Rural–Urban Differences in Behavioral Outcomes among Adults with Lifetime History of Traumatic Brain Injury with Loss of Consciousness: 2016–2019 Ohio BRFSS

Abstract

This study examined if the associations between lifetime history of traumatic brain injury (TBI) with loss of consciousness (LOC) and unhealthy alcohol use or mental health problems differ by location of living (rural vs. urban). The lifetime history data of TBI with LOC, location of living, unhealthy alcohol use (binge drinking, heavy drinking), and mental health problems (depression diagnosis, number of poor mental health days) were sourced from the 2016, 2017, 2018, and 2019 Ohio Behavioral Risk Factory Surveillance Surveys, and the final sample included 16,941 respondents. We conducted multivariable logistic regressions to determine the odds ratios for each of the five outcomes between individuals living in rural vs. urban areas and between individuals with vs. without a lifetime history of TBI with LOC. No interaction between location of living and lifetime history of TBI with LOC was observed for any outcomes, indicating rurality did not modify these relationships. Living in a rural area was associated with decreased binge drinking or heavy drinking but not mental health outcomes. Lifetime history of TBI with LOC was associated with an increased risk of binge drinking, heavy drinking, depression diagnoses, and poor general mental health, regardless of location of living. Our findings support the need for TBI screenings as part of mental health intake evaluations and behavioral health screenings. Though rurality was not associated with mental health outcomes, rural areas may have limited access to quality mental health care. Therefore, future research should address access to mental health services following TBI among rural residents.

Online screening assessment of lifetime exposure to traumatic brain injury: a pilot study of associations between exposure and health status

“…The BRFSS is a telephone survey of BHRs and chronic health conditions (Centres for Disease Control and Prevention 2014). Several studies (Bogner et al 2020;Manchester et al 2020;Feiss et al 2022) have used specific BRFSS items to examine relationships between TBI exposure and BHRs (e.g. substance use, depression, and days of poor mental health; Bogner et al 2020).…”

“…severe injury or mild injury with loss of consciousness [LOC]; Rabinowitz et al 2020). A recent study found that LTE metrics -with LOC--were associated with increased risks, such as heavy drinking and poor general mental health (Feiss et al 2022). Further studies must clarify the relation between LTE and BHRs, including which injuries (and by extension which OSU TBI-ID indices) show these relations.…”

Health disparities among rural individuals with mental health conditions: A systematic literature review.

“…There is research looking specifically at rural mental health outcomes and urban mental health outcomes in North America, but less directly comparing the outcomes of these groups (Fox & Kim-Godwin, 2011; Hauenstein & Peddada, 2007; Hoyt et al, 1997; Okkels et al, 2018; van der Wal et al, 2021). There is research regarding outcomes on traumatic brain injury (Feiss et al, 2022), cognitive impairment and dementia (Chuang et al, 2021; Rahman et al, 2020), substance use disorders (Kiang et al, 2021; Nguyen et al, 2019; Turvey et al, 2020), and literature regarding rural differences internationally (Forthal et al, 2019; Khare et al, 2020; Souza et al, 2022). However, to our knowledge, this is the first review of the literature on the disparities between those living in rural versus urban settings with mental illness in North America (Batterham et al, 2022).…”