Faces of U of T Medicine: Angela Colantonio
How has your research investigated mental health?
Over the last two decades we have shown that mental health conditions are both a predictor and consequence of concussion/traumatic brain injury. Persons with pre-existing mental health conditions often fare worse following a traumatic brain injury (TBI) than those that do not. We know that intimate partner violence is a primary cause of injury to women and that both TBI and intimate partner violence are linked to high rates of mental illness, unemployment and poverty. This knowledge underpins our research in this area. Our research has also identified high prevalence rates of brain injury in populations that are under-served with respect to formal and informal health care services and supports, such as homeless and criminalized individuals.
Our research has led to numerous requests for education among front line service providers. Our research also supports the need for more access to interventions and supports that address cognitive disability. For example, the integration of occupational therapy research with clinical placements relevant to our research programs has created awareness of how occupational therapy can meet these complex needs.
Our team is now funded to address the fragmentation of care for persons with traumatic brain injury, mental health and addictions, because many people with co-existing conditions are poorly served. This is a province-wide study with several stakeholders that addresses the intersection of these conditions among persons who are criminalized, homeless or experience intimate partner violence. Details about this study and other related work is available on our website.
What has your research shown about environments that promote mental health?
Our research takes a client/service user-centred approach. People with brain health conditions – including mental health – have identified that the support of family, friends and treatment providers are most important for creating supportive environments. In the workplace, having appropriate accommodations is also incredibly important to support employees’ successful return to work. Our research has identified the types of workplace accommodations that are most effective.
Much of our research aims to integrate explicit consideration of sex and gender in our methodologies and analyses. We have identified differential preferences for care by women and men after injury that should inform clinical practice. Targeting care to clients’ preferences creates a more supportive environment.
Given what you know about environments that promote mental health, what steps can be taken to create them?
Our strategies include changing policies and providing education to promote supportive environments and provide better services. Over the years, we have addressed major education gaps about brain injury and co-existing conditions in underserved contexts. Currently, we’re addressing a major knowledge gap about brain injury among front line providers serving women who experience intimate partner violence and we have designed a toolkit for that purpose. We found that front line workers have little awareness of TBI and the variety of co-existing physical, cognitive and mental health conditions. This lack of awareness not only means that their clients will not receive appropriate support, but also that the safe environment they aim to provide is compromised. Education goes a long way to facilitate a supportive environment.
We have also used innovative strategies such as research-informed theatrical productions to demonstrate the impact that lack of awareness of TBI has within healthcare environments, and inevitably, on the health of clients. Our play ‘After the Crash’ is based on real-life experiences of people with a TBI and has been proven to lead to better client-centred practice among care providers.
I am especially appreciative of the people with lived experience of brain injury who have shared their experiences with us and have provided mentorship; their contributions to the research program are essential and are, we hope, reciprocally beneficial.
What does your research show about strategies that individuals can use to support or maintain their mental health?
We have conducted pilot studies showing the positive effects of physical activity on mood and overall well-being. This is currently being tested in a larger study led by one of my doctoral students. The trainees in my lab have also shown how problems with sleep affect function and their integration back into their communities after a TBI. We have shown that addressing sleep disorders can have a positive impact on physical, cognitive, and mental health outcomes. I am grateful for the many outstanding trainees, staff, colleagues, collaborators and sponsors who have supported our research program.
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