Social determinants of health associated with psychological distress stratified by lifetime traumatic brain injury status and sex: Cross-sectional evidence from a population sample of adults in Ontario, Canada

This study identified the social determinants of health (SDoH) associated with psychological distress in adults with and without a self-reported history of traumatic brain injury (TBI), stratified by sex. Data from the 2014-2017 cycles of the Centre for Addiction and Mental Health Monitor Survey, a representative survey of adults ≥18 years in Ontario, Canada, were analyzed (N = 7,214). The six-item version of the Kessler Psychological Distress Scale was used to determine moderate to severe psychological distress. Self-reported lifetime TBI was defined as a head injury resulting in a loss of consciousness for ≥5 minutes or at least onenight stay in the hospital (16.4%). Among individuals reporting a history of TBI, 30.2% of males and 40.1% of females reported psychological distress (p = 0.0109). Among individuals who did not report a history of TBI, 17.9% of males and 23.5% of females reported psychological distress (p<0.0001). Multivariable logistic regression analyses showed that the SDoH significantly associated with elevated psychological distress were similar between individuals with and without a history of TBI. This included unemployment, student, or 'other' employment status among both males and females; income below the provincial median and age 65 + among males; and rural residence among females. This study highlighted opportunities for targeted population-level interventions, namely accessible and affordable mental health supports for individuals with lower income. Notably, this study presented evidence suggesting adaptations to existing services to accommodate challenges associated with TBI should be explored, given the finite and competing demands for mental health care and resources.