A scoping review of psychiatric care in traumatic brain injury patients in low-and middle-income countries in the Asia-Pacific region
Article Sidebar
Main Article Content
Abstract
Introduction
Asia has the highest percentage of Traumatic Brain Injury (TBI)-related outcomes, among other regions in the world. Lower-middle income countries (LMICs) report thrice the total TBIs compared with Higher-income countries (HICs). Despite the high prevalence of patients with TBI in the region, TBI-related psychiatric disorders are often given the least priority in trauma management.
Objectives
This study focuses on LMICs in the Asia-Pacific region and examines existing literature within the past decade to (1) identify the common psychiatric conditions associated with TBI; (2) determine the most commonly used pharmacologic and nonpharmacologic psychiatric interventions in the management of TBI-related psychiatric disorders; and (3) identify the barriers in the screening, diagnosis, and management of these TBI-related psychiatric conditions.
Methods
The researchers used a scoping review methodology to search relevant articles through nine online databases (e.g., PubMed, Google Scholar, Cochrane). Findings were reported according to the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Upon review, 75 journals were included in the current study. Among the articles, there are limited studies among Asia-Pacific LMICs that focus on this topic.
Results
Post-traumatic stress disorder, major depressive disorder, and substance-related disorders were among the common psychiatric sequelae of TBI reported in 54 studies. Forty-two articles highlighted the effectiveness of antidepressants and Cognitive Behavioral Therapy (CBT) in managing TBI-related psychiatric disorders. Barriers to managing these conditions in Asia-Pacific LMICs include low socioeconomic status, psychiatric illness stigma, and the scarcity of healthcare resources.
Conclusion
The psychiatric care in the management of TBI patients is clearly recognized but often overlooked. As LMICs struggle to provide a holistic approach to TBI cases in the face of limited resources, there emerges the need to raise awareness and encourage resourcefulness in utilizing accessible management and treatment strategies that can be used in different trauma centers in the region.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
© Journal of Asian Medical Students’ Association (JAMSA). Released under a Creative Commons license.
References
Dewan MC, Rattani A, Gupta S, Baticulon RE, Hung Y-C, Punchak M, et al. Estimating the global incidence of traumatic brain injury. J Neurosurg. 2018 Apr 27;130(4):1080–97.
Perry DC, Sturm VE, Peterson MJ, Pieper CF, Bullock T, Boeve BF, et al. Association of traumatic brain injury with subsequent neurological and psychiatric disease: a meta-analysis. J Neurosurg. 2016 Feb 1;124(2):511–26.
Chaudhury S, Biswas PS, Kumar S. Psychiatric sequelae of traumatic brain injury. Med J Dr Patil Univ. 2013 Jul 1;6(3):222.
Ghosh A, Desai B, Halder A, Ghosh A, Das P, Saldanha D. Psychiatric sequelae of traumatic brain injury (TBI). Asian J Med Sci. 2020 Sep 1;11(5):77–82.
Leong Bin Abdullah MFI, Ng YP, Sidi HB. Depression and anxiety among traumatic brain injury patients in Malaysia. Asian J Psychiatry. 2018 Oct;37:67–70.
Puvanachandra P, Hyder AA. THE BURDEN OF TRAUMATIC BRAIN INJURY IN ASIA: A CALL FOR RESEARCH. 2009;4:6.
McLane HC, Berkowitz AL, Patenaude BN, McKenzie ED, Wolper E, Wahlster S, et al. Availability, accessibility, and affordability of neurodiagnostic tests in 37 countries. Neurology. 2015 Nov 3;85(18):1614–22.
Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med. 2018 Sep 4;169(7):467–73.
World Bank Country and Lending Groups – World Bank Data Help Desk [Internet]. [cited 2021 Apr 10]. Available from: https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groups
James SL, Theadom A, Ellenbogen RG, Bannick MS, Montjoy-Venning W, Lucchesi LR, et al. Global, regional, and national burden of traumatic brain injury and spinal cord injury, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2019 Jan;18(1):56–87.
Khan A, Prince M, Brayne C, Prina AM. Lifetime Prevalence and Factors Associated with Head Injury among Older People in Low and Middle Income Countries: A 10/66 Study. Abe T, editor. PLOS ONE. 2015 Jul 6;10(7):e0132229.
Välimäki M, Korkeila J, Kauppi K, Kaakinen JK, Holm S, Vahlo J, et al. Digital Gaming for Improving the Functioning of People With Traumatic Brain Injury: Protocol of a Feasibility Study. JMIR Res Protoc. 2016 Feb 9;5(1):e6.
Gómez-de-Regil L, Estrella-Castillo DF, Vega-Cauich J. Psychological Intervention in Traumatic Brain Injury Patients. Behav Neurol. 2019 May 2;2019:1–8.
Chen Y-H, Huang EY-K, Kuo T-T, Miller J, Chiang Y-H, Hoffer BJ. Impact of Traumatic Brain Injury on Dopaminergic Transmission. Cell Transplant. 2017 Jul;26(7):1156–68.
Nuhu F, Yusuf A. Psychiatric sequelae of traumatic brain injury: Retrospective analysis of 75 subjects from Kaduna, Nigeria. Niger J Clin Pract. 2012;15(4):397.
Carroll LJ, Cassidy JD, Cancelliere C, Côté P, Hincapié CA, Kristman VL, et al. Systematic Review of the Prognosis After Mild Traumatic Brain Injury in Adults: Cognitive, Psychiatric, and Mortality Outcomes: Results of the International Collaboration on Mild Traumatic Brain Injury Prognosis. Arch Phys Med Rehabil. 2014 Mar;95(3):S152–73.
Fehily B, Fitzgerald M. Repeated Mild Traumatic Brain Injury: Potential Mechanisms of Damage. Cell Transplant. 2017 Jul;26(7):1131–55.
Reddy RP, Rajeswaran J, Devi BI, Kandavel T. Cascade of Traumatic Brain Injury: A Correlational Study of Cognition, Postconcussion Symptoms, and Quality of Life. Indian J Psychol Med. 2017 Jan;39(1):32–9.
Brett BL, Kramer MD, Whyte J, McCrea MA, Stein MB, Giacino JT, et al. Latent Profile Analysis of Neuropsychiatric Symptoms and Cognitive Function of Adults 2 Weeks After Traumatic Brain Injury: Findings From the TRACK-TBI Study. JAMA Netw Open. 2021 Mar 30;4(3):e213467.
Lurie DI. An Integrative Approach to Neuroinflammation in Psychiatric disorders and Neuropathic Pain. J Exp Neurosci. 2018 Jan;12:117906951879363.
Zhao W, Wu R, Wang S, Qi H, Qian Y, Wang S. Behavioral and neurophysiological abnormalities during cued continuous performance tasks in patients with mild traumatic brain injury. Brain Behav. 2018 May;8(5):e00966.
Oyesanya TO, Ward EC. Mental Health in Women With Traumatic Brain Injury: A Systematic Review on Depression and Hope. Health Care Women Int. 2016 Jan 2;37(1):45–74.
Alway Y, Ponsford J, McKay A. The relationship between family expressed emotion, perceived criticism and criticism sensitivity and psychiatric outcomes following traumatic brain injury. Psychiatry Res. 2016 Dec;246:827–32.
Timmer ML, Jacobs B, Schonherr MC, Spikman JM, van der Naalt J. The Spectrum of Long-Term Behavioral Disturbances and Provided Care After Traumatic Brain Injury. Front Neurol. 2020 Apr 7;11:246.
O’Connor MK, Mueller L, Kwon E, Drebing CE, O’Connor AA, Semiatin A, et al. Enhanced vocational rehabilitation for Veterans with mild traumatic brain injury and mental illness: Pilot study. J Rehabil Res Dev. 2016;53(3):307–20.
Kumar V, Abbas A, Aster J. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Elsevier Inc.; 2015.
Bangirana P, Giordani B, Kobusingye O, Murungyi L, Mock C, John CC, et al. Patterns of traumatic brain injury and six-month neuropsychological outcomes in Uganda. BMC Neurol. 2019 Dec;19(1):18.
Yu J, Tam HMK, Lee TMC. Traumatic Brain Injury Rehabilitation in Hong Kong: A Review of Practice and Research. Behav Neurol. 2015;2015:1–8.
Sun H, Luo C, Chen X, Tao L. Assessment of cognitive dysfunction in traumatic brain injury patients: a review. Forensic Sci Res. 2017 Oct 2;2(4):174–9.
Wu C-H, Tsai T-H, Su Y-F, Zhang Z-H, Liu W, Wu M-K, et al. Traumatic Brain Injury and Substance Related Disorder: A 10-Year Nationwide Cohort Study in Taiwan. Neural Plast. 2016;2016:1–8.
Wojtowicz M, Silverberg ND, Bui E, Zafonte R, Simon N, Iverson GL. Psychiatric Comorbidity and Psychosocial Problems Among Treatment-Seeking Veterans With a History of Mild Traumatic Brain Injury. FOCUS. 2017 Oct;15(4):384–9.
Kennedy E, Heron J, Munafò M. Substance use, criminal behaviour and psychiatric symptoms following childhood traumatic brain injury: findings from the ALSPAC cohort. Eur Child Adolesc Psychiatry. 2017 Oct;26(10):1197–206.
Stein MB, Jain S, Giacino JT, Levin H, Dikmen S, Nelson LD, et al. Risk of Posttraumatic Stress Disorder and Major Depression in Civilian Patients After Mild Traumatic Brain Injury: A TRACK-TBI Study. JAMA Psychiatry. 2019 Mar 1;76(3):249.
Rosen V, Ayers G. An Update on the Complexity and Importance of Accurately Diagnosing Post-Traumatic Stress Disorder and Comorbid Traumatic Brain Injury. Neurosci Insights. 2020 Jan;15:263310552090789.
Dieter JN, Engel SD. Traumatic Brain Injury and Posttraumatic Stress Disorder: Comorbid Consequences of War. Neurosci Insights. 2019 Nov;14:117906951989293.
Zaninotto AL, Vicentini JE, Fregni F, Rodrigues PA, Botelho C, de Lucia MCS, et al. Updates and Current Perspectives of Psychiatric Assessments after Traumatic Brain Injury: A Systematic Review. Front Psychiatry [Internet]. 2016 Jun 14 [cited 2021 May 9];7. Available from: http://journal.frontiersin.org/article/10.3389/fpsyt.2016.00095
Moriarty H, Robinson KM, Winter L. The additional burden of PTSD on functioning and depression in veterans with traumatic brain injury. Nurs Outlook. 2021 Mar;69(2):167–81.
Combs HL, Berry DTR, Pape T, Babcock-Parziale J, Smith B, Schleenbaker R, et al. The Effects of Mild Traumatic Brain Injury, Post-Traumatic Stress Disorder, and Combined Mild Traumatic Brain Injury/Post-Traumatic Stress Disorder on Returning Veterans. J Neurotrauma. 2015 Jul;32(13):956–66.
Baker MT, Moring JC, Hale WJ, Mintz J, Young-McCaughan S, Bryant RA, et al. Acute Assessment of Traumatic Brain Injury and Post-Traumatic Stress After Exposure to a Deployment-Related Explosive Blast. Mil Med. 2018 Nov 5;183(11–12):e555–63.
Dai W, Liu A, Kaminga AC, Deng J, Lai Z, Yang J, et al. Prevalence of acute stress disorder among road traffic accident survivors: a meta-analysis. BMC Psychiatry. 2018 Dec;18(1):188.
Zaman S, Arouj K, Irfan S. The relationship between post-traumatic stress disorder and acquired brain injury among civilian patients. Clin Neurol Neurosurg. 2020 Sep;196:105981.
Chendrasekhar A, Kuczabski B, Cohen D, Grageda M, Genovese-Scullin D, Patwari J, et al. Delayed Sequelae Related to Mild Traumatic Brain Injury in Children. Glob Pediatr Health. 2020 Jan;7:2333794X2094798.
Korgaonkar MS, Williamson T, Bryant RA. Neural activity during response inhibition in mild traumatic brain injury and posttraumatic stress disorder. Neurobiol Stress. 2021 May;14:100308.
Schachar RJ, Park LS, Dennis M. Mental Health Implications of Traumatic Brain Injury (TBI) in Children and Youth. 2015;9.
Osborn AJ, Mathias JL, Fairweather-Schmidt AK. Depression following adult, non-penetrating traumatic brain injury: A meta-analysis examining methodological variables and sample characteristics. Neurosci Biobehav Rev. 2014 Nov;47:1–15.
Ho C-H, Hsieh K-Y, Liang F-W, Li C-J, Wang J-J, Chio C-C, et al. Pre-existing hyperlipidaemia increased the risk of new-onset anxiety disorders after traumatic brain injury: a 14-year population-based study. BMJ Open. 2014 Jul 17;4(7):e005269–e005269.
Ma H-P, Chen P-S, Wong C-S, Chang C-F, Ou J-C, Tsai Y-R, et al. Psychometric Evaluation of Anxiety, Depression, and Sleep Quality after a Mild Traumatic Brain Injury: A Longitudinal Study. Behav Neurol. 2019 Apr 14;2019:1–9.
Leong Bin Abdullah MFI, Ng YP, Sidi HB. Depression and anxiety among traumatic brain injury patients in Malaysia. Asian J Psychiatry. 2018 Oct;37:67–70.
Roy D, Koliatsos V, Vaishnavi S, Han D, Rao V. Risk Factors for New-Onset Depression After First-Time Traumatic Brain Injury. Psychosomatics. 2018 Jan;59(1):47–57.
Lu Y-C, Wu M-K, Zhang L, Zhang C-L, Lu Y-Y, Wu C-H. Association between suicide risk and traumatic brain injury in adults: a population based cohort study. Postgrad Med J. 2020 Feb 3;postgradmedj-2019-136860.
Max JE. Neuropsychiatry of Pediatric Traumatic Brain Injury. Psychiatr Clin North Am. 2014 Mar;37(1):125–40.
Li L, Liu J. The effect of pediatric traumatic brain injury on behavioral outcomes: a systematic review: Review. Dev Med Child Neurol. 2013 Jan;55(1):37–45.
Huebner ARS, Cassedy A, Brown TM, Taylor HG, Stancin T, Kirkwood MW, et al. Use of Mental Health Services by Adolescents After Traumatic Brain Injury: A Secondary Analysis of a Randomized Controlled Trial. PM&R. 2018 May;10(5):462–71.
Karver CL, Kurowski B, Semple EA, Stancin T, Taylor HG, Yeates KO, et al. Utilization of Behavioral Therapy Services Long-Term After Traumatic Brain Injury in Young Children. Arch Phys Med Rehabil. 2014 Aug;95(8):1556–63.
Max JE, Ch MBB, Wilde EA, Bigler ED, MacLeod M, Vasquez AC, et al. Psychiatric Disorders After Pediatric Traumatic Brain Injury: A Prospective, Longitudinal, Controlled Study. J Neuropsychiatry Clin Neurosci. 2012;10.
Emery CA, Barlow KM, Brooks BL, Max JE, Villavicencio-Requis A, Gnanakumar V, et al. A Systematic Review of Psychiatric, Psychological, and Behavioural Outcomes following Mild Traumatic Brain Injury in Children and Adolescents. Can J Psychiatry. 2016 May;61(5):259–69.
Christensen J, Eyolfson E, Salberg S, Mychasiuk R. Traumatic brain injury in adolescence: A review of the neurobiological and behavioural underpinnings and outcomes. Dev Rev. 2021 Mar;59:100943.
Chang H-K, Hsu J-W, Wu J-C, Huang K-L, Chang H-C, Bai Y-M, et al. Risk of attempted suicide among adolescents and young adults with traumatic brain injury: A nationwide longitudinal study. J Affect Disord. 2019 May;250:21–5.
Kurowski BG, Wade SL, Kirkwood MW, Brown TM, Stancin T, Taylor HG. Behavioral Predictors of Outpatient Mental Health Service Utilization Within 6 Months After Traumatic Brain Injury in Adolescents. PM&R. 2013 Dec;5(12):1026–34.
Di Battista A, Godfrey C, Soo C, Catroppa C, Anderson V. Depression and Health Related Quality of Life in Adolescent Survivors of a Traumatic Brain Injury: A Pilot Study. Bruce A, editor. PLoS ONE. 2014 Jul 10;9(7):e101842.
Vu HM, Dang AK, Tran TT, Vu GT, Truong NT, Nguyen CT, et al. Health-Related Quality of Life Profiles among Patients with Different Road Traffic Injuries in an Urban Setting of Vietnam. Int J Environ Res Public Health. 2019 Apr 24;16(8):1462.
Rauen K, Reichelt L, Probst P, Schäpers B, Müller F, Jahn K, et al. Quality of life up to 10 years after traumatic brain injury: a cross-sectional analysis. Health Qual Life Outcomes. 2020 Dec;18(1):166.
Williamson D, Frenette AJ, Burry LD, Perreault M, Charbonney E, Lamontagne F, et al. Pharmacological interventions for agitated behaviours in patients with traumatic brain injury: a systematic review. BMJ Open. 2019 Jul;9(7):e029604.
Lauterbach M, Notarangelo P, Nichols S, Lane K, Koliatsos V. Diagnostic and treatment challenges in traumatic brain injury patients with severe neuropsychiatric symptoms: insights into psychiatric practice. Neuropsychiatr Dis Treat. 2015 Jul;1601.
Hicks AJ, Clay FJ, Hopwood M, James AC, Jayaram M, Perry LA, et al. The Efficacy and Harms of Pharmacological Interventions for Aggression After Traumatic Brain Injury—Systematic Review. Front Neurol. 2019 Nov 29;10:1169.
Paraschakis A, Katsanos A. Antidepressants for Depression Associated with Traumatic Brain Injury: A Meta-analytical Study of Randomised Controlled Trials. Trauma Brain Inj. 2017;27:8.
Kumar KS, Samuelkamaleshkumar S, Viswanathan A, Macaden AS. Cognitive rehabilitation for adults with traumatic brain injury to improve occupational outcomes. Cochrane Work Group, editor. Cochrane Database Syst Rev [Internet]. 2017 Jun 20 [cited 2021 May 9]; Available from: http://doi.wiley.com/10.1002/14651858.CD007935.pub2
McDonald BC, Flashman LA, Arciniegas DB, Ferguson RJ, Xing L, Harezlak J, et al. Methylphenidate and Memory and Attention Adaptation Training for Persistent Cognitive Symptoms after Traumatic Brain Injury: A Randomized, Placebo-Controlled Trial. Neuropsychopharmacology. 2017 Aug;42(9):1766–75.
Han K, Chapman SB, Krawczyk DC. Cognitive Training Reorganizes Network Modularity in Traumatic Brain Injury. Neurorehabil Neural Repair. 2020 Jan;34(1):26–38.
Gertler P, Tate RL, Cameron ID. Non-pharmacological interventions for depression in adults and children with traumatic brain injury. Cochrane Injuries Group, editor. Cochrane Database Syst Rev [Internet]. 2015 Dec 14 [cited 2021 May 9]; Available from: http://doi.wiley.com/10.1002/14651858.CD009871.pub2
das Nair R, Bradshaw LE, Day FE, Drummond A, Harris SR, Fitzsimmons D, et al. Clinical and cost effectiveness of memory rehabilitation following traumatic brain injury: a pragmatic cluster randomized controlled trial. Clin Rehabil. 2019 Jul;33(7):1171–84.
Rasmussen MS, Andelic N, Pripp AH, Nordenmark TH, Soberg HL. The effectiveness of a family-centred intervention after traumatic brain injury: A pragmatic randomised controlled trial. Clin Rehabil. :14.
Yao X, Liu C, Feng D, Yin J, Chen G. Transcranial Near-infrared Laser Therapy in Improving Cognitive Recovery of Function Following Traumatic Brain Injury. Curr Neuropharmacol. 2018 Oct 5;16(9):1320–6.
Yeh T-C, Chien W-C, Chung C-H, Liang C-S, Chang H-A, Kao Y-C, et al. Psychiatric Disorders After Traumatic Brain Injury: A Nationwide Population-Based Cohort Study and the Effects of Rehabilitation Therapies. Arch Phys Med Rehabil. 2020 May;101(5):822–31.
Hamzah N, Narayanan V, Ramli N, Mustapha NA, Mohammad Tahir NA, Tan LK, et al. Randomised controlled clinical trial of a structured cognitive rehabilitation in patients with attention deficit following mild traumatic brain injury: study protocol. BMJ Open. 2019 Sep;9(9):e028711.
Adamson MM, Shakil S, Sultana T, Hasan MA, Mubarak F, Enam SA, et al. Brain Injury and Dementia in Pakistan: Current Perspectives. Front Neurol. 2020 Apr 30;11:299.
Yue JK, Upadhyayula PS, Avalos LN, Phelps RRL, Suen CG, Cage TA. Concussion and Mild-Traumatic Brain Injury in Rural Settings: Epidemiology and Specific Health Care Considerations. J Neurosci Rural Pract. 2020 Jan;11(01):023–33.
Al-Adawi S, Al-Busaidi Z, Al-Adawi S, Burke DT. Families Coping With Disability Due to Brain Injury in Oman: Attribution to Belief in Spirit Infestation and Ensorcellment. SAGE Open. 2012 Jul 23;2(3):215824401245740.
Ali G-C, Ryan G, De Silva MJ. Validated Screening Tools for Common Mental Disorders in Low and Middle Income Countries: A Systematic Review. Burns JK, editor. PLOS ONE. 2016 Jun 16;11(6):e0156939.