TBI is the signature wound of the Iraq and Afghanistan wars with over 370,000 military service members worldwide identified with a TBI from 2000-2017. TBIs can occur in military service from a variety of sources including gunshots, blasts, motor-vehicle collisions, or training exercises. With NC having the third largest active duty population and over 770,000 veterans, many service members may need long-term care in North Carolina communities related to diagnosed or undiagnosed injuries. TBI can often be masked in military populations due to stigma or co-occurring mental health conditions.6
Sports- & Age-related
An estimated 1.6-3.8 million sports- and recreation-related concussions occur in the US each year with the most common injuries occurring from cycling, football, baseball/softball, and soccer. The actual incidence may potentially be much higher for those not treated or treated by their general doctor. The leading cause of TBI in the US is falls, with children 0-4 years of age and adults 75 years of age and older most at risk.7
Domestic Violence & Intimate Partner Assaults
TBI can be an unrecognized result of domestic violence and intimate partner assaults, commonly in women. The head and face are most commonly targets in these situations for TBI and individuals may experience an ABI if they lose oxygen to their brain caused by airway obstruction for too long of a time (caused by choking, strangulation, near drowning, or drug reaction/overdose). In one study, 67% of women at three metropolitan EDs reported problems potentially head-injury related with 30% experienced a loss of consciousness at least once. Multiple traumatic or acquired brain injuries can lead to cumulative cognitive, physical and emotional challenges over time and therefore make disengaging from the situation almost impossible due to decision-making and planning.8,9
Individuals experiencing Homelessness or Economic Instability
TBI-related cognitive and behavioral challenges (e.g., limitations in memory; planning and organization; and reasoning, comprehension and problem solving, as well as impulsive decision-making) lead to an increased risk for economic and housing instability.10 Homeless individuals also are more vulnerable to common causes of TBI: Substance abuse related accidents (including falls) and victimization from violence. Thus, TBI-related cognitive and behavioral deficits not only increase risk for homelessness, but homelessness itself contributes to increased risk for TBI. On one night in January 2017, 8,962 people experienced homelessness in NC (be sure to take this number with a grain of salt as it is only a snapshot of a much larger population).11 Meanwhile, in one study of 904 people, approximately half of those experiencing homelessness had sustained a TBI, of which 70% experienced their first brain injury before they experienced homelessness.12 We do not know the true numbers of individuals that are experiencing homelessness in NC or the true number of people with TBI experiencing homelessness, but with increased access to community resources and screening the hope is that more people can be identified and their needs addressed.
Mental Health Experiences
Studies have indicated that those with positive TBI screens were more likely to have mental health disorders. The most common mental health disorders following a brain injury are schizophrenia, depression, bipolar disorder, and organic mental disorder. The nature of and whether mental health disorders or TBI have a direct causal effect on one another is heavily debated in research. In addition, diagnosis can be difficult due to the overlapping of signs and symptoms of concussion/mTBI and mental illness. For example, an individual with a TBI may experience agitation, impulsivity, poor-judgement that may mirror differences in attention deficit/hyperactivity disorder (ADHD). Flashbacks, hypervigilance, avoidance, nightmares could be attributed to TBI or to post-traumatic stress disorder (PTSD). An individual with depression may experience lack of motivation, sadness, and fatigue – so may a person with a TBI.13,14 It is important when working with individuals with mental health conditions to consider TBI and similarly mental health to consider with TBI. Similarly, if you are living with TBI and experiencing mental health symptoms, connect with community resources including your doctor, a counselor, or neuropsychiatrist. Mental health after brain injury may be attributed to a variety of factors that either medication, alternative therapies, or community/social engagement can be helpful for
Similarly, to the overlapping symptoms between metal health and TBI, substance misuse and TBI interconnect as well.15 The relationship with substance misuse including alcohol and other drugs is a complicated and often bidirectional one. A large number of TBIs incur when individuals are intoxicated due to poor motor control, impaired decision making, vulnerability to victimization, and propensity toward belligerent/aggressive behaviors. Likewise, substance misuse following injury can increase the risk of sustaining additional TBIs, interfere with the brain’s recovery process after brain injury, have a more powerful effect after brain injury, and increase the risk of seizures after brain injury.1 If you have an individual who has an identified TBI and is using substances, these are important factors to consider. If you are having trouble with substances, it can be helpful to seek professional consult as substance misuse can frequently affect mood, employment retention, social relationships, and community involvement. This can make it important to screen for TBI and ABI to assist in accessing appropriate services if you are a professional working with individuals who are misusing substances.