@article {10557,
	title = {Lifetime History of Traumatic Brain Injury is Associated with Increased Loneliness in Adults: A U.S. Nationally Representative Study},
	journal = {International Journal of Geriatric Psychiatry},
	volume = {35},
	year = {2020},
	pages = {553-563},
	abstract = {Background/Objectives: An estimated 55 million individuals worldwide live with chronic disability associated with Traumatic Brain Injury (TBI) which may include cognitive, behavioral and social impairments. Reduced participation in social activities is common after TBI, however few studies have evaluated loneliness among survivors of TBI. The current study aimed to evaluate the association between history of TBI and loneliness, and to identify mediators of this association. 

Methods/Design: Retrospective cohort study. Nationally representative sample of N=724 adults over age 50 (Health and Retirement Study). Loneliness was evaluated using the 11-item Revised UCLA (R-UCLA) Loneliness Scale (range 11-33). Lifetime history of TBI evaluated retrospectively using the Ohio State University TBI Identification Method. We included the following covariates: age, sex, race, education; and mediators: depressive symptoms, number of comorbidities, chronic pain, difficulty with activities of daily living, and social network index. 

Results: History of TBI was associated with a 1.28 point (95\% CI: 0.46, 2.11, p<0.05; Cohen{\textquoteright}s D=0.284) increase in R-UCLA loneliness scale scores, after covariate adjustment. Individuals with more recent injuries (within 10 years) and multiple lifetime TBIs 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: History of TBI was associated with greater loneliness compared to individuals without TBI in a representative sample of U.S. adults. Managing depressive symptoms and medical consequences of TBI may be a target to ameliorate reporting of loneliness in this population. This article is protected by copyright. All rights reserved.},
	keywords = {Loneliness, Older Adults, Traumatic Brain Injury},
	doi = {10.1002/gps.5271},
	author = {Raj G. Kumar and Katherine A Ornstein and Bollens-Lund, Evan and Watson, Eric M. and Claire K. Ankuda and Amy Kelley and Dams-O{\textquoteright}Connor, Kristen}
}
