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Max JE, Troyer EA, Arif H, Vaida F, Wilde EA, Bigler ED, Hesselink JR, Yang TT, Tymofiyeva O, Wade O, Paulsen JS. Traumatic Brain Injury in Children and Adolescents: Psychiatric Disorders 24 Years Later. J Neuropsychiatry Clin Neurosci 2022; 34:60-67. [PMID: 34538075 PMCID: PMC9818773 DOI: 10.1176/appi.neuropsych.20050104] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE The investigators aimed to extend findings regarding predictive factors of psychiatric outcomes among children and adolescents with traumatic brain injury (TBI) from 2 to 24 years postinjury. METHODS Youths aged 6-14 years who were hospitalized following TBI from 1992 to 1994 were assessed at baseline for TBI severity and for preinjury psychiatric, adaptive, and behavioral functioning; family functioning; family psychiatric history; socioeconomic status; and intelligence within weeks of injury. Predictors of psychiatric outcomes following pediatric TBI at 3, 6, 12, and 24 months postinjury have previously been reported. In this study, repeat psychiatric assessments were completed at 24 years postinjury with the same cohort, now adults aged 29-39 years, with the outcome measure being presence of a psychiatric disorder not present before the TBI ("novel psychiatric disorder"). RESULTS Fifty participants with pediatric TBI were initially enrolled, and the long-term outcome analyses focused on data from 45 individuals. Novel psychiatric disorder was present in 24 out of 45 (53%) participants. Presence of a current novel psychiatric disorder was independently predicted by the presence of a preinjury lifetime psychiatric disorder and by severity of TBI. CONCLUSIONS Long-term psychiatric outcome (mean=23.92 years [SD=2.17]) in children and adolescents hospitalized for TBI can be predicted at the point of the initial hospitalization encounter by the presence of a preinjury psychiatric disorder and by greater injury severity.
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Affiliation(s)
- Jeffrey E. Max
- Department of Psychiatry, University of California, San Diego (Max, Troyer, Arif);Rady Children’s Hospital, San Diego (Max); Department of Psychiatry, University of Iowa, Iowa City (Max, Wade, Paulsen); Department of Family Medicine and Public Health, University of California, San Diego (Vaida); Department of Neurology, TBI and Concussion Center, University of Utah, Salt Lake City (Wilde, Bigler); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Wilde); Department
| | - Emily A. Troyer
- Department of Psychiatry, University of California, San Diego (Max, Troyer, Arif);Rady Children’s Hospital, San Diego (Max); Department of Psychiatry, University of Iowa, Iowa City (Max, Wade, Paulsen); Department of Family Medicine and Public Health, University of California, San Diego (Vaida); Department of Neurology, TBI and Concussion Center, University of Utah, Salt Lake City (Wilde, Bigler); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Wilde); Department
| | - Hattan Arif
- Department of Psychiatry, University of California, San Diego (Max, Troyer, Arif);Rady Children’s Hospital, San Diego (Max); Department of Psychiatry, University of Iowa, Iowa City (Max, Wade, Paulsen); Department of Family Medicine and Public Health, University of California, San Diego (Vaida); Department of Neurology, TBI and Concussion Center, University of Utah, Salt Lake City (Wilde, Bigler); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Wilde); Department
| | - Florin Vaida
- Department of Psychiatry, University of California, San Diego (Max, Troyer, Arif);Rady Children’s Hospital, San Diego (Max); Department of Psychiatry, University of Iowa, Iowa City (Max, Wade, Paulsen); Department of Family Medicine and Public Health, University of California, San Diego (Vaida); Department of Neurology, TBI and Concussion Center, University of Utah, Salt Lake City (Wilde, Bigler); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Wilde); Department
| | - Elisabeth A. Wilde
- Department of Psychiatry, University of California, San Diego (Max, Troyer, Arif);Rady Children’s Hospital, San Diego (Max); Department of Psychiatry, University of Iowa, Iowa City (Max, Wade, Paulsen); Department of Family Medicine and Public Health, University of California, San Diego (Vaida); Department of Neurology, TBI and Concussion Center, University of Utah, Salt Lake City (Wilde, Bigler); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Wilde); Department
| | - Erin D. Bigler
- Department of Psychiatry, University of California, San Diego (Max, Troyer, Arif);Rady Children’s Hospital, San Diego (Max); Department of Psychiatry, University of Iowa, Iowa City (Max, Wade, Paulsen); Department of Family Medicine and Public Health, University of California, San Diego (Vaida); Department of Neurology, TBI and Concussion Center, University of Utah, Salt Lake City (Wilde, Bigler); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Wilde); Department
| | - John R. Hesselink
- Department of Psychiatry, University of California, San Diego (Max, Troyer, Arif);Rady Children’s Hospital, San Diego (Max); Department of Psychiatry, University of Iowa, Iowa City (Max, Wade, Paulsen); Department of Family Medicine and Public Health, University of California, San Diego (Vaida); Department of Neurology, TBI and Concussion Center, University of Utah, Salt Lake City (Wilde, Bigler); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Wilde); Department
| | - Tony T. Yang
- Department of Psychiatry, University of California, San Diego (Max, Troyer, Arif);Rady Children’s Hospital, San Diego (Max); Department of Psychiatry, University of Iowa, Iowa City (Max, Wade, Paulsen); Department of Family Medicine and Public Health, University of California, San Diego (Vaida); Department of Neurology, TBI and Concussion Center, University of Utah, Salt Lake City (Wilde, Bigler); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Wilde); Department
| | - Olga Tymofiyeva
- Department of Psychiatry, University of California, San Diego (Max, Troyer, Arif);Rady Children’s Hospital, San Diego (Max); Department of Psychiatry, University of Iowa, Iowa City (Max, Wade, Paulsen); Department of Family Medicine and Public Health, University of California, San Diego (Vaida); Department of Neurology, TBI and Concussion Center, University of Utah, Salt Lake City (Wilde, Bigler); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Wilde); Department
| | - Owen Wade
- Department of Psychiatry, University of California, San Diego (Max, Troyer, Arif);Rady Children’s Hospital, San Diego (Max); Department of Psychiatry, University of Iowa, Iowa City (Max, Wade, Paulsen); Department of Family Medicine and Public Health, University of California, San Diego (Vaida); Department of Neurology, TBI and Concussion Center, University of Utah, Salt Lake City (Wilde, Bigler); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Wilde); Department
| | - Jane S. Paulsen
- Department of Psychiatry, University of California, San Diego (Max, Troyer, Arif);Rady Children’s Hospital, San Diego (Max); Department of Psychiatry, University of Iowa, Iowa City (Max, Wade, Paulsen); Department of Family Medicine and Public Health, University of California, San Diego (Vaida); Department of Neurology, TBI and Concussion Center, University of Utah, Salt Lake City (Wilde, Bigler); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Wilde); Department
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Arif H, Troyer EA, Paulsen JS, Vaida F, Wilde EA, Bigler ED, Hesselink JR, Yang TT, Tymofiyeva O, Wade O, Max JE. Long-Term Psychiatric Outcomes in Adults with History of Pediatric Traumatic Brain Injury. J Neurotrauma 2021; 38:1515-1525. [PMID: 33765846 PMCID: PMC8336207 DOI: 10.1089/neu.2020.7238] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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] [Indexed: 11/13/2022] Open
Abstract
The objective of the study was to compare psychiatric outcomes in adults with and without history of pediatric traumatic brain injury (TBI). Youth ages 6 to 14 years hospitalized for TBI from 1992 to 1994 were assessed at baseline and at 3, 6, 12, and 24 months post-injury. In the current study, psychiatric assessments were repeated at 24 years post-injury with the same cohort, now adults ages 29 to 39 years. A control group of healthy adults also was recruited for one-time cross-sectional assessments. Outcome measures included: 1) presence of a psychiatric disorder since the 24-month assessment not present before the TBI ("novel psychiatric disorder," NPD), or in the control group, the presence of a psychiatric disorder that developed after the mean age of injury of the TBI group plus 2 years; and 2) Time-to-Event for onset of an NPD during the same time periods. In the TBI group, NPDs were significantly more common, and presence of a current NPD was significantly predicted by presence of a pre-injury lifetime psychiatric disorder and by abnormal day-of-injury computed tomography (CT) scan. Compared with controls, the TBI group also had significantly shorter Time-to-Event for onset of any NPD. These findings demonstrate that long-term psychiatric outcomes in adults previously hospitalized for pediatric TBI are significantly worse when compared with adult controls without history of pediatric TBI, both in terms of prevalence and earlier onset of NPD. Further, in the TBI group, long-term NPD outcome is predicted independently by presence of pre-injury psychiatric disorder and abnormal day-of-injury CT scan.
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Affiliation(s)
- Hattan Arif
- Departments of Psychiatry, University of California, San Diego, San Diego, California, USA
| | - Emily A. Troyer
- Departments of Psychiatry, University of California, San Diego, San Diego, California, USA
| | - Jane S. Paulsen
- Departments of Neuroscience, University of Iowa, Iowa City, Iowa, USA
- Neurology, University of Iowa, Iowa City, Iowa, USA
- Psychiatry, and University of Iowa, Iowa City, Iowa, USA
- Psychology, University of Iowa, Iowa City, Iowa, USA
| | - Florin Vaida
- Family Medicine and Public Health, University of California, San Diego, San Diego, California, USA
| | - Elisabeth A. Wilde
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Erin D. Bigler
- Department of Psychology and Neuroscience, Brigham Young University, Provo, Utah, USA
| | - John R. Hesselink
- Radiology, University of California, San Diego, San Diego, California, USA
| | - Tony T. Yang
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Olga Tymofiyeva
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Owen Wade
- Psychiatry, and University of Iowa, Iowa City, Iowa, USA
| | - Jeffrey E. Max
- Departments of Psychiatry, University of California, San Diego, San Diego, California, USA
- Psychiatry, and University of Iowa, Iowa City, Iowa, USA
- Rady Children's Hospital, San Diego, San Diego, California, USA
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Blixen C, Ghearing G, Wade O, Colon-Zimmerman K, Tyrrell M, Sajatovic M. Engaging stakeholders in the refinement of an evidence-based remotely delivered epilepsy self-management program for rural populations. Epilepsy Behav 2021; 118:107942. [PMID: 33845345 PMCID: PMC8107125 DOI: 10.1016/j.yebeh.2021.107942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/15/2021] [Accepted: 03/18/2021] [Indexed: 11/29/2022]
Abstract
A growing body of research supports self-management approaches that can improve outcomes in people living with epilepsy (PLWE). An evidence-based remotely delivered self-management program (SMART) that was successfully delivered in an urban/suburban setting has the potential to be particularly helpful to PLWE who live in rural communities, where heavy stigma burden and limited access to healthcare is common. In this Phase 1 exploratory study, focus groups of key rural stakeholders (PLWE, family members, care providers) were used to: (1) gather information on factors that may impede or facilitate participation in SMART and (2) elicit overall perceptions of the program, as well as suggestions and feedback for refining it for implementation in Phase 2 of the randomized controlled study (RCT). Qualitative data analysis revealed that focus group participants identified geographic and social isolation, and the more limited access to epilepsy care, as the major barriers to epilepsy self-management for rural populations. However, they felt strongly that SMART could fill an epilepsy care gap in rural communities, and provided suggestions for recruitment and retention strategies of subjects, as well as improvement/modifications to the program curriculum for the Phase 2 RCT.
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Affiliation(s)
- Carol Blixen
- Department of Psychiatry and Neurological and Behavioral Outcomes Center, Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
| | - Gena Ghearing
- Department of Neurology, University of Iowa Health Care, Iowa City, IA, USA
| | - Owen Wade
- Department of Neurology, University of Iowa Health Care, Iowa City, IA, USA
| | - Kari Colon-Zimmerman
- Department of Psychiatry and Neurological and Behavioral Outcomes Center, Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Maegan Tyrrell
- Department of Neurology, University of Iowa Health Care, Iowa City, IA, USA
| | - Martha Sajatovic
- Department of Psychiatry and Neurological and Behavioral Outcomes Center, Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Department of Psychiatry & Neurology and Neurological and Behavioral Outcomes Center, Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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