Validating the traumatic brain injury-4 screening measure for veterans seeking mental health treatment with psychiatric inpatient and outpatient service utilization data

Abstract

Objective: To determine whether a positive screen on the Traumatic Brain Injury-4 (TBI-4) can be used to identify veterans who use more inpatient and outpatient mental health services.

Design: Validation cohort.

Setting: Medical center.

Participants: Individuals seeking Veterans Health Administration mental health services (N=1493).

Interventions: Not applicable.

Main outcome measures: One year of inpatient and outpatient mental health utilization data after the TBI-4 screen date.

Results: In the year postmental health intake, those who answered positively to any of the 4 TBI-4 screening questions (criterion 1) or question 2 (criterion 2; ever having been knocked out) had significantly more psychiatric hospitalizations than those who met neither criterion. Those who were positive by criterion 2 also had significantly fewer outpatient mental health contacts.

Conclusions: Veterans screening positive for history of traumatic brain injury on the TBI-4 had more hospital stays in the year postmental health intake. Those who reported having been knocked out also had fewer outpatient mental health visits. These findings may suggest an overall relation in this population between greater needs for mental health care and likelihood of prior injury. For those with a history of loss of consciousness, the reduced use of outpatient care may reflect greater problems engaging in treatment or with preventive aspects of the health care system during non-crisis periods. Using a screener (eg, the TBI-4) could facilitate identification of veterans who might benefit from targeted and intensive outpatient interventions to avoid frequent inpatient psychiatric hospitalization.

Keywords: Brain injuries; Hospitalization; Mental health; Rehabilitation; Utilization [subheading].