Brain injury and mental health: what you need to know

If you’re working to recover from a traumatic brain injury (TBI), you might notice that some days are good, while others are more challenging. Perhaps you’re feeling much more emotional than usual for a long period of time. Or, you might catch yourself feeling down or upset very often or find that your emotions feel totally beyond your control. If that’s the case, you’re not alone! Did you know that there’s a proven link between brain injury and mental well-being?  

In honor of this year’s World Mental Health Day, this post will explore the connection between brain injury and mental health disorders. We also offer ideas for how to seek help if you or a loved one are struggling with mental health issues after a brain injury.  

What the research shows about brain injury and mental health

Not everyone who sustains a brain injury will struggle with mental health issues. However, if you are a survivor of brain injury who does, it is important to know that you are not the only one. Scientists who study TBI have found that individuals with brain injuries might face a higher risk of certain mental health challenges.   

The trauma of brain injury can feel overwhelming. And the physical injury to the brain, which can damage structures that help regulate and process emotions, can cause survivors of traumatic brain injury to be more prone to conditions like PTSD, depression, anxiety, and bipolar disorder. You might even notice some changes to your personality or experience more mood swings than you’re used to. 

A 2019 study published in JAMA Psychiatry, for instance, found that the risk of developing post-traumatic stress disorder (PTSD) and major depressive disorder was higher for people who had sustained a mild traumatic brain injury. Researchers at the University of California San Diego found that one-fifth of the survivors of traumatic brain injury reported mental health difficulties three months after injury.

Previous studies have similarly found that mental health disorders are a common aftereffect in survivors of traumatic brain injury. For example, in a 2014 study published in the American Journal of Psychiatry, researchers at the University of Copenhagen found that people who had been hospitalized for brain injury faced a 65% higher risk for schizophrenia and a 59% higher risk for depression. 

While the exact cause of the link between brain injury and emotional difficulties is still unknown, researchers have proposed several possible explanations. Scientists suspect that damage to the brain’s white matter, inflammation of the brain, and a stress-related imbalance between free radicals and antioxidants in the body might all play a role. 

Note that this research simply shows that mental health challenges can be another side effect of a traumatic brain injury for certain people. If you are a survivor of TBI who is struggling with your mental health, you should not blame yourself at all or feel that you are a failure. In fact, mental health disorders are very common — over one-quarter of all people in America deal with some kind of mental health issue every year. Fortunately, there are lots of options available to help you feel better when you’re struggling with your emotions. We will discuss some of them in the next sections. 

Signs and symptoms of mental health issues

Early detection of mental health struggles can significantly improve outcomes. If you are a survivor of traumatic brain injury or a loved one or caregiver to someone who is, be on the lookout for the following signs and symptoms:

• Having unusually strong emotional reactions to people or events that are part of your daily life
  • Ask yourself: When you meet someone new, do you ever immediately decide you love or hate them without really knowing them? Or, if something in your routine goes a little bit wrong, such as the bus taking longer to arrive than usual, do you ever feel that your emotions get beyond your control?
• Feeling that you rarely experience one emotion for a long period of time and that your mood is constantly changing
  • Try drawing out the moods you experience in one hour on a piece of paper. Start with a straight line, and include a spike in the drawing every time your emotion changed, such as going from sadness to anger, or love to guilt. Ask yourself: Is your line pretty straight, or are there a lot of spikes? The latter might be a sign that your mood is more unstable than usual. 
• Noticing that other people are confused by some of your emotional reactions
  • Ask yourself: Do you ever laugh when you hear something sad, without knowing why you reacted that way, or vice versa? 
• Being unable to put your mind to rest or always worrying that something bad is about to happen 
  • Ask yourself: Do you ever feel that your heart is beating so quickly that you can’t get it to slow down? Or, do you ever find yourself predicting that only the worst case scenarios will happen in your life? 
• Finding that activities you used to enjoy doing are no longer interesting or fun
  • Ask yourself: Are there things you used to do a lot that suddenly seemed tiring or pointless to do? Are there hobbies you gave up because you decided it was too hopeless to try doing them still?
• Sleeping a lot more or a lot less than you usually do
  • Ask yourself: Are you taking more naps during the day, or do you ever find yourself unable to fall asleep at night? 
• Losing or gaining a lot of weight in a short span of time
  • Ask yourself: Are your clothes much looser or tighter than they normally are?

What you can do

While no single solution can necessarily cure a mental health disorder immediately or completely, there are a range of effective treatments that can help survivors of traumatic brain injuries who are struggling with emotional challenges. Here are some options your healthcare provider might recommend:

• Medication. If you have been diagnosed with a specific psychological disorder, medication might prove helpful in mitigating some of the strongest symptoms. Many psychiatric medications take time to work, and your doctor might need to adjust your dose or ask you to try a different medication. Try your best to be patient, and be sure to report any side effects to your provider. If you take any other medications, it is also important to make sure that there are no drug interactions before starting a new treatment.
• Talk therapy. Therapy can be a highly effective way to process traumatic events and treat emotional or mental health disorders. There are many different types of therapy that might be helpful in treating different conditions and individuals. These include Acceptance and Commitment Therapy (ACT), Dialectical Behavioral Therapy (DBT), and Cognitive Behavioral Therapy (CBT). Your therapist can help you talk through the things you are struggling with and might also recommend daily practices, such as mindfulness, to improve your emotional well-being. If you feel you might benefit from starting therapy, make an appointment with a psychologist, psychiatrist, or social worker to see how they can help. 
• Support groups. It can be an isolating and lonely experience to live with a traumatic brain injury, and those feelings might contribute to a sense of sadness, hopelessness, or anger. Brain injury support groups can help you build community into your recovery process by introducing you to other people who are going through a similar journey. Your healthcare provider might have recommendations for local support groups. Alternatively, visit this link to find a chapter of the Brain Injury Association near you. 

If you are a survivor of traumatic brain injury, do not give up hope if you feel that you are struggling with your mental health after your injury. There is no shame in facing mental health challenges. On the contrary, it is an admirable sign of strength and bravery to realize that you need help and to reach out for it. And never forget that, with time and the right support, better days will come. 

For additional resources, check out the following:

• Centers for Disease Control and Prevention. (2021, May 12). Get the facts about TBI. Centers for Disease Control and Prevention. Retrieved October 12, 2021, from https://www.cdc.gov/traumaticbraininjury/get_the_facts.html. 
• Dewan, M. C., Rattani, A., Gupta, S., Baticulon, R. E., Hung, Y.-C., Punchak, M., Agrawal, A., Adeleye, A. O., Shrime, M. G., Rubiano, A. M., Rosenfeld, J. V., & Park, K. B. (2019). Estimating the global incidence of traumatic brain injury. Journal of Neurosurgery, 130(4), 1080–1097. https://doi.org/10.3171/2017.10.jns17352 
• Emotional problems after traumatic brain injury. (n.d.). Retrieved October 12, 2021, from https://uwmsktc.washington.edu/sites/uwmsktc/files/files/TBI_emotional.pdf. 
• Find your BIA. Brain Injury Association of America. (2021, January 11). Retrieved October 12, 2021, from https://www.biausa.org/find-bia. 
• Mental health disorder statistics. Johns Hopkins Medicine. (n.d.). Retrieved October 12, 2021, from https://www.hopkinsmedicine.org/health/wellness-and-prevention/mental-health-disorder-statistics#:~:text=An%20estimated%2026%25%20of%20Americans,substance%20abuse%20and%20anxiety%20disorders. 
• Orlovska, S., Pedersen, M. S., Benros, M. E., Mortensen, P. B., Agerbo, E., & Nordentoft, M. (2014). Head injury as risk factor for psychiatric disorders: A nationwide register-based follow-up study of 113,906 persons with head injury. American Journal of Psychiatry, 171(4), 463–469. https://doi.org/10.1176/appi.ajp.2013.13020190 
• Rodriguez, T. (2014, September 1). Head injury may cause mental illness. Scientific American. Retrieved October 12, 2021, from https://www.scientificamerican.com/article/head-injury-may-cause-mental-illness. 
• Practice mindfulness to optimize well-being after stroke or brain injury. Constant Therapy. (2021, August 18). Retrieved October 12, 2021, from https://constanttherapyhealth.com/brainwire/practice-mindfulness-to-optimize-well-being-after-stroke-or-brain-injury/. 
• Stein, M. B., Jain, S., Giacino, J. T., Levin, H., Dikmen, S., Nelson, L. D., Vassar, M. J., Okonkwo, D. O., Diaz-Arrastia, R., Robertson, C. S., Mukherjee, P., McCrea, M., Mac Donald, C. L., Yue, J. K., Yuh, E., Sun, X., Campbell-Sills, L., Temkin, N., Manley, G. T., … Zafonte, R. (2019). Risk of posttraumatic stress disorder and major depression in civilian patients after mild traumatic brain injury. JAMA Psychiatry, 76(3), 249. https://doi.org/10.1001/jamapsychiatry.2018.4288 
• U.S. Department of Health and Human Services. (2019, January 30). Mental health disorders common following mild head injury. National Institutes of Health. Retrieved October 12, 2021, from https://www.nih.gov/news-events/news-releases/mental-health-disorders-common-following-mild-head-injury. 
• Walz, R. (2008). Psychiatric disorders and traumatic brain injury. Neuropsychiatric Disease and Treatment, 797. https://doi.org/10.2147/ndt.s2653