtained. We also screened for depression, psychosis, personality disorder, drug and alcohol use, and ‘social connectedness’.Main outcome and results: Among the 200 study participants, 82% reported past TBI. TBI was associated with a history of engagement in contact sports, school expulsion, daily illicit drug use, depression and psychosis.Conclusions: Past TBI is common among prisoners entering the criminal justice system and, amongst other correlates, appears to be highly associated with increased rates of major mental illness.