Disparities in mental health symptoms recovery across race/ethnicity and education level following mild traumatic brain injury

Rosemay A Remigio-Baker; Lars D Hungerford; Su Yeon Lee-Tauler; Jason M Bailie; Melissa Caswell; Ida Babakhanyan; Mark L Ettenhofer

doi:10.1016/j.dialog.2022.100048

Disparities in mental health symptoms recovery across race/ethnicity and education level following mild traumatic brain injury

Dialogues Health. 2022 Sep 24:1:100048. doi: 10.1016/j.dialog.2022.100048. eCollection 2022 Dec.

Authors

Rosemay A Remigio-Baker^{1

2}, Lars D Hungerford^{1

2

3}, Su Yeon Lee-Tauler^{4

5}, Jason M Bailie^{1

2

6}, Melissa Caswell^{1

2

6}, Ida Babakhanyan^{1

2

6}, Mark L Ettenhofer^{1

2

3

7}

Affiliations

¹ Traumatic Brain Injury Center of Excellence (TBICoE), Silver Spring, MD, USA.
² General Dynamics Information Technology, Falls Church, VA, USA.
³ Naval Medical Center San Diego, San Diego, CA, USA.
⁴ Henry M. Jackson Foundation, Bethesda, MD, USA.
⁵ Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
⁶ Naval Hospital Camp Pendleton, Camp Pendleton, CA, USA.
⁷ University of California, San Diego, La Jolla, CA, USA.

Abstract

Purpose: The purpose of this study was to investigate the relationship between race/ethnicity and post-concussive mental health (i.e., depressive, post-traumatic stress disorder [PTSD]) and neurobehavioral symptoms among service members, and whether this association differed by education level.

Methods: The study sample consisted of 524 patients from a multidisciplinary US military outpatient treatment facility for post-concussive symptoms. Poisson regression with robust error variance was utilized to investigate outcome (i.e., clinically-elevated depressive [Patient Health Questionnaire-8 ≥15], PTSD [PTSD Checklist, DSM 5 ≥38] and neurobehavioral [Neurobehavioral Symptom Inventory >75th percentile] symptoms at admission and last follow-up in this cohort study. Modification by education level (low [no college degree] vs. high [associate's degree or higher]) was additionally evaluated.

Results: The relationship between race/ethnicity and mental health/neurobehavioral symptoms varied by education level (p-interaction: depressive symptoms = 0.002, PTSD symptoms = 0.035, neurobehavioral symptoms = 0.040). Specifically, non-Whites were at a significantly higher prevalence for clinically-elevated depressive symptoms post-treatment than Whites, but only among those with higher education level (PR = 2.22, CI = 1.37-3.59). A similar trend was demonstrated for PTSD and neurobehavioral symptoms.

Conclusion: Military healthcare may need to increase depression-focused treatment options that are acceptable for racial/ethnic minority patients, particularly those with higher education, while they are recovering from comorbid traumatic brain injury.

Keywords: Depressive Symptoms; Educational Status; Military Health; Neurobehavioral Signs and Symptoms; Post-traumatic Stress Disorder; Race/ethnicity.