June marked National Brain Injury Awareness month, and although this post is not as timely as I had hoped, I thought I could still shed light on the mental health challenges that individuals with brain injury may experience.
A brain injury can result from a number of causes and is classified accordingly: an acquired brain injury can result from trauma, hypoxia, tumour, substance abuse, degenerative neurological disorders, or stroke, whereas traumatic brain injury, a subset of acquired brain injury, is an insult to the brain caused by an external physical force (Kirsh et al., 2008). Any sort of trauma to the brain can trigger biochemical alterations and difficulty with the regulations of body systems such as the endocrine system, which when left untreated, can manifest themselves in mental health issues (Brain Injury Help, 2015).
WHEN MENTAL HEALTH AND BRAIN INJURY OVERLAP
While cognitive issues relating to brain injury remain stable or improve over time, mental health symptoms can have an onset that post-dates the injury, or fluctuate depending on mood (Brain Injury Help, 2015). In fact, those living with an acquired brain injury are often more susceptible than the general population to mental health issues such as anxiety, post-traumatic stress disorder, and depression (ABIKUS, 2007). The trauma, changes in ability, and loss of social connection that many face following their brain injury may be plausible triggers for such issues (Brain Injury Help, 2015).
The following are some of the common mental health challenges which can vary in presentation and severity following a brain injury (Brain Injury Help, 2015):
Emotional lability reflects a person's tendency to laugh and cry very easily, or shift from one emotional state to another very rapidly. Loss of control over emotions means that one may express their feelings inappropriately or at the wrong time. Although this can be very tiring and embarrassing, emotional control can be effectively re-learned.
Depression is an extremely common emotional reaction experienced in the later stages of rehabilitation, and often occurs when a person recognizes the full extent of the problems caused by their brain injury. However, this can be seen as a positive sign as the person becomes aware of the reality of the situation, and may begin to come to terms with the emotional consequences. If a person feels that the depression is overbearing, professional counselling from someone who understands the nature of brain injury may be helpful.
It is very natural for people who have had a traumatic experience to feel anxious afterwards. Individuals may experience decreased confidence when faced with situations and tasks that are difficult to cope with. However, problems can occur if difficult situations are continually avoided, or if those caring for them encourage dependence rather than independence. Voicing fears and worries is very helpful in this regard. Learning new ways to stay calm under stress can also reduce the effect of anxiety on everyday life and at work. Consider reading some of our previous posts around anxiety for more management ideas.
WORK INTEGRATION AFTER BRAIN INJURY
After brain injury, return to work can be an intimidating pursuit. Although brief in description, the following key principles can support the transition of individuals with brain injury and mental health challenges into mainstream work. These principles are depicted in the figure below and should be explored further on an individual basis:
What are your experiences with brain injury and mental health challenges? How can we support this population in the workplace? Let us know in the comments below!
Acquired Brain Injury Knowledge Uptake Strategy (ABIKUS) Guidelines. (2007). Evidence-based review of moderate to severe acquired brain injury. Retrieved from http://www.abiebr.com/pdf/abikus_aug_07.pdf
Brain Injury Help. (2015). Brain injury mental health. Retrieved from http://braininjuryhelp.ca/mental-health-and-addictions/
Headway. (2015). Emotional and behavioural effects of brain injury. Retrieved from https://www.headway.org.uk/about-brain-injury/individuals/effects-of-brain-injury/emotional-and-behavioural-effects/
Kirsh, B., Stergiou-Kita, M., Gewurtz, R., Dawson, D., Krupa, T., Lysaght, R., & Shaw, L. (2008). From margins to mainstream: What do we know about work integration for persons with brain injury, mental illness and intellectual disability? Work, 32, 391-405.
Photo Credit: https://drnibber.com/wp-content/uploads/2016/06/AdobeStock_89316912.jpeg