Substance Use, Mental Health Outcomes, and Mental Health Treatment Utilization Among Adults with Self-Reported Head Injury with Loss of Consciousness in the U.S

Background and Purpose: Traumatic brain injury (TBI) is a major public health problem that can lead to substance abuse and mental health problems. Social workers in the mental health and substance use fields are well-positioned to facilitate access to these services, yet gaps exist in accessing mental health services for people with TBI. Therefore, the objectives of this study were to: 1) Identify factors associated with head injury with loss of consciousness (LOC); 2) Examine risk factors associated with substance use among adults with head injury with LOC; 3) Examine risk factors associated with depression among adults with head injury with LOC; and 4) Examine influences associated with mental health service utilization among adults with head injury with LOC.

Methods: Data were obtained from the National Health and Nutrition Examination Survey (NHANES, 2011–2014). Using Andersen’s Behavioral Model of Health framework, predisposing (age, gender, race, military involvement) enabling (marital status, household income, education, insurance coverage), and need factors (substance use, depression) were assessed for adults with self-reported head injury with LOC. Binary logistic regression was conducted in STATA 15 to determine risk factors associated with head injury, substance use (i.e. marijuana, cocaine/crack, heroin, and methamphetamine), depression, and mental health service utilization.

Results: Of 7,399 adults, 948 (12.8%) self-reported ever having had at least one head injury with LOC. In model 1, factors associated with head injury include being male (odds ratio [OR] = 1.74, p<.001), low income (OR = 1.38, p<.001), uninsured (OR = 1.20, p<.001), and having depression levels warranting treatment (OR = 2.97, p<.001). In model 2, risk factors associated with substance use among people with head injury include being non-Hispanic white (OR = 2.66, p<.001), non-Hispanic black (OR =3.99, p<.001), having served in the military (OR = 3.21, p=.012), and low income (OR = 1.87, p=.024). In model 3, risk factors for depression levels warranting treatment among adults with head injury include being female (OR = 2.18, p=.021), low income (OR = 2.89, p=.002), and having some college education or higher (OR = 2.00, p=.044). In model 4, mental health service utilization was higher among people with insurance (OR =2.71, p=.006), lower among males (OR = 1.95, p=.017), and higher among people with depression levels warranting treatment (OR = 2.74, p=006).

Conclusions and Implications: Risks for head injury are particularly high among low-income and uninsured populations. Further, low-income populations with head injury are at high risk for substance abuse and depression. Indeed, having insurance is associated with access to mental healthcare in this population. Although people with insurance may have access to treatment, those most likely to suffer head injuries are not accessing these needed resources. Social workers who serve military personnel, women, certain racial and ethnic groups, and low-income populations should be particularly attuned to recognizing risk factors associated with head injury among clients reporting substance use and mental health issues. More research is needed to determine if and how social workers are addressing co-occurrence of substance abuse, mental health issues, and head injuries among clients.