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Psychiatric sequelae of traumatic brain injury — future directions in research

Nature Reviews Neurology volume 19, pages 556–571 (2023)Cite this article

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Abstract

Despite growing appreciation that traumatic brain injury (TBI) is an important public health burden, our understanding of the psychiatric and behavioural consequences of TBI remains limited. These changes are particularly detrimental to a person’s sense of self, their relationships and their participation in the wider community, and they continue to have devastating individual and cumulative effects long after TBI. This Review relates specifically to TBIs that confer objective clinical or biomarker evidence of structural brain injury; symptomatic head injuries without such evidence are outside the scope of this article. Common psychiatric, affective and behavioural sequelae of TBI and their proposed underlying mechanisms are outlined, along with a brief overview of current treatments. Suggestions for how scientists and clinicians can work together in the future to address the chasms in clinical care and knowledge are discussed in depth.

Key points

  • Neuropsychiatric conditions after traumatic brain injury (TBI) are prevalent and varied, and have a major impact on functional outcome.

  • Common and important symptoms include mood disorders, anxiety, substance misuse, emotional lability and dysregulation, apathy, and suicide.

  • TBI may lead to neuropsychiatric conditions through disruption to brain networks and neurotransmitter systems. Complex intersectional relationships exist between TBI and neuropsychiatric conditions, which are also influenced by social and environmental factors.

  • Future research should prioritize understanding the mechanisms by which TBI leads to neuropsychiatric conditions.

  • Interventional studies need to account for the heterogeneity in populations with TBI, seeking to understand predictors of treatment response.

  • Datasets from existing large TBI cohorts as well as routinely collected data could be combined and leveraged to further these research aims.

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Fig. 1: Proposed future of research for post-TBI psychiatric symptoms.
Fig. 2: Bidirectional relationships and shared risk factors in TBI.
Fig. 3: Key resting-state networks implicated in post-TBI disturbances in cognitive and psychiatric function.

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Acknowledgements

The authors thank D. Kurtin for assistance with the preparation of Fig. 2.

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Authors and Affiliations

  1. Department of Brain Sciences, Imperial College London, London, UK

    Lucia M. Li

  2. Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK

    Alan Carson

  3. Brain Injury Research Center, Department of Rehabilitation and Human Performance, Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Kristen Dams-O’Connor

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All authors planned the article content and researched data for the article. L.M.L. wrote the first draft and K.D.O.C. and A.C. reviewed and edited the manuscript before submission.

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Correspondence to Lucia M. Li.

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Competing interests

A.C. declares that he is employed as Editor of the Journal of Neurology, Neurosurgery and Psychiatry; is the current President of the Functional Neurologic Disorders Society; is Chair of the Research and Data Usage Committee of the Scottish Trauma Network; and receives payment for providing expert testimony in court on neuropsychiatric conditions, including traumatic brain injury. The other authors declare no competing interests.

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Related links

CENTER-TBI: https://www.center-tbi.eu/

CREACTIVE: http://creactive.marionegri.it/

MSKTC TBI Model Systems: https://msktc.org/tbi/model-system-centers

The Nurses’ Health Study: https://nurseshealthstudy.org/

TRACK-TBI: https://tracktbi.ucsf.edu/transforming-research-and-clinical-knowledge-tbi

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Li, L.M., Carson, A. & Dams-O’Connor, K. Psychiatric sequelae of traumatic brain injury — future directions in research. Nat Rev Neurol 19, 556–571 (2023). https://doi.org/10.1038/s41582-023-00853-8

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