October 1, 2023

In the United States of America, since 2007, traumatic brain injury (TBI) related emergency department visits have increased by more than 50%. As per the available data, in 2013, TBI resulted in approximately 2.8 million emergency room visits, hospitalizations, or even death.  

Traumatic brain injury (TBI) is a neurological condition. It results from external trauma or a force that permanently or temporarily alters the brain’s normal functioning. It takes a significant toll on both the mental and physical well-being of the patient. Any damage to the brain’s frontal lobe causes impairment in the patient’s ability to regulate emotions, behavioral, and cognitive skills. 

What are TBI and behavioral health problems?

The effects of a traumatic brain injury depend on the severity and location of the initial injury. Hence, the TBI consequences regarding the treatment of behavioral health conditions are crucial. Behavioral health comorbidities and TBI are linked, including depression, anxiety, psychotic spectrum disorders, post-traumatic stress disorders, etc. As per the reviews of electronic health records from 8 healthcare systems in the U.S., it is found that the people diagnosed with TBI were approximate 9x times more likely to commit suicide than others of similar sex, age, psychiatric diagnosis, etc. TBI produces behavioral health issues and causes associated deficits that reduce the effectiveness of a behavioral health problem treatment. 

Why would TBI cause behavioral health problems?

Traumatic brain injury involves force from trauma or blows to the head. Regardless of the point of injury, the extreme force causes the brain to jiggle. This further damages the frontal lobe and anterior tips of the temporal lobe, leading to tearing and shearing of the neuronal pathways that connect the midbrain, basal ganglia, and prefrontal cortex. Thus, no matter where the brain injury occurs, it may cause damage in the brain’s frontal areas. The frontal lobes regulate emotional expression, problem-solving, planning, thinking, behavioral skills, self-awareness, etc. Therefore, any damage to the frontal lobe during a traumatic brain injury incident leads to behavioral health problems. 

Behavioral health treatment

Treatment for behavioral health conditions must incorporate specific strategies. The treatment strategies are applicable for adults and children. However, in the case of children, it is crucial to consider their development concerning the injury and its recovery. In children, any brain injury can disrupt the developmental trajectory. Injury of any severity may also affect/ restrict a child’s participation in school or other activities. Hence, proper treatment planning is of utmost importance. Behavioral health treatment must incorporate the following recommendations:

  • Screening for TBI exposure: TBI and behavioral health problems need identification of the condition by behavioral health professionals. These professionals should screen the patient for their history or lifetime exposure to TBI. Before starting any behavioral health treatment, the professional should know a patient’s history of TBI, as it can affect treatment. The professional can use various reliable, easy-to-use standardized methods to screen the patient for TBI history. Then, doctors and medical professionals can use the obtained information for the treatment and routine behavioral health care.
  • Treatment for neurobehavioral deficits due to TBI: Professionals must recognize neurobehavioral deficits that may be the consequences of executive function impairment. Medical professionals should accommodate such weaknesses in their behavioral health treatment plan. 
  • A holistic approach to accommodate co-morbid conditions: TBI patients often experience several other medical problems and behavioral health disorders. For example, headaches, fatigue, balance issues, sleep disturbances, seizure disorders, etc., are common health problems that patients with TBI face. These common health issues necessitate medication, which presents extra considerations while treating behavioral health conditions. In addition, the use of multiple medicines further complicates the treatment as they may increase the patient’s sensitivity to side effects which may have a disproportionate impact on cognitive function, alertness, and behavioral control. Hence, a holistic approach is needed to treat patients with comorbid conditions. 
  • Insights that support improvement: The chances of intention to change behavior and success are more significant in patients with TBI history. Factors like internal states, environmental influences, and time play a crucial role in a patient’s successful behavior change. This insight is beneficial in patients with neurobehavioral deficits because of TBI. Treatment begins by seeking information and insights into the need to change behavior. Also, the patient’s social environment plays a significant role in encouraging and sustaining changed behavior.  

Today, public awareness related to TBI has dramatically increased, but there may be some gap in knowledge about behavioral health conditions, TBI, and treatment implications.