Health Services Research
Traumatic Brain Injury (TBI) and loneliness are both highly prevalent and a significant cause of morbidity in the population, particularly among older adults. This research adds to the literature by evaluating the link between history of TBI and loneliness among middle and older aged adults.
Background/Objectives: An estimated 10 million Americans live with chronic disability associated with Traumatic Brain Injury (TBI). Behavioral and social impairments are common after TBI, however few studies have evaluated loneliness as a consequence of TBI. The primary objective was to evaluate the association between history of TBI and loneliness. The secondary objective was to identify mediators of the association between TBI and loneliness.
Design: Retrospective cohort study; Primary exposure: lifetime history of TBI evaluated retrospectively using the Ohio State University TBI Identification Method; Covariates: age, sex, race, education, and marital status; Mediators: depressive symptoms, number of comorbidities, chronic pain, difficulty with activities of daily living. We ran a multivariable generalized linear regression model testing the association between history of TBI and loneliness, adjusting for covariates. We also fit a structural equation model (SEM) to evaluate upstream mediating variables in the causal path between TBI and loneliness. All models adjusted for United States (US) population sampling weights.
Setting: Population-based representative sample of adults over 50 (Health and Retirement Survey).
Participants: N=724 adults (26.7% with History of TBI with loss of consciousness (LOC); 73.3% with no History of TBI).
Measurements: Loneliness was evaluated using the 11-item Revised UCLA (R-UCLA) Loneliness Scale.
Results: History of TBI was associated with a 1.11 point (95% CI: 0.29, 1.93, p<0.05; Cohen’s D=0.247) increase in R-UCLA loneliness scale scores, after covariate adjustment. Individuals with more recent injuries (within 10 years) and injuries after age 50 reported the highest loneliness scores. In the structural equation model, depressive symptoms and comorbidity burden partially mediated the relationship between TBI and loneliness. All models were adjusted for United States (U.S.) population sampling weights.
Conclusions: Loneliness is common among older adults, and is associated with deterioration in health and decreased longevity. History of TBI was associated with greater loneliness compared to individuals without TBI. Clinicians should screen for history of TBI among middle and older aged adults to identify patients at risk for loneliness.