Traumatic brain injury in women: Time to think about mental health before a pregnancy

by Hilary BrowN & Simone vigod

Traumatic brain injury (TBI) is a common cause of disability, affecting about 2.5% of North Americans. Although one-third of people with TBI are female, most TBI research is focused on high-risk groups that are primarily male, like veterans and professional athletes. This means that the consequences of TBI most relevant to women and those assigned female at birth, like the impact of TBI on mental health around the time of pregnancy, have received little attention.

We used whole-population data from ICES in Ontario, Canada on about 850,000 births to look at how often mental illness is diagnosed in the two years before pregnancy in individuals with TBI. We also identified subgroups with TBI based on their social, health, and injury-related characteristics, and then compared them on their prevalence of pre-pregnancy mental illness diagnoses.

We found that about 44% of individuals with TBI had a mental illness diagnosis in the two years before pregnancy, compared to 26% of those without TBI. This elevated risk was seen for a range of mental health conditions, like mood and anxiety disorders, psychotic disorders, addiction, and self-harm.

Among individuals with TBI, we identified three important subgroups. One group (about 8% of those with TBI) were mostly low-income and had a high rate of prior assault, and their most recent TBI was due to violence. Another group (49% of those with TBI) were mostly young and had few prior births, and their most recent TBI was due to non-violent injuries, like falls and car accidents. The last group (about 43% of those with TBI) were in their mid-reproductive years, had a previous birth, were higher income, and had chronic conditions, and their most recent TBI was due to non-violent injuries.

When looking at mental illness diagnoses in the two years before pregnancy across these groups, the rate was the highest in the small group of individuals with violence-related TBIs, with nearly 60% of them having a mental illness diagnosis in the two years before pregnancy.

With so much TBI-related research focused on men, health care providers have reported that a lack of information on TBI and its consequences around the time of pregnancy is a major barrier to providing the best care. Our findings suggest possible actions in post-injury, preconception, and pregnancy-related care for individuals with TBI.

Post-injury and preconception care for TBI in women and those assigned female at birth should include screening for mental illness, tailored information on mental health, and provision of additional supports to optimize brain health and mental health before pregnancy through better management of TBI symptoms as well as other social and environmental risk factors that might increase mental illness risk.

Mental illness after TBI can be difficult to treat. Given that nearly half of individuals with TBI in our study entered pregnancy with a mental illness, our data show that health care providers should be aware of the potential need for tailored treatment approaches for this population around the time of pregnancy. In those with TBI who have experienced violence, this also means understanding how trauma can inform their experiences and outcomes of care.

Mental health has important implications for long-term parental well-being and the health and development of the next generation. Our research shows that there is room to improve the mental health of individuals with TBI before they enter pregnancy.

Article Details
Mental Illness in the 2 Years Prior to Pregnancy in a Population With Traumatic Brain Injury: A Cross-Sectional Study: La maladie mentale dans les deux ans précédant une grossesse dans une population souffrant de lésion cérébrale traumatique : une étude transversale
Authors: Hilary K. Brown, Rachel Strauss, Kinwah Fung, Andrea Mataruga, Vincy Chan, Tatyana Mollayeva, Natalie Urbach, Angela Colantonio, Eyal Cohen, Cindy-Lee Dennis, Joel G. Ray, Natasha Saunders and Simone N. Vigod
First Published: April 25, 2024
DOI: 10.1177/07067437241249957
The Canadian Journal of Psychiatry

About the Authors

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Hilary Brown, PhD, is an Associate Professor at the University of Toronto, in the Department of Health & Society and the Dalla Lana School of Public Health. She is cross-appointed to the Temerty Faculty of Medicine’s Department of Psychiatry and is an Adjunct Scientist at Women’s College Hospital and ICES. Dr. Brown holds a Tier 2 Canada Research Chair in Disability & Reproductive Health. Her research program examines maternal and child health and mental health across the life course, with a focus on populations with disabilities and chronic illness, health equity, and the social determinants of health.

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Dr. Simone Vigod is Head of the Department of Psychiatry at Women’s College Hospital, a Professor in the Department of Psychiatry and the Institute for Health Policy, Management and Evaluation at the University of Toronto, and a Senior Adjunct Scientist at ICES. Dr. Vigod holds the Shirley A. Brown Memorial Chair in Women’s Mental Health Research at Women’s College Hospital. Her research aims to address disparities in health and health care for individuals with psychiatric disorders, with a specific focus on women across the lifespan and on equity in access to treatment for diverse populations.