This toolkit is meant for educational purposes only. The information within it should not be used to diagnose or treat brain injury in your clients.

Photo: Mental Illness and Brain Injury

Mental Illness and Brain Injury

Understanding the link between mental illness and brain injury

Some of the short- and long-term effects of brain injury are related to mental health, and can include anxiety, depression, aggression, and impulsivity. It is important to note that these symptoms do not always mean that a survivor has a diagnosable mental illness.

The relationship between brain injury and mental health is complex. It can be difficult to disentangle whether the symptoms a survivor is experiencing are a consequence of a pre-existing mental illness, possibly made worse by the brain injury, or a consequence of the brain injury alone. This is partly because symptoms of brain injury and those of some psychiatric disorders overlap (e.g., fatigue, insomnia, loss of appetite, poor concentration, and difficulty taking part in activities).1 What we do know is at people who sustain a brain injury are at an increased risk of experiencing mental illness.2-5

The psychiatric consequences of brain injury are influenced by pre-injury status, co-occurring disorders, injury-related factors, and pre- and post-injury environmental factors, among other potential influences. Being a woman is also a potential risk factor. Its been found that women fare worse than men after traumatic brain injury when it comes to symptoms of headaches and dizziness, confidence and initiative, and perception of need for supervision.6 Women with traumatic brain injury likewise report more depression, stress, and anxiety symptoms.7

Women survivors of IPV commonly experience post-traumatic stress disorder (PTSD). Traumatic brain injury is reported to increase the risk of post-traumatic stress symptoms.8 This is significant not only because of the of the potentially devastating additive effects of both PTSD and brain injury, but also because of the issue symptom overlap creates for identification of brain injury in women survivors, with symptoms of brain injury possibly misattributed to PTSD.9

The co-occurrence of traumatic brain injury with depression and PTSD can affect the recovery process after a brain injury. That, together with the knowledge that women generally are worse off after their brain injury than men, highlights the importance of addressing the specific needs of women survivors of IPV who have sustained a traumatic brain injury, and whose mental health and history of injury likely places them at an even greater risk for poor health than women in the general population.7

References

1M. Schwarzbold, A. Diaz, E. T. Martins, A. Rufino, L. N. Amante, M. E. Thais, J. Quevedo, A. Hohl, M. N. Linhares, and R. Walz, “Psychiatric disorders and traumatic brain injury,” Neuropsychiatric Disease and Treatment, vol. 4, no. 4. pp. 797–816, 2008.

2J. R. Fann, A. Leonetti, K. Jaffe, W. J. Katon, P. Cummings, and R. S. Thompson, “Psychiatric illness and subsequent traumatic brain injury: A case control study,” J. Neurol. Neurosurg. Psychiatry, vol. 72, no. 5, pp. 615–620, 2002.

3D. C. Perry, V. E. Sturm, M. J. Peterson, C. F. Pieper, T. Bullock, B. F. Boeve, B. L. Miller, K. M. Guskiewicz, M. S. Berger, J. H. Kramer, and K. A. Welsh-Bohmer, “Association of traumatic brain injury with subsequent neurological and psychiatric disease: a meta-analysis,” J. Neurosurg., vol. 124, no. 2, pp. 511–526, 2016.

4A. C. Scholten, J. A. Haagsma, M. C. Cnossen, M. Olff, E. F. van Beeck, and S. Polinder, “Prevalence of and Risk Factors for Anxiety and Depressive Disorders after Traumatic Brain Injury: A Systematic Review,” J. Neurotrauma, vol. 33, no. 22, pp. 1969–1994, 2016.

5H. S. Levin and R. R. Diaz-Arrastia, “Diagnosis, prognosis, and clinical management of mild traumatic brain injury,” The Lancet Neurology, vol. 14, no. 5. pp. 506–517, 2015.

6A. Colantonio, J. E. Harris, G. Ratcliff, S. Chase, and K. Ellis, “Gender differences in self reported long term outcomes following moderate to severe traumatic brain injury,” BMC Neurol., vol. 10, 2010.

7T. O. Oyesanya and E. C. Ward, “Mental Health in Women With Traumatic Brain Injury: A Systematic Review on Depression and Hope,” Health Care for Women International, vol. 37, no. 1. pp. 45–74, 2016.

8A. I. Greenspan, A. Y. Stringer, V. L. Phillips, F. M. Hammond, and F. C. Goldstein, “Symptoms of post-traumatic stress: Intrusion and avoidance 6 and 12 months after TBI,” Brain Injury, vol. 20, no. 7. pp. 733–742, 2006.

9K. M. Iverson, C. M. Dardis, and T. K. Pogoda, “Traumatic brain injury and PTSD symptoms as a consequence of intimate partner violence,” Compr. Psychiatry, vol. 74, pp. 80–87, 2017.