Lifetime history of traumatic brain injury is associated with increased loneliness in adults: A US nationally representative study

Kumar, Raj G.; Ornstein, Katherine; Bollens‐Lund, Evan; Watson, Eric; Ankuda, Claire K.; Kelley, Amy S.; Dams-O’Connor, Kristen

doi:10.1002/gps.5271

Cited by 17 publications

(11 citation statements)

References 64 publications

(137 reference statements)

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“…We characterized participants’ time in various locations, social contexts, and activities as they went about their daily lives. TBI is associated with reduced community mobility and increased risk of loneliness and social isolation (Kumar et al, 2020; Ponsford et al, 2014). Our group-level findings comport with prior studies suggesting that people with moderate–severe TBI spend much of their time at home (Lenaert et al, 2019) and alone (Winkler et al, 2005).…”

Section: Discussionmentioning

confidence: 99%

Ecological momentary assessment of affect in context after traumatic brain injury.

Rabinowitz¹,

Hart²,

Wilson³

2021

Rehabilitation Psychology

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Purpose: To describe where, with whom, and how time was spent daily, and to characterize positive and negative affect, boredom, enjoyment, and perceived accomplishment as a function of time, activity, location, and social context, in people with chronic moderate-severe traumatic brain injury and depression/anxiety. Research Method: Participants (N = 23) responded to a smartphone app five times daily for approximately 2 weeks prior to treatment in a trial of Behavioral Activation. The app queried activity and physical/social context; concurrent positive and negative affect; and perceived boredom, enjoyment, and accomplishment. Descriptive statistics captured time use, and linear mixed models were used to analyze relations between affect and contextual factors. Results: Ecological Momentary Assessment (EMA) response rate was positively correlated with integrity of episodic memory and education. Participants spent most time at home versus elsewhere, and alone versus with others. The most frequent activity was watching TV. Mixed model results based on 17 participants with .33% response rate showed that positive affect was associated with being outside of home, and with other people; however, socializing was related to higher negative affect. TV watching was related to lower negative affect but also low accomplishment. Conclusions: EMA can provide unique information on the effects of social context and activity on mood in TBI. Clinicians should consider negative as well as positive affect associated with increasing social participation. Impact and ImplicationsEcological Momentary Assessment (EMA) is generally feasible for individuals with moderate-severe traumatic brain injury (TBI), but cognitive supports such as extra training and supervised practice might be needed to boost response rate for individuals with lower education or more severe memory impairment. Individuals with moderate-severe TBI may spend a large proportion of time alone and at home, and relatively little time engaged in outdoor activities and exercise. Positive affect is associated with productive activity such as working and doing chores. These findings point to the need for interventions that promote activity and community engagement after TBI. Spending time with others may be associated with both positive and negative emotional states, suggesting that clinicians might encourage a graded approach (beginning with lower-stress activities) to increasing socialization for people with moderate-severe TBI.

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Section: Discussionmentioning

confidence: 99%

Ecological momentary assessment of affect in context after traumatic brain injury.

Rabinowitz¹,

Hart²,

Wilson³

2021

Rehabilitation Psychology

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“…Social needs outweigh the physical and cognitive needs in ranking of importance by both survivors themselves and their families. These findings have been demonstrated and replicated within an international contextand a recent study in the United States (US) found that history of brain injury was associated with greater loneliness compared with individuals without brain injury in a representative sample of US adults (Kumar et al, 2020). They recommended that treating depressive symptoms and medical consequences of brain injury may be a target to ameliorate reporting of loneliness in this population.…”

Section: Introductionmentioning

confidence: 75%

‘Lonely in my head’: The experiences of loneliness in individuals with brain injury

Lowe

Crawley

Wilson

et al. 2020

British J Health Psychol

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Primary objective. This paper reports on the personal experiences of loneliness for individuals living with brain injury.Research design. This is a qualitative research design, employing semi-structured interviews and subsequent contextualist thematic analysis.Methods and procedures. Eleven clients (two female and nine male, aged between 27 and 63 years) with brain injury participated in semi-structured interviews. Thematic analysis was employed in the interpretation of the data.Main outcomes and results. The interview data and subsequent analysis depicted three overarching themes in a healing process -'Internal Loneliness', 'Healing the Cracks', and 'Visible with Cracks'. Participants described five factors which contribute to their feeling of loneliness: trauma, social isolation, concealment, rejection of part of self, and invisibility of their disability. The participants' accounts also detailed the necessity of a therapeutic intervention and relationship to deal with and address some of these issues.Conclusions. This study highlights that processing the trauma, developing dialectical thinking, self-compassion, and a degree of self-acceptance assist in the movement of participants towards allowing themselves to be 'Visible with Cracks'. This allowance of self to be fully seen appears to serve an important function for reconnection with self and others. These results may help to inform brain injury rehabilitative care, through developing their understanding of the internal loneliness factors that may be influencing an individual's social isolation or social withdrawal. Statement of contributionWhat is already known on this subject?Individuals with brain injury continue to report significant problems developing social contacts and maintaining significant relationships years post-injury. Social needs often outweigh the physical and cognitive needs in ranking of importance by both individuals with brain injury themselves and their families.

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“…Though we did not observe population-level differences in mood by pandemic exposure in our study, mental health should still be continually monitored in TBI populations moving forward. Individuals with moderate-to-severe TBI already struggle with anxiety [ 49 ], loneliness [ 50 ], and limited social participation compared to non-injured peers [ 51 , 52 ]. These daily challenges would likely only worsen during a global pandemic due to fear of contracting the virus and recommendations or mandates to limit in-person social interaction.…”

Section: Discussionmentioning

confidence: 99%

Changes in alcohol use and mood during the COVID-19 pandemic among individuals with traumatic brain injury: A difference-in-difference study

et al. 2022

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Objective To evaluate the impact of COVID-19 pandemic exposure on changes in alcohol use and mood from years 1 to 2 after traumatic brain injury (TBI). Methods We used a difference-in-difference (DiD) study design to analyze data from 1,059 individuals with moderate-to-severe TBI enrolled in the TBI Model Systems (TBIMS) National Database. We defined COVID-19 pandemic exposure as participants who received their year 1 post-injury interviews prior to January 1, 2020, and their year 2 interview between April 1, 2020 and January 15, 2021. Pandemic-unexposed participants had both year 1 and 2 follow-up interviews before January 1, 2020. We measured current alcohol use as any past month alcohol use, average number of drinks per drinking occasion, and past month binge drinking. We measured depression symptoms using Patient Health Questionnaire-9, and anxiety symptoms using the Generalized Anxiety Disorder-7. Results We found persons with TBI exposed to the pandemic had greater increases in the average number of drinks per occasion from year 1 to 2 post-injury compared to pandemic-unexposed individuals (β = 0.36, 95% CI: 0.16, 0.57, p = 0.001), with males, adults <65 years old, and Black and Hispanic subgroups showing the greatest increases in consumption. Though average consumption was elevated, changes in rates of any alcohol use or binge drinking by pandemic exposure were not observed. Overall, there were no significant changes in depressive and anxiety symptoms over time between pandemic exposed and unexposed groups; however, pandemic-exposed Hispanics with TBI reported significant increases in anxiety symptoms from year-1 to year-2 post-injury compared to pandemic-unexposed Hispanics (β = 2.35, 95% CI: 0.25, 4.47, p = 0.028). Conclusion Among persons living with TBI, those exposed to the pandemic had significant increases in average alcohol consumption. Pandemic-exposed Hispanics with TBI had large elevations in anxiety symptoms, perhaps reflecting health inequities exacerbated by the pandemic, and suggesting a need for targeted monitoring of psychosocial distress.

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Lifetime history of traumatic brain injury is associated with increased loneliness in adults: A US nationally representative study

Cited by 17 publications

References 64 publications

Ecological momentary assessment of affect in context after traumatic brain injury.

Ecological momentary assessment of affect in context after traumatic brain injury.

‘Lonely in my head’: The experiences of loneliness in individuals with brain injury

Changes in alcohol use and mood during the COVID-19 pandemic among individuals with traumatic brain injury: A difference-in-difference study

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