Work-related and non-work-related mild traumatic brain injury: Associations with mental health and substance use challenges in a Canadian population-level survey

Article type: Research Article

Authors: Wickens, Christine M.^{a; b; c; d; e; *} | Mann, Robert E.^{a; b; c} | Stoduto, Gina^a | Toccalino, Danielle^d | Colantonio, Angela^{c; f; g; h; i} | Chan, Vincy^{d; f; g}

Affiliations: [a] Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada | [b] Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada | [c] Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada | [d] Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada | [e] Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada | [f] Kite-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada | [g] Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada | [h] Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada | [i] ICES, Toronto, ON, Canada

Correspondence: [*] Address for correspondence: Dr. Christine M. Wickens, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, M5 S 2S1, ON, Canada. Tel.: +1 416 535 8501 /Ext.: 34711; E-mail: Christine.Wickens@camh.ca.

Abstract: BACKGROUND: Mild traumatic brain injury (mTBI) can profoundly impact overall health, employment, and family life. Incidence of mTBI in the workplace represents an important subgroup with poorer outcomes. Mental health (MH) and substance use (SU) challenges are a primary correlate of TBI, but are rarely assessed among individuals with a work-related (wr)-mTBI, particularly at a population-level. OBJECTIVE: This study aimed to assess the association between lifetime wr-mTBI and non-wr-mTBI and the experience of MH and SU challenges. METHODS: The 2019 Centre for Addiction and Mental Health (CAMH) Monitor is a cross-sectional telephone survey of adults aged≥18 years in Ontario, Canada, employing a stratified (six regions) two-stage (telephone number, respondent) list-assisted random digit dialing probability selection procedure (N = 1792). Adjusting for sociodemographic variables, binary logistic regression was conducted to assess the association between lifetime wr-mTBI and non-wr-mTBI (relative to no TBI) and four outcomes: hazardous use of alcohol and of cannabis, psychological distress, and fair/poor mental health. RESULTS: Adjusting for sociodemographic variables, non-wr-mTBI demonstrated increased odds of hazardous alcohol (AOR = 2.12, 95% CI = 1.41, 3.19) and cannabis use (AOR = 1.61, 95% CI = 1.05, 2.45), psychological distress (AOR = 1.68, 95% CI = 1.14, 2.49), and fair/poor mental health (AOR = 1.70, 95% CI = 1.11, 2.59). Lifetime wr-mTBI demonstrated increased odds of reporting psychological distress (AOR = 3.40, 95% CI = 1.93, 5.97) and fair/poor mental health (AOR = 2.16, 95% CI = 1.12, 4.19) only. CONCLUSIONS:Non-wr-mTBI was associated with both MH and SU, whereas wr-mTBI was associated with MH only. MH outcomes were more strongly associated with wr-mTBI than non-wr-mTBI. Physicians, employers, and insurers need to consider the potential association between wr-mTBI and MH, and provide care accordingly.

Keywords: Brain injuries, traumatic, workplace, mental health, psychological distress, substance-related disorders, ethanol, cannabis

DOI: 10.3233/WOR-230418

Journal: Work, vol. 79, no. 1, pp. 331-338, 2024