Grant: Master's Award: Canada Graduate Scholarships

Traumatic brain injury is a leading cause of death and disability in Canada. It is estimated that 2% of the population live with lifelong disabilities resulting from traumatic brain injury and roughly one in four adults with traumatic brain injury are unable to return to work one year after injury because of physical or mental disabilities resulting from post-concussive syndrome. An understanding of who is most at risk of worse recovery is important for directing physicians to those most in need of early intervention. There is an emerging body of evidence suggesting that individuals who have suffered from abuse in childhood may be at risk of worse physical health in adulthood. Studies have shown that individuals who have experienced abuse in childhood may be more likely to suffer from a traumatic brain injury in adulthood. As well, survivors of childhood sexual abuse may be at risk for poor adjustment following traumatic brain injury in adulthood. However, no known studies have examined whether a history of childhood maltreatment puts individuals at risk for persistent symptoms following traumatic brain injury in adulthood. Such information could provide critical knowledge to clinicians treating survivors of traumatic brain injury. The aim of my Masters project will be to examine the association between childhood maltreatment and persisting symptoms following traumatic brain injury sustained in adulthood. To achieve this aim I will examine data from a database of over 2000 adult patients (age 18 years and older) who have been seen at the outpatient Head Injury Clinic at St. Michael’s Hospital, in downtown Toronto, Canada. At baseline (first visit to the Clinic), demographic information and details of the injury event were collected on each patient. Patients completed the Adverse Childhood Experiences Tool, a measure of ten different adverse childhood events occurring before the age of 18, including sexual, physical and emotional abuse, neglect, witnessing domestic violence and parental mental illness. Post-concussive symptoms were measured using the Rivermead Post Concussion Symptoms Questionnaire, which was repeated every three months thereafter for two years. Using the database, I will answer the following research questions: 1) How common is a history of childhood maltreatment among a sample of patients with traumatic brain injury? ; 2) Does a history of childhood maltreatment put individuals at risk for persistent post-concussive symptoms in adulthood? ; 3) Are certain forms of maltreatment or adverse childhood experiences more predictive of worse outcome following traumatic brain injury in adulthood? It is expected that a history of childhood maltreatment will be common among this population of adults with traumatic brain injury. Having experienced abuse in childhood is also expected to be a predictor of more severe and persistent post-concussive symptoms. The results of these investigations will contribute important clinical knowledge to physicians treating traumatic brain injury, a misunderstood and under-studied epidemic in Canada.