A comparison of substance abuse and violence in the prediction of long-term rehabilitation outcomes after traumatic brain injury.
ABSTRACT To determine the relative contributions of substance abuse history and violent etiology to the prediction of outcomes for individuals who sustained a traumatic brain injury (TBI) requiring inpatient rehabilitation.
Longitudinal study of outcomes 1 year postdischarge from rehabilitation.
Specialized TBI acute rehabilitation unit.
Three hundred fifty-one individuals consecutively admitted for rehabilitation.
Gathered data from patients' medical records (including etiology of injury, initial Glasgow Coma Scale scores, and FIMtrade mark instrument scores at discharge), demographic details, and history of substance abuse; phone and mail survey data from individuals (Satisfaction with Life Scale [SWLS]; Community Integration Questionnaire [CIQ]).
CIQ and SWLS; relative contributions of injury etiology, demographic and injury-related dependent variables, and substance abuse history to predictive model.
Almost 80% of persons with injuries from violence-related causes had a history of substance abuse. Substance abuse was found to contribute to the prediction of life satisfacton and productivity, while violent etiology was not a significant contributor to predictive models.
Substance abuse history proved to be a strong predictor of long-term outcomes, while violent etiology of injury was less influential. The results of this study emphasize the need to include substance abuse history in all studies of outcomes after TBI, and to increase prevention efforts to limit the effects of such a history.
SourceAvailable from: etd.lsu.edu
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ABSTRACT: Cranioencephalic traumatisms in developed countries are caused by the following types of accidents: traffic, work, domestic and that occurring while practicing a sport. We should add cranial traumatisms caused by heteroaggressions that mean an elevated percentage of cases in some countries to these external causes. Accidents in general are caused by a complex interaction of very different factors: socioeconomic (industrialization, progressive mechanization of society, increase in availability of economic resources as occurs in periods of economic expansion, etc.); sociocultural (increase of social aggressiveness, consumption of stimulant drugs, progressive habit of practicing risk sports, etc.) and individual. Within the latter, psychological and psychiatric factors are of great importance and can predispose an individual to an accident and therefore a cranioencephalic traumatism. In this chapter, the authors perform an up-dated review of the existing data on this latter aspect, trying to use a multiaxial approach: «psychiatric disorders», «personality disorders» and «reaction of the individuals to psychosocial and environmental problems.» This multiaxial system provides us an adequate format to understand the complexity of these clinical situations and promotes the application of the biopsychosocial model in the study of this area of knowledge of traumatic brain damage. Finally, we refer to the predisposition to accidents both in infants as well as in the geriatric age.Rehabilitación 01/2002; 36(6):353–363. DOI:10.1016/S0048-7120(02)73307-0
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ABSTRACT: The purpose of the study was to disentangle the relative contributions of day-of-injury alcohol intoxication and pre-injury alcohol misuse on outcome from TBI. Participants were 142 patients enrolled from a Level 1 Trauma Center (in Vancouver, Canada) following a traumatic brain injury (TBI; 43 uncomplicated mild TBI and 63 complicated mild-severe TBI) or orthopedic injury [36 trauma controls (TC)]. At 6-8 weeks post-injury, diffusion tensor imaging (DTI) of the whole brain was undertaken using a Phillips 3T scanner. Participants also completed neuropsychological testing, an evaluation of lifetime alcohol consumption (LAC), and had blood alcohol levels (BALs) taken at the time of injury. Participants in the uncomplicated mild TBI and complicated mild-severe TBI groups had higher scores on measures of depression and postconcussion symptoms (d = 0.45-0.83), but not anxiety, compared with the TC group. The complicated mild-severe TBI group had more areas of abnormal white matter on DTI measures (all p < .05; d = 0.54-0.61) than the TC group. There were no difference between groups on all neurocognitive measures. Using hierarchical regression analyses and generalized linear modeling, LAC and BAL did provide a unique contribution toward the prediction of attention and executive functioning abilities; however, the variance accounted for was small. LAC and BAL did not provide a unique and meaningful contribution toward the prediction of self-reported symptoms, DTI measures, or the majority of neurocognitive measures. In this study, BAL and LAC were not predictive of mental health symptoms, postconcussion symptoms, cognition, or white-matter changes at 6-8 weeks following TBI.Archives of Clinical Neuropsychology 06/2014; DOI:10.1093/arclin/acu027 · 1.92 Impact Factor