Mental Health/Brain Health

Students: Danielle Burlie and Lauren Marcus
Supervisors: Vincy Chan (Principal Supervisor), Angela Colantonio, and Robert E. Mann
Introduction: Traumatic brain injury (TBI) is a leading cause of disability in Canada. TBI can negatively affect every functional domain, including increasing risk of psychological distress. These outcomes can be influenced by various social and demographic factors. Objectives: To explore the relationship between the social determinants of health (SDH) and psychological distress in Ontario adults with and without a self-reported TBI. Methods: Data from 2014-2017 CAMH Monitor surveys were analyzed. Psychological distress was measured using the validated Kessler Psychological Distress Scale, which has been used with individuals with various socio-demographic backgrounds and cognitive challenges, including TBI. Sex-specific descriptive analyses were used to describe the sample of Ontarians with psychological stress. Separate logistic regression analyses for individuals with and without TBI were conducted to examine the relationship between various SDH and psychological distress to identify similarities and differences between the two groups. Results: The sample consisted of 1662 participants who responded to the CAMH monitor survey. 40.1% of females and 30.2% of males within the TBI sample, and 23.5% of females and 17.9% of males within the non-TBI sample, reported experiencing psychological distress. Among individuals with a TBI, those with a household income of <$70,000 had a significantly greater odds of reporting psychological distress than those with a household income of $70,000+ (proxy for income and social status); those divorced/separated had a significantly greater odds of reporting psychological distress than those who were married/living with a partner (proxy for social supports and coping skills); those aged 18-29 and 30-39 had a significantly greater odds of reporting psychological distress than those aged 50-64 (proxy for biology and genetic endowment). The magnitude of association between both income and marital status, and psychological distress was higher among people with TBI compared to those without a TBI. Practice Implications: Identifying socio-demographic groups with a TBI that are vulnerable to psychological distress provides an opportunity for targeted intervention. As occupational therapists take a holistic approach and have an understanding of person-environment interactions, they are well-positioned to play a role in promoting wellbeing for individuals of various socio-demographic populations. Conclusions: SDH measures significantly associated with psychological distress included (a) income and social status; (b) social supports and coping skills; and (c) biology and genetic endowment. The negative impact of income and marital status was of greater magnitude in the TBI population compared to non-TBI population. Further research is required to understand the nature of these associations and the specific implications for equitable service provision.

Students: Esther (ChungHyun) Yong and Sarah Trick
Supervisors: Angela Colantonio and Tatyana Mollayeva
Background: Most injuries experienced by workers are multifactorial, involving personal, environmental, and occupational factors. Little is known about work-related traumatic brain injuries (wrTBI) and how injury factors vary between men and women. Purpose: To investigate pre-injury factors related to wrTBI in men and women using the Person-Environment-Occupation (PEO) model within various mechanisms of injury (MOIs). Method: One-hundred and two Ontario workers (52% men, aged 15-69 years, full data available for 91% of sample) with wrTBI were studied. An applied thematic approach was used to retrospectively review data collected from medical records, survey data, and insurer files. Themes from this analysis were incorporated into chi-square and Fisher’s exact tests for testing gender differences in PEO pre-injury factors across and within MOIs. In-depth thematic and quantitative analyses were performed on Struck By/Against an Object (SBA), Struck By an Object (SB), and Struck Against an Object (SA) MOIs to further test gender differences with increased MOI specificity. Findings: Generalizable themes for duties performed immediately pre-injury were revealed and applied to quantitative analyses. Gender differences were observed with Person, Environment, and Occupation-related factors within the SBA MOI, as well as the separated SB and SA MOIs. Within the SBA MOI, differences were seen in factors such as education level, perceived workplace culture and safety, and work industries. Separating SBA into the SB and SA MOIs revealed different gender trends in all aspects of the PEO model with increased specificity in MOI. Implications: Gender differences are observed in all components of the PEO model preceding a wrTBI, even within highly specific MOIs. Critical information for injury prevention strategies is lost as MOIs and genders are grouped. Gender-responsive approaches while targeting PEO factors within specific MOIs should be implemented in primary prevention of wrTBIs.

Students: Lindsay Rideout and Mijal Vonderwalde
Supervisors: Flora Matheson, Catherine Wiseman-Hakes, Hyun Ryu, and Angela Colantonio
Introduction: Women remain underrepresented in traumatic brain injury research due to the higher prevalence among men. Male findings are often inappropriately generalized to women and educational resources lack specificity about gendered experiences. Women are at risk of not receiving appropriate education and support. Purpose: To draw attention to current knowledge translation resources available specific to women who have sustained a traumatic brain injury and identify gaps. Methods: A grey literature search plan was developed to incorporate two searching strategies: (1) a targeted Google search, and (2) consultation with content experts. Websites were identified and screened for relevance based on predetermined criteria. Data including author, year, country, audience, purpose, legitimacy, format, language, and cost were extracted into an Excel spreadsheet for analysis. Results: 471 search hits were generated with only 11 (2.3%) selected for inclusion. Of the included resources, 9 were found on the first page of their respective Google search, and 2 were found on the second. Conclusion: There is a lack of gender-specific educational resources online addressing the unique needs of women. This knowledge translation gap highlights the need for the creation of gendered educational materials to ensure women receive appropriate education and support for recovery and rehabilitation.

Students: Sonia John, and Alexandra Saffran
Supervisors: Catherine Wiseman-Hakes, Flora I. Matheson, Ryu Hyun, and Angela Colantonio
Introduction: Traumatic brain injury (TBI) is becoming recognized as a leading cause of death and disability. The prevalence of individuals with TBIs are particularly high within the criminal justice involvement. Providing appropriate resources prior to being discharged from prison can facilitate successful reintegration into the community, and reduce the risk of homelessness, addictions, recidivism, and re-incarceration. This population would benefit from a comprehensive resource booklet to address their basic needs once released from prison. Objective: The objective of this project is to explore the methods of developing a resource booklet for front-line staff to assist persons with lived experience using an occupational therapy framework. Methods: An environmental scan was conducted utilizing three approaches: (1) academic and grey literature, (2) content specific websites, and (3) consultations with experts. We developed a data extraction tool to screen websites. Practice Implications: The material developed from this research may assist in facilitating successful community reintegration. Conclusions: This research identified the resources currently available in Toronto to assist this population with community reintegration. An OT framework was used to develop a comprehensive resource booklet, which may inform future community reintegration planning for this population.

Students: Alexandra Thompson and Madison Fugard
Supervisor: Bonnie Kirsh
Background: Occupational therapists (OTs) are well suited to contribute to the field of workplace mental health (WMH). There is little research on the role of occupational therapy (OT) in WMH, especially at the organizational level. As more employers take action to address WMH, an in-depth investigation into the OT role is needed to understand and advocate for this emerging position. Purpose: The aim of this research was to describe the OT role in organizational WMH from the perspectives of OTs currently contributing to this area of practice. Method: Using a qualitative design, this research drew on semi-structured interviews conducted with five OTs who work in this area. The interviews were thematically analyzed. Findings: OTs in this role adopt a business lens, organization-centred practice, and a population health approach within workplaces. Implications: To advance this important area of practice, OTs need more knowledge of business practices, a greater focus on health promotion, an organization-centred framework, and evidence-based, organizational outcomes.

Students: Krysta Halliwell and Mauj Yousif
Supervisors: Emily Nalder and Bonnie Kirsh
Background: Students are experiencing increasing levels of depression and anxiety during post-secondary education. With the established gap in mental health services, students often self-employ strategies to manage their mental health. Many individual studies report these strategies but there is a need to synthesize findings in order to draw broader conclusions to better address student mental health. Purpose: To identify and understand the strategies utilized by post-secondary students with depression and/ or anxiety to manage their mental health. Method: A qualitative meta-synthesis was conducted using: systematic search, data extraction and synthesis, the generation of second order categories, and third order interpretations. Findings: Students manage their mental health through three major processes: wellness through action, wellness through help-seeking, and wellness through interpersonal relations and support. Implications: Clinicians can use these processes to inform client-centred practice by enabling students’ occupational choice and providing opportunity and removing barriers for students to help themselves.

Students: Cori Snow and Bristol Baldwin
Supervisors: Tatyana Mollayeva, Angela Colantonio, and Mackenzie Hurst
Introduction: Although research reports sleep and psychiatric disorders are common after traumatic brain injury (TBI), little is known regarding whether they are consequences of TBI or exacerbations of pre-existing disorders, and how these disorders differ between men and women. Objectives: In a consecutive sample of Ontarian workers presenting with delayed recovery from work related TBI, we aimed to describe and compare sex-specific prevalence and type of sleep and psychiatric disorders, preceding injury, considering occupational and environmental factors at the time of injury. Methods: The Person-Environment-Occupation framework was used to analyze complex data pertaining to factors associated with TBI. A medical records review of 344 consecutive workers with work related injuries was performed. After exclusion of 14 workers who did not receive TBI diagnosis, data of 330 workers (71% men, aged 40.29±11.20 for men, and 42.19±10.94 for women) were analyzed. Two-sided t-tests and chi-square tests were conducted to identify differences between men and women in demographics and health status data. Results: Pre-injury depression, anxiety, substance abuse, and sleep disorders were common, affecting 18%, 12%, 17%, and 8% of our sample, respectively. For 16% of injured workers, this was not their first head trauma. Pre-injury, women were more likely to have depression and anxiety disorder diagnoses compared to men (χ2=7.21, p=0.007 and χ2=6.24, p=0.013, respectively). Previous head trauma and substance use disorders were more frequently observed in men compared to women (χ2=3.82, p=0.051 and χ2=11.51, p=0.007, respectively). Of 25 workers diagnosed with a sleep disorder pre-injury, 56% were men and 44% were women. Conclusion: Observed differences between men and women in frequency and type of sleep and psychiatric disorders warrants further investigation. Of interest is to investigate high risk occupational categories, for targeted preventative intervention.