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. 2024 Aug;69(8):607-617.
doi: 10.1177/07067437241249957. Epub 2024 Apr 25.

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

Hilary K Brown  1   2   3   4 , Rachel Strauss  4 , Kinwah Fung  4 , Andrea Mataruga  4 , Vincy Chan  5   6 , Tatyana Mollayeva  5   6 , Natalie Urbach  7 , Angela Colantonio  5   6   8 , Eyal Cohen  4   9   10   11   12 , Cindy-Lee Dennis  13   14 , Joel G Ray  4   9   15 , Natasha Saunders  4   9   10   11   12 , Simone N Vigod  3   4   9   16
Affiliations

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

Hilary K Brown et al. Can J Psychiatry. 2024 Aug.

Abstract
in English, French

Objective: Existing studies, in mostly male samples such as veterans and athletes, show a strong association between traumatic brain injury (TBI) and mental illness. Yet, while an understanding of mental health before pregnancy is critical for informing preconception and perinatal supports, there are no data on the prevalence of active mental illness before pregnancy in females with TBI. We examined the prevalence of active mental illness ≤2 years before pregnancy (1) in a population with TBI, and (2) in subgroups defined by sociodemographic, health, and injury-related characteristics, all compared to those without TBI.

Method: This population-based cross-sectional study was completed in Ontario, Canada, from 2012 to 2020. Modified Poisson regression generated adjusted prevalence ratios (aPRs) of active mental illness ≤2 years before pregnancy in 15,585 females with TBI versus 846,686 without TBI. We then used latent class analysis to identify subgroups with TBI according to sociodemographic, health, and injury-related characteristics and subsequently compared them to females without TBI on their outcome prevalence.

Results: Females with TBI had a higher prevalence of active mental illness ≤2 years before pregnancy than those without TBI (44.1% vs. 25.9%; aPR 1.46, 95% confidence interval, 1.43 to 1.49). There were 3 TBI subgroups, with Class 1 (low-income, past assault, recent TBI described as intentional and due to being struck by/against) having the highest outcome prevalence.

Conclusions: Females with TBI, and especially those with a recent intentional TBI, have a high prevalence of mental illness before pregnancy. They may benefit from mental health screening and support in the post-injury, preconception, and perinatal periods.

Plain language title: Mental illness in the 2 years before pregnancy in a population with traumatic brain injury.

Objectif: Il existe des études, réalisées auprès d’échantillons surtout masculins, comme des anciens combattants et des athlètes, montrant une forte association entre la lésion cérébrale traumatique (LCT) et la maladie mentale. Et pourtant, bien que la compréhension de la santé mentale avant la grossesse soit essentielle pour informer les soutiens préconceptionnels et périnataux, il n’y a pas de données sur la prévalence de la maladie mentale active avant la grossesse chez les femmes souffrant de LCT. Nous avons examiné la prévalence de la maladie mentale active ≤2 ans avant la grossesse (1) dans une population souffrant de LCT, et (2) dans des sous-groupes définis par des caractéristiques sociodémographiques, de santé, et liées à la lésion, tous se comparaient à ceux sans LCT.

Méthode: Cette étude transversale dans la population a été menée en Ontario, Canada, de 2012 à 2020. La régression de Poisson modifiée a généré des ratios de prévalence ajustés (RPa) de maladie mentale active ≤2 ans avant la grossesse chez 15 585 femmes souffrant de LCT contre 846 686 sans LCT. Nous avons ensuite utilisé l'analyse des classes latentes pour identifier des sous-groupes souffrant de LCT selon nos caractéristiques sociodémographiques, de santé et liées à la lésion, et les avons subséquemment comparés aux femmes sans LCT quant à leur prévalence des résultats.

Résultats: Les femmes souffrant de LCT avaient une prévalence plus élevée de maladie mentale active ≤2 ans avant la grossesse que celles sans LCT (44,1% c. 25,9%; RPa 1,46, 95% IC 1,43 à 1,49). Il y avait 3 sous-groupes LCT, la classe 1 ((faible revenu, agression passée, TBI récent décrit comme intentionnel et dû à une collision) ayant la prévalence de résultats la plus élevée.

Conclusions: Les femmes souffrant de LCT, et sen particuoier celles ayant une LCT intentionnelle récente, ont une prévalence élevée de maladie mentale avant la grossesse.Elles peuvent bénéficier d’un dépistage de maladie mentale et d’un soutien dans les périodes post-traumatique, préconceptionnelle et périnatale.

Keywords: brain injuries; cohort studies; femmes; lésions cérébrales; mental health; preconception care; santé mentale; soins préconceptionnels; women; études de cohorte.

Plain language summary

Research has shown a strong association between traumatic brain injury (TBI) and mental illness. Most previous studies have been conducted in primarily male samples, like veterans and professional athletes. Understanding mental health before pregnancy is important for deciding what supports people need before and during pregnancy. However, there are no studies on the frequency of mental illness in females with TBI before a pregnancy. We examined the frequency of mental illness 2 years before pregnancy in a population with TBI, and in subgroups defined by different social, health, and injury-related characteristics, compared to those without TBI. We undertook a population-wide study of all females with and without TBI in Ontario, Canada, with a birth in 2012–2020. We used statistical models to compare these groups on the presence of mental illness in the 2 years before pregnancy, before and after accounting for social and health characteristics. We also identified subgroups with TBI according to their social (e.g., poverty), health (e.g., chronic conditions), and injury-related characteristics (e.g., cause of injury) and subsequently compared them to females without TBI on their frequency of mental illness in the 2 years before pregnancy. Forty-four percent of females with TBI had mental illness in the 2 years before pregnancy compared to 25% of those without TBI. There were 3 TBI subgroups. Females with low-income, past assault, and injuries that were described as being intentional had the highest frequency of mental illness in the 2 years before pregnancy. Females with TBI may benefit from mental health screening and support post-injury and around the time of pregnancy.

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Conflict of interest statement

Declaration of Conflicting InterestsThe authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Eyal Cohen reports paid membership on the Committee to Evaluate Drugs, which advises Ontario's Ministry of Health on public drug policy. Natasha Saunders receives an honorarium from the BMJ Group (Archives of Diseases in Childhood). Simone N. Vigod receives royalties from UpToDate for authorship of materials on depression and pregnancy.

Figures

Figure 1.
Figure 1.
Association between traumatic brain injury (TBI) within 10 years before conception and active mental illness ≤2 years before pregnancy. TBI group includes individuals with a TBI recorded in “the most responsible diagnosis” field within 10 years before conception. Individuals with a TBI recorded outside of the “most responsible diagnosis” field and those with injuries that often accompany TBI (N = 52,134) are excluded. Adjusted model controls for age, parity, neighbourhood income quintile, rurality, immigrant status, history of assault, and stable and unstable chronic conditions.
Figure 2.
Figure 2.
Associations between traumatic brain injury (TBI) within 10 years before conception, by TBI class, and active mental illness ≤2 years before pregnancy. Class 1: mostly low-income, high rate of past assault, TBI in the last 2 years, with the most proximal TBI primarily described as being intentional and due to being struck by/against; Class 2: mostly young and primiparous, with the most proximal TBI described as being unintentional; Class 3: mostly mid-reproductive years, multiparous, higher-income, and with chronic conditions, with most proximal TBI described as being unintentional.
See this image and copyright information in PMC

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