BMJ 2014;348:g294 doi: 10.1136/bmj.g294 (Published 20 January 2014)
Page 1 of 1
Research News
RESEARCH NEWS Traumatic brain injury carries long term health risks, finds study Matthew Limb London
Survivors of traumatic brain injuries face elevated health risks in later life that have become a “hidden” problem, say specialists.
Researchers said new findings showed that people who survived for six months after a traumatic brain injury were three times more likely than the general population to die prematurely or from suicide or fatal injuries. Such survivors were found to have higher rates of depression and drug or alcohol abuse, both before and after their injury. Their risk of premature death was higher still—most commonly from suicide, road crashes, and falls, the research said. Seena Fazel, the lead author of the study, said that current treatment guidelines that focused on short term treatment and recovery after traumatic brain injury may need to be revised.
He said, “It may make more sense to treat some TBI [traumatic brain injury] patients as suffering from a chronic problem requiring long term management just like epilepsy or diabetes. “TBI patients should be monitored carefully for signs of depression, substance abuse, and other psychiatric disorders, which are all treatable conditions.”
The study, carried out by researchers at Oxford University and the Karolinska Institute in Sweden, was published in JAMA Psychiatry.1 It sought to examine the relation between traumatic brain injury and premature mortality, particularly death from external causes, and to determine the role of psychiatric comorbidity.
survivors of traumatic brain injuries were “more than twice as likely to kill themselves as unaffected siblings.”
The authors said that the exact reasons for the increased risk of premature death were unknown but that they may involve damage to the parts of the brain responsible for judgment, decision making, and impulse control, which could have lasting effects. Fatal injuries could result from impaired judgment or reactions, they said. Fazel said that around 900 000 UK residents had experienced an acute brain injury. He said that people who had survived the acute effects of their brain injury should receive more information on the long term effects and how to reduce them. The authors said that management of psychiatric comorbidity should be an integral part of efforts to reduce premature mortality among patients with traumatic brain injuries.
Richard Greenwood, consultant neurologist at the Homerton Hospital and the National Hospital for Neurology and Neurosurgery, London, said that it was often difficult for people to access services and that there was a shortage of specialists. “People are falling through the net. It’s a hidden problem,” he said.
Huw Williams, associate professor of clinical neuropsychology and co-director of Exeter University’s Centre for Clinical Neuropsychology Research, said that reformulating problems in terms of chronic ill health or disease would be beneficial, rather than attributing them to a “one-off” event.
Researchers used Swedish medical records to track mortality trends over 40 years among people born after 1953. They identified some 218 300 people who had survived the first six months after traumatic brain injury—defined as a skull fracture, internal bleeding, or loss of consciousness for over an hour or a combination of these symptoms. Of these people, a total of 2378 (1.1%) died before age 56. This was three times the rate in a control group from the general population of almost 2.2 million people without such injuries (adjusted odds ratio 3.2 (95% confidence interval 3.0 to 3.4)). Researchers also studied 150 513 survivor siblings who had not had the same injuries, allowing the researchers to control for genetic factors and early upbringing.
Fazel, who is Wellcome Trust senior research fellow in Oxford University’s department of psychiatry, said this showed that
For personal use only: See rights and reprints http://www.bmj.com/permissions
1
Fazel, S Wolf A, Pillas D, Lichtenstein P, Långström N. Suicide, fatal injuries and other causes of premature mortality in patients with traumatic brain injury: a 41 year Swedish population study. JAMA Psychiatry , 15 Jan 2014. doi:10.1001/jamapsychiatry.2013.3935.
Cite this as: BMJ 2014;348:g294 © BMJ Publishing Group Ltd 2014
Subscribe: http://www.bmj.com/subscribe
Page 1 of 1
Research News
RESEARCH NEWS Traumatic brain injury carries long term health risks, finds study Matthew Limb London
Survivors of traumatic brain injuries face elevated health risks in later life that have become a “hidden” problem, say specialists.
Researchers said new findings showed that people who survived for six months after a traumatic brain injury were three times more likely than the general population to die prematurely or from suicide or fatal injuries. Such survivors were found to have higher rates of depression and drug or alcohol abuse, both before and after their injury. Their risk of premature death was higher still—most commonly from suicide, road crashes, and falls, the research said. Seena Fazel, the lead author of the study, said that current treatment guidelines that focused on short term treatment and recovery after traumatic brain injury may need to be revised.
He said, “It may make more sense to treat some TBI [traumatic brain injury] patients as suffering from a chronic problem requiring long term management just like epilepsy or diabetes. “TBI patients should be monitored carefully for signs of depression, substance abuse, and other psychiatric disorders, which are all treatable conditions.”
The study, carried out by researchers at Oxford University and the Karolinska Institute in Sweden, was published in JAMA Psychiatry.1 It sought to examine the relation between traumatic brain injury and premature mortality, particularly death from external causes, and to determine the role of psychiatric comorbidity.
survivors of traumatic brain injuries were “more than twice as likely to kill themselves as unaffected siblings.”
The authors said that the exact reasons for the increased risk of premature death were unknown but that they may involve damage to the parts of the brain responsible for judgment, decision making, and impulse control, which could have lasting effects. Fatal injuries could result from impaired judgment or reactions, they said. Fazel said that around 900 000 UK residents had experienced an acute brain injury. He said that people who had survived the acute effects of their brain injury should receive more information on the long term effects and how to reduce them. The authors said that management of psychiatric comorbidity should be an integral part of efforts to reduce premature mortality among patients with traumatic brain injuries.
Richard Greenwood, consultant neurologist at the Homerton Hospital and the National Hospital for Neurology and Neurosurgery, London, said that it was often difficult for people to access services and that there was a shortage of specialists. “People are falling through the net. It’s a hidden problem,” he said.
Huw Williams, associate professor of clinical neuropsychology and co-director of Exeter University’s Centre for Clinical Neuropsychology Research, said that reformulating problems in terms of chronic ill health or disease would be beneficial, rather than attributing them to a “one-off” event.
Researchers used Swedish medical records to track mortality trends over 40 years among people born after 1953. They identified some 218 300 people who had survived the first six months after traumatic brain injury—defined as a skull fracture, internal bleeding, or loss of consciousness for over an hour or a combination of these symptoms. Of these people, a total of 2378 (1.1%) died before age 56. This was three times the rate in a control group from the general population of almost 2.2 million people without such injuries (adjusted odds ratio 3.2 (95% confidence interval 3.0 to 3.4)). Researchers also studied 150 513 survivor siblings who had not had the same injuries, allowing the researchers to control for genetic factors and early upbringing.
Fazel, who is Wellcome Trust senior research fellow in Oxford University’s department of psychiatry, said this showed that
For personal use only: See rights and reprints http://www.bmj.com/permissions
1
Fazel, S Wolf A, Pillas D, Lichtenstein P, Långström N. Suicide, fatal injuries and other causes of premature mortality in patients with traumatic brain injury: a 41 year Swedish population study. JAMA Psychiatry , 15 Jan 2014. doi:10.1001/jamapsychiatry.2013.3935.
Cite this as: BMJ 2014;348:g294 © BMJ Publishing Group Ltd 2014
Subscribe: http://www.bmj.com/subscribe
