Relationships between Traumatic Brain Injury, Coping Strategy, Mental Health, and Substance Use Among Youth in the Criminal Justice System

Background and Purpose: Prevalence of traumatic brain injury (TBI) within youth in the criminal justice system is substantially higher than their peers in the general population. TBI increases the likelihood for anxiety, depression, and substance use. Coping has shown to influence outcomes following TBI. Coping strategies largely fall into two groups: active strategies or avoidance strategies. Research on coping strategies and TBI has found avoidance strategies to be associated with negative outcomes, while active coping strategies are associated with more positive outcomes. No research into the relationship between TBI, coping strategy, and outcome has been conducted with youth in the criminal justice system. Therefore, this study investigated whether coping strategy mediated the relationship of TBI on the outcomes of anxiety, depression, and substance use within youth in the criminal justice system.

Methods: Participants (N=227) came from a non-probability sample of youth in two residential facilities in Pennsylvania. The sample was 55.51% male, average age of 16.21, and 77.09% were youth of color. TBI was reported by 22.03%. CASI software was used to conduct all interviews. Outcomes of anxiety/depression and alcohol/drugs were measured with the Massachusetts Youth Screening Instrument. TBI came from a question about lifetime occurrence of head injury with blackout. Coping was assessed with the Coping Strategies Inventory that included the subscales of acting-out, internalizing, partying, prosocial, and expressing. STATA version 14 was used to conduct mediation analysis with the functions medeff and medsens. The function medeff used two linear regression models within a Monte-Carlo framework to compute total, direct, and indirect effects using bootstrapped standard errors. Then, medsens conducted sensitivity analysis to examine results for violation of the sequential ignorability assumption.  

Results: TBI predicted higher scores on anxiety/depression (p < .05) and alcohol/drugs (p < .01). Next, mediation analysis began with regressing TBI on each coping subscale. TBI was significantly associated with higher scores on acting-out coping (p < .01), internalized coping (p < .01), and partying coping (p < .05). Then, the final step regressed the outcome measure on TBI and each coping strategy mediator. For anxiety/depression, full mediation was suggested for acting-out and internalizing with 45% and 48% of the total effect mediated between TBI and anxiety/depression, respectively. For alcohol/drug, full mediation was indicated for acting-out coping and partying coping. Acting-out mediated 33% and partying mediated 51% of the total effect between TBI and alcohol/drugs. Sensitivity analysis found mediation effects to be robust with rho between .30 to .63 depending on the model.

Conclusions and Implications: Study results suggest that addressing the use of avoidant coping strategies, such as acting-out, internalizing, or partying, by youth in the criminal justice system with TBI could help ameliorate the outcomes of anxiety, depression, and substance use. Interventions that focus on the coping skills of individuals with TBI exist. Social workers could be a leader in adapting and evaluating these coping interventions for a juvenile justice context. Future research into TBI and coping within youth in the criminal justice system would benefit from a measure of executive dysfunction.