Cole J. Kennedy
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BA (University of Victoria, 2021)
Topic
Examining the Intersections of Brain Injury, Mental Health and Addictions: A Systematic Evidence Map of Treatments and Analysis of Community-Based Stakeholders’ Priorities for Future Research
Department of Psychology
Date & location
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Wednesday, April 17, 2024
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1:00 P.M.
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Business and Economics Building, Room 454
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And Virtual Defence
Examining Committee
Supervisory Committee
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Dr. Mauricio Garcia-Barrera, Department of Psychology, University of Victoria (Supervisor)
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Dr. Erica Woodin, Department of Psychology, UVic (Member)
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Dr. Julia Schmidt, Department of Occupational Science and Therapy, UBC (Non-Unit Member)
External Examiner
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Dr. Shelina Babul, Department of Pediatrics, University of British Columbia
Chair of Oral Examination
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Dr. Sandra Gibbons, School of Exercise Science, Physical and Heath Education, UVic
Abstract
Introduction: Acquired brain injury (ABI) and mental health and addiction (MHA) related conditions are leading causes of death and disability worldwide. Despite their high comorbidity and the devastatingly synergistic effects of their co-occurrence, ABI and MHA are frequently studied and managed as separate entities in both research and clinical practice. Addressing the profound need to better understand the intersections of ABI and MHA, this thesis involved two innovative community-engaged studies: (1) a systematic evidence map of interventions for MHA in ABI populations, completed with an interactive tool for knowledge users; and (2) a collaborative priority-setting study that identified stakeholders’ top ten priorities for research.
Methods: Study 1: Evidence mapping methodology was used to identify relevant literature. PsycINFO, SCOPUS, MEDLINE, the Cochrane Library (Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials), Web of Science, and CINAHL were searched. The Measurement Tool to Assess Systematic Reviews 2nd edition (AMSTAR-2) evaluated methodological quality, and an iterative prototyping design was employed to develop the evidence map user interface. Study 2: A multi-phasic health research priority-setting process was co-designed and executed with community-based stakeholders, including researchers, clinicians, service providers, policy makers, and people with lived experience. Stakeholders’ ideas led to the generation of research questions, which were prioritized at a one-day workshop and analyzed using an equation we created, the Question Priority Composite (QPC) formula.
Results: Study 1: From the 63,843 identified records, a total of 485 studies involving 735,203 participants with ABI were included, comprised of 283 impact evaluations, 119 systematic reviews and meta-analyses, 39 clinical trial registries, 31 published study protocols, and four clinical practice guidelines. AMSTAR-2 ratings varied, with most falling within the low-quality range. Cerebrovascular injuries, pharmacological interventions, and studies examining depression were among the most researched topics. Several gaps in the evidence base were identified, particularly for housing interventions and treatments for substance use post-ABI. Study 2: Fifty-nine stakeholders participated in the priority-setting activity during the workshop. Analysis of QPC scores resulted in a rank-ordered list of the top ten questions for research addressing the intersections of ABI and MHA. Questions identified touched on several pressing issues (e.g., opioid crisis, homelessness), encompassed multiple sub-types of ABI (e.g., hypoxic ischemic, mild traumatic), and involved different domains (e.g., identification, intervention) of health research.
Conclusions: The present thesis led to two main outcomes. The evidence mapping review, the first of its kind in the field, resulted in the development of DECISION–MAP (Database of Evidence Concerning Interventions Supporting the Intersections Of Neurotrauma–Mental health, & Addictions Problems), a practical tool that culminates research on interventions for MHA in ABI populations while highlighting gaps in the knowledge base (www.decision-map.com). The priority-setting study led to a rank-ordered community driven list of ten research priorities, acting as a blueprint for high impact investigations that address stakeholders’ most urgent needs. Together, these studies underscore the multitude of complexities that lie within the intersections of ABI and MHA and serve as catalyst