Mental health of brain injury survivors

After a brain injury, many people experience mental health struggles. Mental health, in this context, refers to your emotions and thoughts, and how they affect each other. This section deals with supporting a loved one with their mental health challenges.

For survivors, the drastic life changes, symptoms of their brain injury, and daily challenges can have a big impact on their mental health as well as their recovery and rehabilitation. Everything they are experiencing/feeling is incredibly real – this can be scary when they are feeling negative and don’t entirely know why, or they don’t feel like themselves and don’t know what steps to take. After their brain injury, they may not be able to cope with these feelings constructively and may have trouble identifying what exactly is going on.

Mental health is ongoing, and many survivors receive help for their mental health for the rest of their lives – even if they feel better most of the time. Consistent care and therapies over the long-term are what help them continuously improve. Quality continuity of care is crucial in managing ongoing mental health challenges like depression, emotional lability and suicidal tendencies. It requires a team of people including you, other family/friends, and multiple healthcare professionals that can help with different aspects of well-being such as counselling, physical therapy and medication.

Your mental health is also incredibly important and can have a big impact on your physical and emotional well-being. For more information about developing your own mental health plan, visit our page on caring for the caregiver.

Topics in this section include:

Signs of potential mental health problems

A survivor may not realize that they are experiencing mental health challenges – they could believe they are doing just fine. But caregivers and other people close to the survivor are often able to notice changes that could be a sign of a more serious underlying issue.

Signs of potential mental health problems include[1]:

  • Changes in sleeping/eating patterns
  • Changes in their mood
  • Getting easily angered/being impatient
  • Difficulty coping with stress
  • Difficulty concentrating
  • Changes in appearance
  • Increased isolation
  • Fatigue
  • Changes in weight
  • Hearing or seeing things that aren’t there

The presence of these symptoms does not necessarily mean the survivor is experiencing mental health challenges. It could also be related specifically to their brain injury. The healthcare team will be able to help you figure out what is prompting these symptoms, how best to manage them, and how to develop a continuity of care plan.

To provide the support/healthcare teams with the most accurate information, consider using a daily journal to track emotions, situations and activities as they happen.

Difference between mental health and mental illness

It’s important to note that there is a difference between mental health and mental illness.

Mental health is also known as mental well-being. It refers to your emotions, thoughts, and feelings. Mental health is something many Canadians struggle with at some point in their lives. There are multiple factors that can contribute to mental health problems, including:

  • Significant life change
  • Relationships
  • Isolation
  • Physical health
  • Age
  • Gender
  • Stress
  • Trauma
  • Employment

Mental illness is a diagnosed disorder that impairs how a person thinks, feels, behaves, or interacts with others. There are many different mental illnesses which have different symptoms that impact peoples’ lives in different ways, examples of mental illnesses include:

  • Addiction disorders
  • Anxiety disorders
  • Eating disorders
  • Mood disorders, like bipolar
  • Personality disorders
  • Post-traumatic stress disorder
  • Psychosis disorders, like schizophrenia

Studies have shown that individuals with a brain injury have a higher chance of developing a mental illness. A mental illness can only be diagnosed by a doctor/psychiatrist. While the survivor may have symptoms of some of these disorders, that does not mean they have a mental illness – just like individuals with a diagnosed mental illness can experience good mental health. If you have any concerns or questions, speak with a mental health professional[2].

Mental health problems after brain injury

Mental health problems after a brain injury are entirely dependent on the person, their injury, and other factors that make up daily living. For some they are short-lived: for others, mental health management is a life-long endeavour. Many people experience episodes of mental health challenges long after their brain injury: in other words, there will be good and bad days. This is where a continuity of care plan becomes important: it is critical that the survivor has continued support from their family/caregiver as well as the healthcare team. Having an advocate and a supporter who knows them well and can spot changes in their mental health will help survivors manage tougher times and can provide healthcare professionals with valuable insight.

Some mental health challenges a survivor may experience include:

Anxiety is feelings of worry and fear about the unknown. It activates a person’s fight or flight response. It is normal to experience some anxiety, especially as a person recovers from a brain injury – but it becomes problematic when they are unable to manage it, or it doesn’t match the situation. There are a few different types of anxiety a person can experience[3].

General anxiety

General anxiety means a person experiences persistent and excessive anxiety over various parts of life, including work and home life. They find their anxiety difficult to control and may even experience physical symptoms including restlessness, fatigue, muscle tension and sleep disturbance. If a survivor is experiencing anxiety:

  • Have them practice deep breathing – do it with them to help them through it
  • Gently guide them back to easy, routine tasks that are comfortable and familiar
  • Ask them if they want to talk about what’s making them anxious – the act of sharing can be cathartic
  • Acknowledge their feelings and remind them it’s okay to experience these feelings

Social anxiety

With social anxiety, a person is fearful, anxious about, or avoids social interactions and situations that involve the possibility of being watched. This includes meeting unfamiliar people, situations where they are eating/drinking, or situations where they may perform in front of others. Individuals worry about being embarrassed, rejected by others or of offending people.

Social anxiety can lead to staying in and isolation. For more information on social isolation and coping tips, visit our social life and brain injury page.

Panic attacks

Panic attacks are abrupt surges of intense discomfort that reach a high within minutes. They are accompanied by physical/cognitive symptoms. They can be expected or unexpected. Expected panic attacks are connected to a typically feared item or situation. Unexpected panic attacks occur for no apparent reason. Individuals who experience panic attacks are regularly worried about having more panic attacks. They may also change their behaviour to avoid attacks, which can impact them negatively (i.e. skipping exercise, avoiding new places). Panic attacks are often a sign that someone has an anxiety disorder.

There are a few key ways to identify if someone is having a panic attack:

  • Feelings of choking, chest pain, nausea, dizziness
  • Feelings of detachment or unreality
  • Heart palpitations
  • Hot or cold flashes
  • Numbness or tingling
  • Shakiness or trembling
  • Shortness of breath
  • Sweating

A panic attack can be brought on by different things, but often happen when a person is feeling trapped or overly anxious about something. Some people spend a lot of time scared they may have another panic attack and try to isolate themselves or stick to ‘safe’ environments. This is difficult and impacts both you and the survivor.

Ways to help survivors cope with panic attacks include:

  • Practice calm breathing with them
  • Practicing body relaxation – talk them through relaxing different parts of their body, giving them something else to focus on
  • Talk to them about what happened leading up to the panic attack, identifying the cause
  • Use positive visualization
  • Visit a therapist
  • Help them slowly build up a tolerance to the things that start their panic attacks

It takes a lot of time and dedication but managing panic attacks is possible with the right tools.

Depression affects many Canadians every year. Brain injury survivors are particularly susceptible to depression due to the intensity of life changes, shift in sense of self, and the process of adjusting to a new reality. This is incredibly difficult to cope with and can result in elevated stress and feelings of depression. Depression can also be caused by injury to the area of the brain that controls emotion, pre-existing genetic factors, and situational influences[4].

Symptoms of depression include:

  • Changes in eating patterns
  • Changes in sleep
  • Changes in weight
  • Feelings of sadness
  • Focus on the emotions of loss and grief
  • Helplessness, worthlessness and guilt
  • Irritability
  • Less interest or pleasure in things or activities previously enjoyed
  • Loss of sexual interest
  • Physical aches and pains
  • Poor concentration
  • Tiredness or loss of energy
  • Thoughts of death and suicide
  • Withdrawing from friends and family

Please note: A survivor may have some of these symptoms and not have depression. Talk to their doctor or psychotherapist about any emotional or physical symptoms they may be exhibiting. You can keep track in a daily journal.

If a survivor is diagnosed with depression, this can have an impact on their recovery, their daily lives, and on you. They may be more fatigued, have trouble engaging with people, experience bouts of anger and irritability or find participating in rehabilitation more difficult. They might also have trouble recognizing they are depressed and not have the skills to cope with it in a constructive way.

The most common treatments for depression are prescribed medications and talk therapy. Some things you can do at home to help a survivor cope with depression include[5]:

  • Helping them eat a balanced diet
  • Exercising
  • Making sure they avoid using substances
  • Find enjoyable hobbies they can do on their own or with others
  • Make sure they get an appropriate amount of rest
  • Try mindful activities like meditation

While there is a high risk of survivors experiencing depression, there is also a risk that as a caregiver, you will experience depression. Visit our coping with caregiving page to learn more about taking care of yourself as well as the survivor.

Depression is a complex challenge that will most likely be long-term. There will be good days and bad days: the important thing is that treatment is consistent and that both you and the survivor have the support you need to speak openly about it.

Post-traumatic stress disorder (PTSD)
Post-traumatic stress disorder (PTSD) is a mental health disorder that occurs in people who have suffered a traumatic event. It’s common in individuals that have experienced assault, accident survivors, and people in the military. Symptoms of post-traumatic stress disorder include:

  • Anxiety
  • Increase in negative thoughts, feelings, and beliefs stemming from the trauma
  • Disassociation – the person loses touch with the present and feels like they are experiencing the trauma again
  • Hallucination flashbacks
  • Nightmares
  • Avoidance of certain situations that may recall (trigger) the trauma
  • Feeling on guard all the time
  • Not remembering parts of the trauma
  • Sleep problems

Not every person who suffers a traumatic brain injury will have post-traumatic stress disorder. Additionally, not everyone with post-traumatic stress disorder will have a brain injury. It is dependent on the person, injuries, and how the trauma was processed. Only a licensed professional – for example, a psychologist or psychiatrist – can diagnose post-traumatic stress disorder.

A survivor may not realize or be able to acknowledge they have post-traumatic stress disorder, and it can be difficult to bring up the subject with them. It might also cause them to be unintentionally hurtful towards you: it’s important to remember that brain injury survivors can’t always control their behaviour, and post-traumatic stress disorder can be a contributing factor. While difficult, try not to take it personally.

Treatment of post-traumatic stress disorder

Therapy and prescription medication are two of the most common ways to help treat post-traumatic stress disorder. Other things that can be done to support someone with post-traumatic stress disorder include[6]:

  • Attend public support groups with them – their doctor or therapist can direct you to one if it’s available in your area
  • Exercising and taking care of physical health
  • Find activities that make them feel good
  • Identify what triggers their post-traumatic stress
  • Limit substance use

Post-traumatic stress disorder does not have a ‘cure’ – like most mental health challenges, it requires lifelong commitment to continuing care and management.

Suicidal thoughts
After an acquired brain injury, the survivor may experience lasting changes to their personality, abilities, relationships, and how they process information (including impulse control and decision-making). These changes are difficult to cope with, and can leave a person feeling alone, hopeless and angry. In some cases, these mental and environmental factors can lead to a higher risk of suicidal thoughts.

Signs of suicidal thoughts include:

  • Statements about dying or wishing to have died
  • Isolation or withdrawal from others
  • Intense feelings of hopelessness and helplessness – this often comes with feelings of depression.

If you suspect someone is experiencing suicidal thoughts, you should talk to your doctor or a mental health professional immediately.

Suicidal thoughts and tendencies are a complex issue that may be long-term for the survivor.A survivor may make multiple attempts or experience these feelings episodically months or even years after the injury. This means that there needs to be a supportive, multidisciplinary team of caregivers, family and mental health professionals dedicated to continuing care and development of a community plan. Examples of long-term support include antidepressants, counselling, behaviour therapies, and monitoring by caregivers.

There are helplines and crisis centres available across Canada you can call if you need immediate support.

How long will these mental health challenges last?

There is no definitive timeline for mental health challenges. Some people may experience them for the rest of their lives; some may experience them episodically (off and on); still others may only experience them for short periods of time. Challenges may not last forever, but mental health care and management is ongoing. Continuous care for mental health is required to make sure that everyone is as healthy as possible.

Mental health resources

Helplines & crisis centres

If you need access to supports or crisis centres for your mental health, use this list of contact information to find a helpline for your area.

See sources

Disclaimer: There is no shortage of web-based online medical diagnostic tools, self-help or support groups, or sites that make unsubstantiated claims around diagnosis, treatment and recovery. Please note these sources may not be evidence-based, regulated or moderated properly and it is encouraged individuals seek advice and recommendations regarding diagnosis, treatment and symptom management from a regulated healthcare professional such as a physician or nurse practitioner. Individuals should be cautioned about sites that make any of the following statements or claims that:

  • The product or service promises a quick fix
  • Sound too good to be true
  • Are dramatic or sweeping and are not supported by reputable medical and scientific organizations.
  • Use of terminology such as “research is currently underway” or “preliminary research results” which indicate there is no current research.
  • The results or recommendations of product or treatment are based on a single or small number of case studies and has not been peer-reviewed by external experts
  • Use of testimonials from celebrities or previous clients/patients that are anecdotal and not evidence-based

Always proceed with caution and with the advice of your medical team.