Despite our best attempts to keep ourselves and loved ones safe, accidents are unfortunately just a part of everyday life. We can follow safety measures, wear our seatbelts, and hold onto hand railings, but sometimes the inevitable occurs and someone may trip up, they may fall, or even get seriously hurt. Congested roadways and high-speed drivers in the US have resulted in over 21,130 vehicle-related deaths in the first half of 2023, and 1 in 4 older adults report falling every year.1,2 With such prevalent rates of accidental occurrences in the US, Americans are also at risk of experiencing traumatic brain injuries, also known as TBI. You might associate traumatic brain injuries with freak accidents or “one-off” occurrences that really only happen in football games or big accidents. But the truth is, TBI is a leading cause of death and disability in the US. Statistics show that there were over 214,000 TBI-related hospitalizations and nearly 70,000 TBI-related deaths in 2021 alone.3,4 Individuals all over the country are at risk of experiencing a TBI and the repercussions that accompany the recovery and rehabilitation of such an injury. While the physical damage to the brain and related body parts is extremely crucial and important to treat as a result of TBIs, research has shown that these brain injuries are linked to some consequences within the world of mental health as well. In this blog, we will discuss some of the psychiatric and behavioral issues that arise as a result of TBIs, and what can be done to recognize the signs and treat subsequent mental health issues as they arise.
How Common are Traumatic Brain Injuries?
As mentioned above, a traumatic brain injury (TBI) is a type of injury that occurs as a result of a blow or immense force to the head. According to the Center for Disease Control and Prevention, TBIs are a leading cause of disability and even death for children and young adults in the US.5 They estimate that over 1.5 million individuals within the country endure a TBI every year. Statistics show that an estimated 230,000 people are hospitalized due to TBIs and survive; 80,000 to 90,000 people experience long-term disability as a result of TBIs; and 50,000 individuals will die due to TBIs. Overall, a cumulative of 5.3 million men, women, and children live with a permanent disability as a result of a TBI in the US. You may be wondering to yourself — how is this statistic so high? Are people really getting into serious accidents that cause so much trauma to the head? The answer is that TBIs are a type of injury that vary in its severity. Most of the time, TBIs are more mild and individuals are able to recover from their injuries in days. You may more commonly refer to these types of TBIs as concussions. With more severe cases, TBIs can cause permanent injury or even death. Therefore, there is a wide variety of factors that can cause a TBI to occur. The injuries can result from things such as:
- Blow, strike, or jolt to the head
- Motor vehicle crashes
- Penetrative wounds, such as a gunshot wound
- Falls
- Sports, work, and recreational-related injuries
- Impact to the head as a result of explosions
Symptoms that you may experience as a result of a TBI include:
- Blurred vision
- Hearing problems
- Headaches
- Difficulty speaking, slurred speech
- Behavior changes
- Sensitivity to light
- Feeling dizzy
- Changes to sleep patterns, sleeping too much or too little
- Change in mental focus or memory
- Changes to smell and taste
- Issues with concentration
- Mood changes, such as feeling easily angered or frustrated 6,7
Some people are more likely to have TBIs than others
TBIs can affect individuals of all ages from all walks of life. However, there are certain groups of people that are more likely to experience TBIs, are at a greater risk for dying from TBIs, or experiencing long-term injuries or issues as a result of the injury. Statistics show that nearly 80% of TBIs happen to males, and they are more common for individuals 65+ years old. This makes sense because older individuals are more likely to lose balance, fall, and potentially hit their heads. Of course, even babies or young children can experience TBIs as a result of being dropped, sports, falling from a bed, etc. People in certain job professions may be more likely to experience TBIs such as athletes, construction workers, police officers, law enforcement workers, and those in the military.
Mental Health Consequences of Traumatic Brain Injuries
Unfortunately, individuals who sustain TBIs are more likely to experience permanent brain damage, disabilities, and have a higher risk for developing mental health conditions such as depression, anxiety, and post-traumatic stress disorder. Rare consequences of TBIs include an increased risk for developing Alzheimer’s disease, dementia, or other types of movement disorders.7 TBIs are sometimes coined as being an ‘invisible’ epidemic due to its complexity and not-so-obvious presentations in those who suffer from them. For example, the physical symptoms of a TBI may resolve themselves quickly in comparison to the non-tangible, mental issues that arise from a TBI. The recovery for each person with a TBI is highly subjective, and depends on the severity of the injury and biological disposition of the individual. Even so, most individuals with moderate to severe TBIs are likely to suffer from changes to their cognitive, behavioral, and emotional well-being. Motor and emotional impairments can cause major strain to their social, personal, and work relationships. A majority of the time, these individuals are unaware of their behavioral changes and this can cause even further distress to themselves and those around them. Research has found that TBIs have a higher likelihood of developing comorbid illness along with their brain injuries that increase the need for healthcare intervention. Within the first year following a TBI, up to 77% of those injured receive a psychiatric diagnosis.8 That is about 3 in 4 TBI survivors! The most common mental health conditions TBI patients develop are anxiety, mood disorders, major depressive disorder, schizophrenia, and substance-use disorders.
In addition, PTSD was found to be a common diagnosis to develop after TBI when compared to other types of injuries, and research has supported that physical trauma to the brain contributes directly to the development of the disorder.9 This may attributed to the fact that TBIs can be very emotionally traumatic events, in addition to the physical trauma. When individuals undergo one or more of these brain injuries, it can be hard to disentangle themselves from the emotional and physical trauma that TBIs create. Therefore, studies have shown that TBI can be an important risk factor for developing PTSD. TBI can also cause significant changes to one’s personality, including their impulsivity, irritability, instability, and apathy. A famous example of such a drastic change in personality is the example of Phineas Gage, a railroad foreman who experienced a TBI after an iron rod was driven through his head.10 Prior to his injury, Gage was known as a model worker, well-liked by his peers and employers. However, in the months that followed his injury, friends and close colleagues noted that he was no longer his former self. He became irritable, forgetful of plans, shouted profanities at random times, and became unemployable at his former job. While a lot of TBIs do not cause such a drastic change to personality, the truth remains that TBIs have a large influence on behavioral and emotional responses post-injury. In addition, studies have shown that even though having a psychiatric illness before a TBI is a strong predictor for having a psychiatric diagnosis post TBI, a high number of mood and anxiety disorders that injured individuals experienced only occurred after the TBI event.9 This shows consistency with the claim that TBI can actually cause mental health conditions to develop over time; and specifically, these conditions were more likely to develop after a TBI that occurred in military or civilian circumstances. Just as TBIs can range in type and severity, the mental health conditions that may develop are just as subjective to each individual person.
Traumatic Brain Injuries Affect Children Differently than Adults
What makes a brain injury different for a child compared to an adult? The difference is that a young child’s brain is not yet fully developed, and regardless of the severity of a TBI, an injury can majorly disrupt that child’s crucial brain development. Children are just as likely to experience changes to their behavioral and emotional processes as a result of a TBI, and these consequences can prove to be especially difficult when a child is still learning how to make friends properly, play sports with their peers, and practice self-regulation. Among all the individuals that suffer from TBIs, children have the highest rate of ER visits for issues associated with TBIs.11 While adults have to manage through the negative consequences of TBIs such as disability, mental health diagnoses, physical rehabilitation, and other emotional rehabilitation, children are at a completely different stage of neurodevelopment and are at a high risk for impairment. While their physical injuries may heal, their thinking and behavioral changes may be hard to detect and treat since they are not quantifiable. Any type of TBI can cause issues for growing children, such as cognitive impairments, behavioral deficits, socialization issues, and participation issues.11
Wholly, TBIs of any severity are disruptive to any individual that sustains one. Beyond the physical manifestations of the injuries are a number of mental conditions that individuals are a higher risk for as a result of their injury. Because there are no set rules or general outline for how mental health conditions arise as a result of TBIs, navigating and understanding the topic is complex, yet necessary. Many individuals in the US suffer from TBIs every year and must continue to be taken seriously.
