Mobilizing Early Management of Mental Health Complications After Mild Traumatic Brain Injury (M4)

March 25, 2026 updated by: Noah Silverberg, University of British Columbia
Mental health problems frequently complicate recovery from mild traumatic brain injury (mTBI) but are under-recognized and under-treated. Our research program aims to identify evidence-based strategies for closing this knowledge-practice gap. Building on a successful pilot trial, the reseachers will evaluate the effectiveness of a clinical practice guideline implementation tool designed to support proactive management of mental health complications after mTBI in primary care.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Goal: To determine if a clinical practice guideline implementation tool, designed to support proactive management of mental health complications, can improve clinical outcomes from mild traumatic brain injury (mTBI).

Background: Up to 1 in 4 people who sustain an mTBI develop depression or an anxiety disorder within the first 3 months. Mental health problems triple the risk of long-term disability after mTBI. However, mental health disorders after mTBI are under-detected and under-treated. Canadian clinical practice guidelines for mTBI developed by the Ontario Neurotrauma Foundation (ONF) recommend that family physicians proactively screen and initiate treatment for mental health disorders.

Aims: To evaluate the effectiveness of an implementation intervention designed to facilitate timely detection and treatment of mental health complications in primary care.

Approach: Triple-blinded (treatment provider, patient, assessor) cluster randomized controlled trial with two arms. The intervention involves collecting screening test results from patients and a complex intervention with two components: sharing the screening test results in an actionable format with their family physician and activating patients for the clinical encounter with the family physician by sharing education materials about mental health problems and treatment options after mTBI. The comparison group is usual care.

Hypotheses: The researchers hypothesize that the guideline implementation tool will be associated with lower rates of mental health complications at 26 weeks post-injury, compared to usual care.

Study Type

Interventional

Enrollment (Actual)

537

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Canada
    • British Columbia
      • North Vancouver, British Columbia, Canada, V7L 1A5
        • Urgent and Primary Care Center: North Vancouver
      • North Vancouver, British Columbia, Canada, V7L 2L7
        • Lion's Gate Hosital
      • Prince George, British Columbia, Canada, V2M 1S2
        • University Hospital of Northern British Columbia
      • Richmond, British Columbia, Canada, V6X 1A2
        • Richmond Hospital
      • Vancouver, British Columbia, Canada, V6Z 1Y6
        • St. Paul's Hospital
      • Vancouver, British Columbia, Canada, V5Z 1M9
        • Vancouver General Hospital
      • Vancouver, British Columbia, Canada, V6T 2B5
        • University of British Columbia Hospital
      • Vancouver, British Columbia, Canada, V5T 3N4
        • Mount Saint Joseph's Hospital
      • Vancouver, British Columbia, Canada, V6Z 0A3
        • Urgent and Primary Care Center: City Center

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years to 69 years (Adult, Older Adult)

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Age 18-69 years old,
  • presentation to emergency department within 72 hours of injury,
  • probable mTBI diagnosis per emergency department chart review and interview based on World Health Organization Neurotrauma Task Force diagnostic criteria,
  • fluent in English,
  • primary residence in British Columbia,
  • designate a specific family physician or walk-in clinic where they plan to seek follow-up care

Exclusion Criteria:

  • Pre-existing unstable/serious medical condition (e.g., cancer, multiple sclerosis, etc.)
  • Pre-existing unstable/severe mental illness (e.g., schizophrenia requiring hospital admission in past year)

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Triple

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: Arm 1: Minimally enhanced usual care
See intervention/treatment description
Other: Generic information about concussion management
Family physicians will receive a generic letter drawing their attention to Canadian clinical practice guidelines for mild Traumatic Brain Injury (developed by the Ontario Neurotrauma Foundation). Patients will receive instructions about how to access generic education materials about mTBI (from concussion.vch.ca/), which they should have received anyway as part of usual care.
Experimental: Arm 2: Guideline implementation tool
See intervention/treatment description
Other: Guideline implementation tool
Family physicians will receive a tailored letter with their patient's mental health screening test results and associated mental health treatment recommendations from the Ontario Neurotrauma Foundation guidelines, as well as a list of mental health treatment resources. In addition, the patient will receive a written information package about mental health problems after mTBI and treatment options to discuss with their family physician.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
MINI version 7.0.2 for DSM-5
Time Frame: 26 weeks post injury
Structured diagnostic interview
26 weeks post injury

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Rivermead Postconcussion Symptom Questionnaire
Time Frame: 2, 12, 26 weeks post injury
Standardized questionnaire
2, 12, 26 weeks post injury
World Health Organization Disability Assessment Schedule 2.0 12-item version
Time Frame: 12 and 26 week post injury
Standardized interview
12 and 26 week post injury

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

University of British Columbia

Collaborators

Canadian Institutes of Health Research (CIHR)

Investigators

  • Principal Investigator: Noah Silverberg, University of British Columbia

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

February 1, 2021

Primary Completion (Actual)

April 30, 2023

Study Completion (Actual)

October 30, 2025

Study Registration Dates

First Submitted

January 7, 2021

First Submitted That Met QC Criteria

January 7, 2021

First Posted (Actual)

January 11, 2021

Study Record Updates

Last Update Posted (Actual)

March 31, 2026

Last Update Submitted That Met QC Criteria

March 25, 2026

Last Verified

March 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • H20-00562

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

YES

IPD Plan Description

Upon reasonable request

IPD Sharing Time Frame

October 2025

IPD Sharing Supporting Information Type

  • STUDY_PROTOCOL
  • ICF

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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