National Institute of Neurological Disorders and Stroke (NINDS)
TBI is a major public health problem, especially among male adolescents and young adults ages 15 to 24, and among elderly people of both sexes age 75 and older. Children age 5 and younger are also at high risk for TBI. TBI, a form of acquired brain injury, occurs when a sudden trauma causes damage to the brain. TBI can result when the head suddenly and violently hits an object, or when an object pierces the skull and enters brain tissue. Symptoms of a TBI can be mild, moderate, or severe, depending on the extent of the damage to the brain.
This section provides examples of recent scientific advances from National Institutes of Health (NIH)-sponsored research and is not intended to be a comprehensive list.
The largest study of mental health risk and resilience ever conducted among U.S. military personnel today released its first findings related to suicide attempts and deaths in a series of three JAMA Psychiatry articles. Findings from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) include: the rise in suicide deaths from 2004 to 2009 occurred not only in currently and previously deployed soldiers, but also among soldiers never deployed; nearly half of soldiers who reported suicide attempts indicated their first attempt was prior to enlistment; and soldiers reported higher rates of certain mental disorders than civilians, including attention deficit hyperactivity disorder (ADHD), intermittent explosive disorder (recurrent episodes of extreme anger or violence), and substance use disorder.
Drivers eat, reach for the phone, text, or otherwise take their eyes off the road about 10 percent of the time they are behind the wheel, according to a study using video technology and in-vehicle sensors. Risks of distracted driving were greatest for newly licensed teen drivers, who were substantially more likely than adults to be involved in a crash or near miss while texting or engaging in tasks secondary to driving, according to the researchers from the NIH and Virginia Tech. “Anything that takes a driver’s eyes off the road can be dangerous,” said study co-author Bruce Simons-Morton, Ed.D., M.P.H., of the NICHD. “But our study shows these distracting practices are especially risky for novice drivers, who haven’t developed sound safety judgment behind the wheel.”
There is more than meets the eye following even a mild traumatic brain injury. While the brain may appear to be intact, new findings reported in Nature suggest that the brain’s protective coverings may feel the brunt of the impact. Using a newly developed mouse trauma model, senior author Dorian McGavern, Ph.D., scientist at the National Institute of Neurological Disorders and Stroke (NINDS), part of the National Institutes of Health, watched specific cells mount an immune response to the injury and try to prevent more widespread damage. Notably, additional findings suggest a similar immune response may occur in patients with mild head injury. In this study, researchers also discovered that certain molecules, when applied directly to the mouse skull, can bypass the brain’s protective barriers and enter the brain. The findings suggested that, in the mouse trauma model, one of those molecules may reduce effects of brain injury.
Many adults and teens suffer tears to their anterior cruciate ligament (ACL) while playing sports. The American Academy of Orthopaedic Surgeons estimates that more than 100,000 ACLs are repaired each year. Some are for first-time patients, but others have reinjured their repaired knee or have torn the ACL in their other leg. NIAMS-funded researchers recently reported that within 6 years of their first surgery, approximately 19% of the 900 patients in the Multicenter Orthopaedic Outcomes Network (MOON) cohort study underwent at least one additional operation on the knee that already had been repaired, while 10% of patients needed surgery on the other knee. Younger patients were more likely to require subsequent surgeries. The rate of repeat surgery also was higher in patients treated with a cadaver (allograft) ligament than one from their own body. While the results of this study support the orthopaedic literature showing that ACL reconstruction is a safe and effective procedure in active people, they provide patients, parents, providers, coaches, and trainers with additional valuable information. Allograft tissue has long been associated with risk of rejection due to immuno-incompatibility and risk of infectious disease transmission. The identification of another potential complication further emphasizes the importance of discussing the tissue source for ACL reconstruction with patients. Moreover, healthcare providers also now have data that they can refer to when discussing the possibility of needing subsequent surgeries with patients who are planning to return to their previous activities.
Soldiers preoccupied with threat at the time of enlistment or with avoiding it just before deployment were more likely to develop post-traumatic stress disorder (PTSD) in a study of Israeli infantrymen. Such predeployment threat vigilance and avoidance, interacting with combat experience and an emotion-related gene, accounted for more than a third of PTSD symptoms that emerged later, say NIH scientists, who conducted the study in collaboration with American and Israeli colleagues. Soldiers performed a computerized task that required paying attention to locations of neutral words, such as “data,” or threatening words, such as “dead.” A faster reaction time for identifying the location of threat words indicated increased threat vigilance. Slower reaction times to such word locations indicated attention away from threat, or threat avoidance. As expected, soldiers who experienced higher combat exposure—for example, served in units operating outside Israel’s security fence—tended to show more threat vigilance than those with less stressful assignments. Compared with soldiers who were neither vigilant nor avoidant on the eve of deployment, soldiers with greater vigilance at recruitment or avoidance at 6 months had more PTSD symptoms at the end of their first year of service.
A set of four questions that takes emergency department (ED) nurses or physicians less than 2 minutes to administer can successfully identify youth at risk for attempting suicide, reported a study. Most individuals who die by suicide have visited a healthcare provider 3 months to 1 year before their death. Typically, these patients saw an ED nurse and physician for some other health concern such as abdominal pain or headaches. These at-risk individuals often go unrecognized by ED staff who either lack the time or training to properly screen patients. To date, there are no screening instruments to assess suicide risk in children and adolescents who visit EDs for medical or surgical reasons. Based on results from the new questionnaire, 18.7% of the ED patients (98 of the 524) screened positive for suicide risk, most of whom had come to the ED with psychiatric concerns (84 of the 524). Elevated suicide risk was detected in 4.1% of the ED patients (14 of the 344) with medical/surgical concerns. Had it not been for the new screening tool, the suicide risk in these 14 patients most likely would have gone undetected.
Violence is the second leading cause of death for American adolescents and young adults. Such violence is alarmingly higher in racial and ethnic minorities. In the southwestern United States, Latino youth violence is particularly high. Therefore, effective violence prevention strategies for youth in Latino communities is critical, especially as the proportion of Latin youth throughout the country continues to rise. Researchers compared two different programs aimed at Latino adolescents to assess their effect on violence prevention. El Joven Noble is a culturally tailored character development program that focuses on maintaining healthy relationships with self, intimate partners, family, and community. It addresses relationship issues and violence prevention directly, using educational strategies including storytelling, crafts, and small group discussions. The Teen Medical Academy is a health career promotion program that focuses on common medical conditions and teaches human anatomy and pathology using hands-on diagnostic and therapeutic equipment. This program does not address violence prevention directly. Surprisingly, at 9 months after enrollment, high school students who participated in the Teen Medical Academy reported fewer acts of nonphysical aggression and fewer acts of physical violence than high school students who participated in the El Joven Noble program. Teen Medical Academy participants also reported fewer acts of intimate partner violence. The results suggest that an effective approach to decreasing youth violence may be to focus on promoting youth access to positive life options such as health-related careers.
Over 125,000 children are injured by fires and burns at home each year, according to estimates from the Centers for Disease Control and Prevention. Both fires and burns can sometimes be prevented by simple methods like smoke detectors and safe water heater settings. Using a checklist that identifies common safety hazards, researchers assessed the quality of housing for 100 low-income African American families. This measure of housing quality included items related to heating systems, locks, rodents or bugs, mold, and other damage. Researchers also evaluated the relationships between different aspects of housing quality and the use of preventive measures, including smoke detectors and safe water temperatures. The researchers found that virtually all the families in the sample were living in housing that failed one or more items on the housing quality checklist. The most common problems were inadequate heat; peeling paint; mold, mildew, or water damage; and rats. Each of these problems put the children at risk for injury or illness. Unsurprisingly, households with a greater number of other housing problems were also significantly less likely to have injury prevention measures in place, including smoke detectors and safe water settings. The lack of these preventive measures increases the children’s risk for fire and burn injury.
Coordinated strategies that address alcohol availability, alcohol policy enforcement, and drinking norms can help colleges and their communities protect students from the harms of high-risk drinking, according to a new study supported by the NIAAA. In the Study to Prevent Alcohol-Related Consequences (SPARC), researchers found that a comprehensive environmental intervention implemented by campus-community coalitions reduced students’ scores on an index of severe consequences of college drinking. The index included items such as car accidents, driving under the influence/driving while intoxicated, the need for medical treatment as a result of drinking, physical fights, and sexual assaults. “This study adds to a growing body of evidence suggesting that strategic changes to the environment on campus and in the surrounding community can have an impact on high-risk drinking and its consequences among college students,” said Kenneth R. Warren, Ph.D., Acting Director of NIAAA.
Instances of interpersonal violence among Iraq and Afghan War veterans following their return home from military service is of growing concern, particularly those individuals with unmet mental health needs. To implement violence reduction strategies for this population, we need a better understanding of factors that may reduce the likelihood that an individual will engage in violence. NIMH-supported researchers implemented the National Post-Deployment Adjustment Survey (NPDAS) with a sample of 1,388 individuals who served in the U.S. military after the attacks of September 11, 2001. Results indicated that one-third of these veterans had participated in violent acts, but that having a stable living situation and perceived control over one’s life were associated with a reduced likelihood to engage in violence. The findings support the value of focusing on improving basic functioning (living, financial, vocational) and well-being (resilience, social support) as a way of reducing violence in veterans.
Significant numbers of individuals who have experienced traumatic events develop PTSD. There are effective treatments for PTSD, yet many who suffer with this disorder do not seek treatment and/or suffer for years before seeking help. This delay in seeking treatment increases the risk for complex co-morbidity of mood, other anxiety disorders, and substance abuse accompanied by substantial impairment in activities of daily living. Findings from an NIMH study provide additional evidence that multiple forms of early intervention are helpful in reducing the risk of developing chronic PTSD after trauma and that “early” can mean months after trauma exposure. Specifically, the use of two different forms of psychotherapy, prolonged exposure (PE) and cognitive therapy (CT), delivered over 12 weeks starting within 1 month (or after 5 months) to civilian survivors of traumatic events seen in an emergency room and who exhibited severe acute trauma symptoms (essentially meeting PTSD diagnostic criteria) was found to prevent PTSD. There are significant and similar preventive effects of PE and CT. Delaying delivery of PE did not affect the 9-month outcome. When early intervention is feasible, as in typical acute trauma contexts, resources for early intervention should be directed toward those identified at greatest risk; when early intervention may not be practical, as in immediate disaster response and in military/combat contexts, treatment within months is still quite effective.