Depression Trajectories during the First Year after Traumatic Brain Injury

Abstract

Major depression is prevalent after traumatic brain injury (TBI) and associated with poor outcomes. Little is known about the course of depression after TBI. Participants were 559 consecutively admitted patients with mild to severe TBI recruited from inpatient units at Harborview Medical Center, a Level I trauma center in Seattle, WA. Participants were assessed with the Patient Health Questionnaire-9 (PHQ-9) depression measure at months 1-6, 8, 10, and 12 post-injury. We used linear latent class growth mixture modeling (LCGMM) of PHQ-9 total scores to identify homogeneous subgroups with distinct longitudinal trajectories. A four-class LCGMM had good fit indices and clinical interpretability. Trajectory groups were: low depression (70.1%), delayed depression (13.2%), depression recovery (10.4%), and persistent depression (6.3%). Multinomial logistic regression analyses were used to distinguish trajectory classes based on baseline demographic, psychiatric history, and clinical variables. Relative to the low depression group, the other three groups were consistently more likely to have a pre-injury history of other mental health disorders or major depressive disorder, a positive toxicology screen for cocaine or amphetamines at the time of injury, and a history of alcohol dependence. They were less likely to be on Medicare versus commercial insurance. Trajectories based on LCGMM are an empirical and clinically meaningful way to characterize distinct courses of depression after TBI. When combined with baseline predictors, this line of research may improve our ability to predict prognosis and target groups who may benefit from treatment or secondary prevention efforts (e.g., proactive telephone counseling).

A narrative literature review of depression following traumatic brain injury: prevalence, impact, and management challenges

“…Furthermore, being unemployed or impoverished at the time of injury or substance abuse before or at the time of injury also conferred a higher likelihood of developing PTD 8,12,13,15,94. Personality characteristics and pre-injury psychiatric conditions that increase the risk of sustaining a TBI95,96 may also put individuals at greater risk for developing PTD 7,85,94. In fact, one of the biggest predictors of PTD was a pre-injury history of depression or other psychiatric disorder 7,94,97.…”

Advanced Therapy in Traumatic Brain Injury Inpatient Rehabilitation: Effects on Outcomes During the First Year After Discharge

“…30 All of these measures have established reliability and validity for use with persons with TBI. 18,21,23,24,[31][32][33][34][35][36] The PHQ-9 was analyzed as a dichotomous variable: likely major depression vs. no major depression. 36 When the person with TBI was not able to complete the follow-up, the SWLS and PHQ-9 were not administered and the FIM and PART-O-17 were based on a proxy report.…”

Prophylaxis Pharmacotherapy to Prevent the Onset of Post-Traumatic Brain Injury Depression: A Systematic Review

“…There is substantial heterogeneity associated with TBI and while not all patients with TBI develop depression, studies have shown that some survivors become depressed early, others become depressed in the post-acute stage and others have sub-threshold depressive symptoms that can lead to later depression. 21 Contributory factors to the onset and course of post-TBI depression include the extent of social support and post-acute services, preinjury mental health disorders, injury related changes and posttraumatic adaptive issues. Gender, age and level of education are important in some studies but not in others.…”

“…2 Once depression becomes established it likely becomes more difficult to treat and many individuals post-TBI require medications over extended periods for depression. 21,22 Given the high prevalence of depression post-TBI, consideration of a preventative approach may be an option and indeed a desirable goal for clinicians, patients and carers. Secondary prevention aims to reduce the impact of a disease or injury that has already occurred.…”