Psychosocial interventions for mental health difficulties following moderate-to-severe traumatic brain injury: A systematic review and meta-analysis

Mental health difficulties are common following moderate-to-severe traumatic brain injury (TBI) and impact health-related quality of life. This systematic review and meta-analysis evaluated the effectiveness of psychosocial interventions for adults with moderate-to-severe TBI experiencing mental health difficulties (anxiety, depression, psychological distress, suicidality, alcohol/substance misuse, insomnia and sexual dysfunction). Psychological and behavioural interventions across settings were compared with control/baseline conditions in clinical trials or single-case experimental-designs, with self-reported mental health symptoms as the primary outcome. Five databases were searched in May 2024 for studies published worldwide. Screening and risk-of-bias ratings were performed by two independent reviewers. Thirty-three studies were identified; 22 were included in the meta-analysis. Cognitive behaviour therapy (CBT) showed moderate effects for anxiety, depression, distress and suicidality (Hedges’ g = 0.48); acceptance and commitment therapy showed small-moderate effects (g = 0.43). Psychological interventions (e.g., motivational interviewing) showed small-moderate effects for alcohol/substance misuse (g = 0.39), and CBT showed small-moderate effects for insomnia (g = 0.30). GRADE certainty of evidence was low for anxiety, depression, distress and suicidality, and very low for alcohol/substance misuse, sleep difficulties/insomnia and sexual dysfunction. Psychosocial interventions appear beneficial for mental health difficulties post-TBI, with most consistent evidence for CBT. Findings will inform Clinical Practice Guidelines.