Article

Mental health problems are common after pediatric traumatic brain
injury (TBI). Many patients in need of mental health services do not receive
them, but studies have not consistently used prospective and objective methods or
followed samples for more than 1 year. OBJECTIVE: To examine adolescents' use of
mental health services after TBI. DESIGN: Secondary analysis from multicenter
prospective randomized controlled trial. SETTING: Five level 1 U.S. trauma
centers. PARTICIPANTS: Adolescents aged 12-17 years with moderate-to-severe TBI
were recruited for a randomized clinical trial (n = 132 at baseline, 124 at 6
months, 113 at 12 months, and 101 at 18 months). METHODS: Participants were
randomly assigned to counselor-assisted problem-solving or Internet resource
comparison. Follow-up assessments were completed at 6, 12, and 18 months after
baseline. Generalized estimating equations with a logit link were used to examine
use of mental health services. Treatment group and participant impairment were
examined as predictors of use. MAIN OUTCOME MEASUREMENTS: Mental health care use
was measured with the Service Assessment for Children and Adolescents; daily
functioning and clinical outcome with the Child and Adolescent Functional
Assessment Scale; behavioral and emotional functioning with the Child Behavior
Checklist; and executive dysfunction with the Behavior Rating Inventory of
Executive Function. RESULTS: Use of mental health services ranged from 22% to 31%
in the 2 years post-TBI. Participants with impairments were about 3 times more
likely than those without impairments to receive services (odds ratio 4.61; 95%
confidence interval 2.61-8.14; P < .001). However, 50%-68% of patients identified
as impaired had unmet mental health care needs. CONCLUSIONS: Less than one half
of adolescents with behavioral health needs after TBI received mental health
services. Future studies are needed to examine barriers associated with seeking
services after TBI and psychoeducation as preventive care for this population.
LEVEL OF EVIDENCE: II.
CI - Copyright (c) 2018 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS