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Nichter B, Hill ML, Fischer I, Panza KE, Kline AC, Na PJ, Norman SB, Rowcliffe M, Pietrzak RH. Firearm storage practices among military veterans in the United States: Findings from a nationally representative survey. J Affect Disord 2024; 351:82-89. [PMID: 38280567 DOI: 10.1016/j.jad.2024.01.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 01/16/2024] [Accepted: 01/18/2024] [Indexed: 01/29/2024]
Abstract
BACKGROUND Unsafe storage of firearms is associated with increased risk of suicide.. However, contemporary population-based data on the prevalence and correlates of firearm storage practices among veterans are limited. METHODS Data were from the 2022 National Health and Resilience in Veterans Study, a nationally representative sample of 2441 veterans. Analyses examined: (1) the prevalence of firearm storage practices; (2) sociodemographic, psychiatric, and clinical characteristics associated with storing firearms loaded and/or in non-secure location; and (3) associations between types of potentially traumatic events and storage practices. RESULTS More than half of veterans reported owning one or more personal firearms (50.9%). Among firearm owners, 52.9% reported some form of unsafe firearm storage practice (i.e., loaded and/or non-secure location), with 39.9% reporting that they stored one or more firearms loaded. After adjusting for sociodemographic characteristics, major depressive, alcohol and drug use disorders, direct trauma exposures, future suicidal intent, and traumatic brain injury were associated with storing firearms loaded and/or in a non-secure location (ORs = 1.09-7.16). Veterans with a history of specific forms of direct trauma exposure (e.g., physical assault) were more likely to store firearms unsafely. LIMITATIONS Cross-sectional design precludes causal inference. CONCLUSIONS Half of U.S. veterans who own firearms store at least one personal firearm loaded and/or in a non-secure location, with approximately four-in-ten keeping a loaded firearm in the home. These high rates underscore the importance of nationwide training initiatives to promote safe firearm storage for all service members and veterans, regardless of risk status, as well as for healthcare professionals working with veterans.
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Affiliation(s)
- Brandon Nichter
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
| | - Melanie L Hill
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Ian Fischer
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Kaitlyn E Panza
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA; VA San Diego Healthcare System, San Diego, CA, USA
| | - Alexander C Kline
- Naval Health Research Center, San Diego, CA, USA; Leidos, Reston, VA, USA
| | - Peter J Na
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Sonya B Norman
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA; VA San Diego Healthcare System, San Diego, CA, USA; National Center for PTSD, White River Junction, VT, USA
| | - Mara Rowcliffe
- 321(st) Special Tactics Squadron, U.S. Air Force Special Operations Command, USA
| | - Robert H Pietrzak
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, USA; Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
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Morin RT, Li Y, Karel MJ, Consolino T, Hwong A, Clark R, Byers AL. Comorbidity profiles in older patients last seen by mental health prior to suicide attempt. Aging Ment Health 2024; 28:551-556. [PMID: 37545400 DOI: 10.1080/13607863.2023.2228228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 06/11/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVES Suicide in late life is a public health concern. Determining profiles of psychiatric/medical comorbidity in those who attempt while engaged in mental health services may assist with prevention. We identified comorbidity profiles and their association with utilization, means, and fatality in a national sample who attempted suicide. METHODS Using latent class analysis, all patients aged ≥ 65 from the Department of Veterans Affairs (VA) healthcare services (2012-2018) last seen in mental health prior to suicide attempt were included. Diagnoses and attempt data were obtained from VA and Center for Medicare & Medicaid Services, VA Suicide Prevention Applications Network, and VA National Mortality Data Repository. RESULTS 2,269 patients were clustered into three profiles, all with high probability of depression. Profiles included minimal comorbidity (50.4%), high medical comorbidity (28.6%), and high (psychiatric/medical) comorbidity (21.0%). Over half (61.7%) attempted suicide within one week of their visit. The class with highest comorbidity had lowest proportion of fatal attempts, while minimal comorbidity class had highest proportion. CONCLUSIONS Older patients last seen in mental health prior to suicide attempt were characterized by depression and varying additional comorbidity and attempt-related factors. Findings have implications for risk assessment and intervention in mental health settings, beyond depression.
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Affiliation(s)
- Ruth T Morin
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
- Hoag Memorial Hospital Presbyterian, Newport Beach, CA, USA
| | - Yixia Li
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
- Northern California Institute for Research and Education, San Francisco, CA, USA
| | - Michele J Karel
- VA Central Office, Office of Mental Health and Suicide Prevention, Washington, D.C., USA
| | | | - Alison Hwong
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
- Department of Psychiatry & Behavioral Sciences and Medicine, University of California, San Francisco, CA, USA
- UCSF National Clinician Scholars Program, San Francisco, CA, USA
| | - Ryan Clark
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
- Northern California Institute for Research and Education, San Francisco, CA, USA
| | - Amy L Byers
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
- Department of Psychiatry & Behavioral Sciences and Medicine, University of California, San Francisco, CA, USA
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Ramsay I, Miranda-Cantellops NDM, Acosta O, Shapiro LT. Firearm injury prevention counseling for patients with traumatic brain injury: a survey of brain injury physicians. Front Neurol 2023; 14:1237095. [PMID: 37693749 PMCID: PMC10484094 DOI: 10.3389/fneur.2023.1237095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 08/10/2023] [Indexed: 09/12/2023] Open
Abstract
Background Survivors of traumatic brain injury are at increased risk for firearm-related injuries, including suicide. Aims To determine current practices of Brain Injury Medicine (BIM) physicians and their rehabilitation teams in assessing patients' access to firearms and in providing firearm safety education, and the impact of having received training on this topic on physicians' likelihood of inquiring about patients' access to firearms. Methods 14-item web-based cross-sectional survey of 86 U.S. physiatrists board-certified in BIM. Results 81% of respondents indicated they believe BIM physicians should counsel their patients on firearm safety but only 12.9% reported always doing so. Fifteen percent reported always inquiring about their patients' access to firearms. 88.2% indicated having never received formal training on firearm injury prevention counseling. Physicians who received such training had 7.5 times higher odds of reporting at least sometimes inquiring about patients' access to firearms than those who were not trained [95% confidence interval (1.94, 28.64)]. They also had 5.7 times higher odds for reporting being at least moderately comfortable providing patients firearm safety counseling [95% CI: (1.39, 23.22)]. Conclusion While most BIM specialists who responded to this survey believe they should counsel patients on firearm safety, few always or usually do so. Moreover, most do not routinely inquire about their patients' access to firearms. The provision of firearm injury prevention training to BIM physicians was strongly associated with an increased likelihood they will inquire about their patients' access to guns and with an improved comfort level in providing counseling on this subject matter.
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Affiliation(s)
- Ian Ramsay
- MD/MPH Program, University of Miami Leonard M. Miller School of Medicine, Miami, FL, United States
| | | | - Oliver Acosta
- Physical Medicine & Rehabilitation Residency Program, University of Miami/Jackson Health System, Miami, FL, United States
| | - Lauren T. Shapiro
- Department of Physical Medicine & Rehabilitation, University of Miami Leonard M. Miller School of Medicine, Miami, FL, United States
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Waltzman D, Sarmiento K, Daugherty J, Lumba-Brown A, Klevens J, Miller GF. Firearm-Related Traumatic Brain Injury Homicides in the United States, 2000-2019. Neurosurgery 2023; 93:43-49. [PMID: 36727717 PMCID: PMC10391713 DOI: 10.1227/neu.0000000000002367] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/15/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Traumatic brain injury (TBI) is a leading cause of homicide-related death in the United States. Penetrating TBI associated with firearms is a unique injury with an exceptionally high mortality rate that requires specialized neurocritical trauma care. OBJECTIVE To report incidence patterns of firearm-related and nonfirearm-related TBI homicides in the United States between 2000 and 2019 by demographic characteristics to provide foundational data for prevention and treatment strategies. METHODS Data were obtained from multiple cause of death records from the National Vital Statistics System using Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research database for the years 2000 to 2019. Number, age-adjusted rates, and percent of firearm and nonfirearm-related TBI homicides by demographic characteristics were calculated. Temporal trends were also evaluated. RESULTS During the study period, there were 77 602 firearm-related TBI homicides. Firearms were involved in the majority (68%) of all TBI homicides. Overall, men, people living in metro areas, and non-Hispanic Black persons had higher rates of firearm-related TBI homicides. The rate of nonfirearm-related TBI homicides declined by 40%, whereas the rate of firearm-related TBI homicides only declined by 3% during the study period. There was a notable increase in the rate of firearm-related TBI homicides from 2012/2013 through 2019 for women (20%) and nonmetro residents (39%). CONCLUSION Firearm-related violence is an important public health problem and is associated with the majority of TBI homicide deaths in the United States. The findings from this study may be used to inform prevention and guide further research to improve treatment strategies directed at reducing TBI homicides involving firearms.
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Affiliation(s)
- Dana Waltzman
- Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control (NCIPC), Division of Injury Prevention, Atlanta, Georgia, USA
| | - Kelly Sarmiento
- Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control (NCIPC), Division of Injury Prevention, Atlanta, Georgia, USA
| | - Jill Daugherty
- Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control (NCIPC), Division of Injury Prevention, Atlanta, Georgia, USA
| | | | - Joanne Klevens
- Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control (NCIPC), Division of Injury Prevention, Atlanta, Georgia, USA
| | - Gabrielle F. Miller
- Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control (NCIPC), Division of Injury Prevention, Atlanta, Georgia, USA
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Bahraini N, Adams RS, Caban J, Kinney A, Forster JE, Hoffmire CA, Monteith LL, Brenner LA. Racial and Ethnic Differences in Deaths by Suicide, Drug Overdose, and Opioid-Related Overdose in a National Sample of Military Members With Mild Traumatic Brain Injury, 1999-2019. J Head Trauma Rehabil 2023; 38:114-124. [PMID: 36883894 PMCID: PMC10399302 DOI: 10.1097/htr.0000000000000829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
OBJECTIVE To examine racial and ethnic differences in suicide and drug and opioid-related overdose deaths among a population-based cohort of military service members who were diagnosed with a mild traumatic brain injury (mTBI) during military service. DESIGN Retrospective cohort. SETTING Military personnel receiving care within the Military Health System between 1999 and 2019. PARTICIPANTS In total, 356 514 military members aged 18 to 64 years, who received an mTBI diagnosis as their index TBI between 1999 and 2019, while on active duty or activated. MAIN MEASURES Death by suicide, death by drug overdose, and death by opioid overdose were identified using International Classification of Diseases, Tenth Revision (ICD-10) codes within the National Death Index. Race and ethnicity were captured from the Military Health System Data Repository. RESULTS Overall crude rates were 38.67 per 100 000 person-years for suicide; 31.01 per 100 000 person-years for drug overdose death; and 20.82 per 100 000 person-years for opioid overdose death. Crude and age-specific rates for military members who self-identified as Other were higher than all other racial/ethnic groups for all 3 mortality outcomes. Adjusting for age, suicide rates for those classified as Other were up to 5 times that of other racial/ethnic groups for suicide, and up to 11 and 3.5 times that of other race/ethnicity groups for drug and opioid overdose death, respectively. CONCLUSION Findings extend previous knowledge regarding risk for suicide and deaths by drug overdose among those with mTBI and highlight new important areas for understanding the impact of race and ethnicity on mortality. Methodological limitations regarding classification of race and ethnicity must be addressed to ensure that future research provides a better understanding of racial and ethnic disparities in suicide and drug overdose mortality among military members with TBI.
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Affiliation(s)
- Nazanin Bahraini
- VA Rocky Mountain Mental Illness Research Education and Clinical Center for Suicide Prevention, Aurora, Colorado
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Rachel Sayko Adams
- VA Rocky Mountain Mental Illness Research Education and Clinical Center for Suicide Prevention, Aurora, Colorado
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Jesus Caban
- National Intrepid Center of Excellence, Bethesda, Maryland
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Adam Kinney
- VA Rocky Mountain Mental Illness Research Education and Clinical Center for Suicide Prevention, Aurora, Colorado
- Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Jeri E. Forster
- VA Rocky Mountain Mental Illness Research Education and Clinical Center for Suicide Prevention, Aurora, Colorado
- Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Claire A. Hoffmire
- VA Rocky Mountain Mental Illness Research Education and Clinical Center for Suicide Prevention, Aurora, Colorado
- Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Lindsey L. Monteith
- VA Rocky Mountain Mental Illness Research Education and Clinical Center for Suicide Prevention, Aurora, Colorado
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Lisa A. Brenner
- VA Rocky Mountain Mental Illness Research Education and Clinical Center for Suicide Prevention, Aurora, Colorado
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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Byers AL, Li Y, Barnes DE, Boscardin WJ, Peltz CB, Yaffe K. TBI and risk of death in military veterans over 14 years: Injury severity, timing, and cause of death. J Psychiatr Res 2022; 156:200-5. [PMID: 36257114 DOI: 10.1016/j.jpsychires.2022.09.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 08/26/2022] [Accepted: 09/16/2022] [Indexed: 01/20/2023]
Abstract
The objective of this study was to determine the association of traumatic brain injury (TBI) with mortality in military veterans and whether this association differs as a function of TBI severity, timing, and cause of death. This national cohort study used U.S. Department of Veterans Affairs' (VA) data of patients 18 years and older with TBI diagnoses (N = 213,290) and 1:1 propensity-matched comparison random sample of patients without TBI (N = 213,290). The main outcome measure was mortality within 6 months of TBI diagnosis and longer-term (after 6 months). Cox proportional hazards models were used to examine risk of all-cause mortality according to TBI severity and Fine-Gray proportional hazards regression to examine time to cause-specific mortality, accounting for competing risk of other deaths. For patients with moderate-to-severe TBI (compared with no TBI), hazard ratios (HRs) for mortality were highest within first 6 months of injury (fully-adjusted HR: 2.42, 95% CI: 2.32-2.53); for mild TBIs, HRs for mortality were lower and relatively constant over time (fully-adjusted HR within first 6 months: 1.33, 95% CI: 1.26-1.39). Veterans with mild and moderate-to-severe TBI had higher risk of future death over short term for 9 out 10 of the U.S. leading causes of death, with only unintentional injury, stroke, and suicide showing differences by TBI severity. Associations attenuated significantly from within to after 6 months TBI diagnosis. These findings indicate that adults with TBI are at increased risk of majority of leading causes of death, with differential risk by TBI severity and timing of death.
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Cifu DX. Clinical research findings from the long-term impact of military-relevant brain injury consortium-Chronic Effects of Neurotrauma Consortium (LIMBIC-CENC) 2013-2021. Brain Inj 2022; 36:587-597. [PMID: 35080997 DOI: 10.1080/02699052.2022.2033843] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
This is a summary of the published research from the 14 observational, longitudinal and big-data, epidemiological studies supported by the LIMBIC-CENC program from 2013-2021 examining the long-term effects of combat-related traumatic brain injury (TBI). Findings from these 43 primary and secondary analyses include: 1) unique fluid, advanced neuroimaging and electrophysiologic biomarkers associated with mild traumatic brain injury (mTBI), number of mTBIs and related dysfunction, 2) increases in a range of chronic difficulties, including neurosensory, sleep, pain, cognitive deficits, behavioral disorders, overall symptom burden, healthcare costs and service-connected disability, associated with mTBI, all-severity traumatic brain injury (TBI), blast exposure, and number of mTBIs, and 3) increases in the risk for suicide and neurodegeneration, including dementia and Parkinson's disease, associated with mTBI and all-severity TBI. Ongoing LIMBIC-CENC longitudinal and epidemiologic research will clarify, confirm and expand upon these findings.
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Affiliation(s)
- David X Cifu
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia, USA.,Department of Veterans Affairs, Washington, DC, USA
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Adams RS, Corrigan JD, Ritter GA, Hagemeyer A, Pliskin MB, Reif S. Association of Lifetime History of Traumatic Brain Injury With Prescription Opioid Use and Misuse Among Adults. J Head Trauma Rehabil 2021; 36:328-37. [PMID: 34489383 DOI: 10.1097/HTR.0000000000000729] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate associations of lifetime history of traumatic brain injury (TBI) with prescription opioid use and misuse among noninstitutionalized adults. PARTICIPANTS Ohio Behavioral Risk Factor Surveillance System (BRFSS) participants in the 2018 cohort who completed the prescription opioid and lifetime history of TBI modules (n = 3448). DESIGN Secondary analyses of a statewide population-based cross-sectional survey. MAIN MEASURES Self-report of a lifetime history of TBI using an adaptation of the Ohio State University TBI-Identification Method. Self-report of past year: (1) prescription pain medication use (ie, prescription opioid use); and (2) prescription opioid misuse, defined as using opioids more frequently or in higher doses than prescribed and/or using a prescription opioid not prescribed to the respondent. RESULTS In total, 22.8% of adults in the sample screened positive for a lifetime history of TBI. A quarter (25.5%) reported past year prescription opioid use, and 3.1% met criteria for prescription opioid misuse. A lifetime history of TBI was associated with increased odds of both past year prescription opioid use (adjusted odds ratio [AOR] = 1.52; 95% CI, 1.27-1.83; P < .01) and prescription opioid misuse (AOR = 1.65; 95% CI, 1.08-2.52; P < .05), controlling for sex, age, race/ethnicity, and marital status. CONCLUSION Results from this study support the "perfect storm" hypothesis-that persons with a history of TBI are at an increased risk for exposure to prescription opioids and advancing to prescription opioid misuse compared with those without a history of TBI. Routine screening for a lifetime history of TBI may help target efforts to prevent opioid misuse among adults.
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Adams RS. Traumatic Brain Injury and Opioid Use: Additional Evidence Supporting the "Perfect Storm" of Cascading Vulnerabilities. J Head Trauma Rehabil 2021; 36:303-9. [PMID: 34489381 DOI: 10.1097/HTR.0000000000000730] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kumar RG, Ornstein KA, Corrigan JD, Sayko Adams R, Dams-O'Connor K. Association between Lifetime History of Traumatic Brain Injury, Prescription Opioid Use, and Persistent Pain: A Nationally Representative Study. J Neurotrauma 2021; 38:2284-2290. [PMID: 33567980 PMCID: PMC8672103 DOI: 10.1089/neu.2020.7496] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Pain is common among adults with traumatic brain injury (TBI), yet little data exist regarding prevalence of opioid use in this population. The objective of this retrospective cohort study was to evaluate the association between lifetime TBI exposure, opioid use, and pain in a nationally representative sample of 1022 adults aged 50+ who participated in the Health and Retirement Study (HRS). Our primary exposure was lifetime TBI history measured via the Ohio State University TBI Identification Method. We evaluated three alternate TBI exposures (years since most recent TBI, age at first TBI, and number of lifetime TBIs) in sensitivity analyses. We evaluated two outcomes: recent opioid medication use, and moderate-to-severe pain measured over two HRS waves. We classified three pain groups (persistent, intermittent, and no pain). Prevalences of opioid use among individuals with and without TBI were 19.7% and 13.6%, respectively. After adjustment for age, sex, and race, individuals with TBI had a 52% increased risk for opioid use compared with individuals without TBI (relative risk = 1.52, 95% confidence interval: 1.11, 2.04). Individuals with recent TBI (1-10 years ago), first TBI after age 40+, and 2+ lifetime TBIs had greatest risk for opioid use. Compared with individuals without TBI, individuals with TBI had 4.9-times increased odds for persistent versus no pain, and 1.9-times increased odds of intermittent versus no pain. Persistent pain among adults with lifetime TBI is elevated compared with the general population, which may contribute to increased opioid use among persons with TBI, particularly those with recent injuries or multiple lifetime TBIs.
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Affiliation(s)
- Raj G. Kumar
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Katherine A. Ornstein
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Medicine, Division of General Internal Medicine, and Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - John D. Corrigan
- Department of Physical Medicine and Rehabilitation, Ohio State University, Columbus, Ohio, USA
| | - Rachel Sayko Adams
- Heller School, Institute for Behavioral Health, Brandeis University, Waltham, Massachusetts, USA
- Rocky Mountain Mental Illness Research Education and Clinical Center, Veterans Health Administration, Aurora, Colorado, USA
| | - Kristen Dams-O'Connor
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Marinkovic I, Isokuortti H, Huovinen A, Trpeska Marinkovic D, Mäki K, Nybo T, Korvenoja A, Rahul R, Vataja R, Melkas S. Prognosis after Mild Traumatic Brain Injury: Influence of Psychiatric Disorders. Brain Sci 2020; 10:E916. [PMID: 33260933 DOI: 10.3390/brainsci10120916] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/15/2020] [Accepted: 11/25/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND We evaluated the prevalence of psychiatric disorders in mild traumatic brain injury (MTBI) patients and investigated psychiatric comorbidity in relation to subjective symptoms and return to work (RTW). METHODS We recruited 103 MTBI patients (mean age 40.8 years, SD 3.1) prospectively from University Hospital. The patients were followed up for one year. The Rivermead Post-Concussion Symptom Questionnaire (RPQ) and Extended Glasgow Outcome Scale (GOSE) were administered one month after MTBI. Three months after MTBI, any psychiatric disorders were assessed using the Structured Clinical Interview for DSM-IV Axis I Disorders. RESULTS Psychiatric disorders were diagnosed in 26 patients (25.2%). The most common disorders were previous/current depression. At three months, there was no difference between patients with psychiatric disorders versus those without them in RTW (95.7% vs. 87.3%, p = 0.260) or at least in part-time work (100% vs. 94.4%, p = 0.245). In Kaplan-Meier analysis, the median time to RTW was 10 days for both groups. The median RPQ score was 13.0 (Interquartile range (IQR) 6.5-19.0) in patients with a psychiatric disorder compared to 8.5 (IQR 2.3-14.0) in those without one (p = 0.021); respectively, the median GOSE was 7.0 (IQR 7.0-8.0) compared to 8.0 (IQR 7.0-8.0, p = 0.003). CONCLUSIONS Approximately every fourth patient with MTBI had a psychiatric disorder. These patients reported more symptoms, and their functional outcome measured with GOSE at one month after MTBI was worse. However, presence of any psychiatric disorder did not affect RTW. Early contact and adequate follow-up are important when supporting the patient's return to work.
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