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Bahraini N.H.,19 Mental Illness Research Education and Clinical Center | Bahraini N.H.,Aurora University | Simpson G.K.,Liverpool Brain Injury Rehabilitation Unit | Simpson G.K.,University of Sydney | And 4 more authors.
Brain Impairment | Year: 2013

Traumatic brain injury (TBI) is prevalent among many populations and existing data suggest that those with TBI are at increased risk for death by suicide. This systematic review serves as an update to a previous review, with the aim of evaluating the current state of evidence regarding prevalence and risk of suicide deaths, post-TBI suicidal ideation and suicide attempts, and treatments to reduce suicide-related outcomes among TBI survivors. Review procedures followed the PRISMA statement guidelines. In all, 1014 abstracts and 83 full-text articles were reviewed to identify 16 studies meeting inclusion criteria. Risk of bias for individual studies ranged from low to high, and very few studies were designed to examine a priori hypotheses related to suicide outcomes of interest. Overall, findings from this systematic review supported an increased risk of suicide among TBI survivors compared to those with no history of TBI. Evidence pertaining to suicidal thoughts and attempts was less clear, mainly due to heterogeneity of methodological quality across studies. One small randomised controlled trial was identified that targeted suicide prevention in TBI survivors. Further research is needed to identify the prevalence of post-TBI ideation and attempts, and to establish evidence-based suicide prevention practices among TBI survivors. Copyright © 2013 The Author(s). Source

Simpson G.K.,Liverpool Brain Injury Rehabilitation Unit | Simpson G.K.,University of Sydney | Baguley I.J.,University of Sydney | Baguley I.J.,Brain Injury Rehabilitation Unit
Critical Reviews in Physical and Rehabilitation Medicine | Year: 2012

Sexuality is an important domain affected by traumatic brain injury (TBI). A scoping review was conducted to identify the evidence base derived from quantitative studies investigating sexual health issues after TBI. A systematic search of 4 electronic databases found 1833 citations published as of the end of 2010, of which 24 met the inclusion/ exclusion criteria. Only 2 treatment studies were identified (a single case treating premature ejaculation and a case series treating sexual dysfunction induced by selective serotonin reuptake inhibitors); both were rated poorly for methodological quality. Fourteen studies reported the prevalence of sexual dysfunction (drive, arousal, orgasm), with rates generally ranging between 10% and 50%. One study reported about the knowledge of safer sex and another reported about the agency use of a sex education program for adults with TBI. Six studies reported mechanisms underpinning sexual function/dysfunction: 2 found that reduction in sexual cognition may be linked to reduced sex drive; 2 reported intact penile function among men in a vegetative state; and 2 reported the duration of amenorrhea and female fertility rates after TBI. Overall, most studies were from a single center, few were controlled, and all observational studies were cross-sectional, meaning that the course of sexual dysfunction after TBI is unknown. Given the frequency and complexity of sexual health issues after TBI, more high quality studies are needed. © 2012 by Begell House, Inc. Source

Simpson G.K.,Liverpool Brain Injury Rehabilitation Unit | Simpson G.K.,University of Sydney | Sabaz M.,Liverpool Brain Injury Rehabilitation Unit | Daher M.,Liverpool Brain Injury Rehabilitation Unit
Journal of Head Trauma Rehabilitation | Year: 2013

Objective: Investigate the prevalence and clinical features of inappropriate sexual behavior (ISB) among a community-based cohort of clients of the New South Wales Brain Injury Rehabilitation program. Setting: All 11 community-based rehabilitation services of the statewide network. Participants: Five hundred seven clients with severe traumatic brain injury. Design: Cross-sectional multicentre study. Main Measures: Overt Behavior Scale, Disability Rating Scale, Sydney Psychosocial Reintegration Scale-2, Health of the Nation Outcome Scale-Acquired Brain Injury, Care and Needs Scale. Results: The point prevalence rate of ISBs was 8.9% (45/507) over the previous 3 months. Inappropriate sexual talk comprised 57.9% of all ISBs, followed by genital and nongenital touching behaviors (29.8%) and exhibitionism/public masturbation (10.5%). In 43 of 45 cases, ISBs were accompanied by other challenging behaviors, most often inappropriate social behavior, and/or aggression. Individuals who sustained more severe injuries and who were younger were significantly more likely to display ISBs. People displaying ISBs were more likely to display higher levels of challenging behaviors overall, lower levels of social participation, and more neuropsychiatric sequelae than 2 other groups: people displaying no challenging behaviors and people displaying challenging behaviors but no ISBs respectively. Conclusions: ISBs pose a complex clinical challenge among a minority of individuals with severe TBI. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins. Source

Hassett L.,University of Sydney | Simpson G.,Ingham Institute of Applied Medical Research | Cotter R.,Royal Rehab | Whiting D.,Liverpool Brain Injury Rehabilitation Unit | And 2 more authors.
Clinical Rehabilitation | Year: 2015

Objective: To investigate whether the introduction of an electronic goals system followed by staff training improved the quality, rating, framing and structure of goals written by a community-based brain injury rehabilitation team. Design: Interrupted time series design. Intervention: Two interventions were introduced six months apart. The first intervention comprised the introduction of an electronic goals system. The second intervention comprised a staff goal training workshop. Methods: An audit protocol was devised to evaluate the goals. A random selection of goal statements from the 12 months prior to the interventions (Time 1 baseline) were compared with all goal statements written after the introduction of the electronic goals system (Time 2) and staff training (Time 3). All goals were de-identified for client and time-period, and randomly ordered. Results: A total of 745 goals (Time 1 n = 242; Time 2 n = 283; Time 3 n = 220) were evaluated. Compared with baseline, the introduction of the electronic goals system alone significantly increased goal rating, framing and structure (χ2 tests 144.7, 18.9, 48.1, respectively, p 〈 0.001). The addition of staff training meant that the improvement in goal quality, which was only a trend at Time 2, was statistically significant at Time 3 (χ2 15.0, p ≤ 001). The training also led to a further significant increase in the framing and structuring of goals over the electronic goals system (χ2 11.5, 12.5, respectively, p ≤ 0.001). Conclusion: An electronic goals system combined with staff training improved the quality, rating, framing and structure of goal statements. © The Author(s) 2014. Source

Simpson G.K.,Liverpool Brain Injury Rehabilitation Unit | Simpson G.K.,University of Sydney | Simpson G.K.,Applied Brain Research | Sabaz M.,Liverpool Brain Injury Rehabilitation Unit | And 4 more authors.
Brain Impairment | Year: 2014

Objective: To examine patterns, predictors and unmet needs of service utilisation and access to mental health and/or drug and alcohol services among community-dwelling adults with severe traumatic brain injury, and compare those who displayed challenging behaviours with those not displaying challenging behaviour. Design: Retrospective multicentre study. Subjects: All active clients (n = 507) of the New South Wales (NSW) Brain Injury Rehabilitation Program (BIRP) community rehabilitation teams. Methods: Clinician-rated data were collected on client challenging behaviours, mental health and functional status, service utilisation and unmet needs. Between-groups analyses (challenging behaviour versus no challenging behaviours) were conducted to examine patterns of service utilisation and unmet needs. Predictors for service utilisation were tested by multiple linear regression. Results: Challenging behaviours were associated with higher use of BIRP and non-BIRP services and greater levels of unmet needs. Challenging behaviour was an independent predictor of higher levels of service utilisation, in conjunction with pre- and post-injury mental health and drug and alcohol co-morbidities and geographic location. Only 15.3% of the 111 clients with challenging behaviours and co-morbid drug and alcohol problems accessed a drug and alcohol service, while another 32.4% had unmet needs for such services. Conclusion: Challenging behaviours make an independent contribution to increased levels of service utilisation after severe traumatic brain injury. Copyright © Australasian Society for the Study of Brain Impairment 2014. Source

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