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

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Published 26th May 2026

Mental health difficulties are common following moderateto-severe traumatic brain injury (TBI) and impact healthrelated quality of life. This systematic review and metaanalysis 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 singlecase 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 smallmoderate 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.

Citation

Carrier, S., Wong, D., Emery, H., Gertler, P., Simpson, G. K., Zuber, O., Ownsworth, T., McDonald, S., Douglas, J., Wearne, T., & Honan, and C. (2026). Psychosocial interventions for mental health difficulties following moderate-to-severe traumatic brain injury: A systematic review and meta-analysis. Neuropsychological Rehabilitation, 1–50.

https://doi.org/10.1080/09602011.2026.2664193

For more information about the broader project see: 

https://www.hopkinscentre.edu.au/publication/defining-the-scope-of-clinical-practice-773

Authors

Tamara Ownsworth

Professor