Incidence of Depression after Traumatic Brain Injury: A Nationwide Longitudinal Study of 2.2 Million Adults

Abstract

Although improvements in acute care for traumatic brain injury (TBI) have increased the patient survival rate, many survivors often suffer from neuropsychiatric sequelae such as depression. This study investigated the influence of TBI on the risk of depression using South Korean nationwide data. Data were extracted from the National Health Insurance Service database for patients who experienced TBI from 2010 to 2017 ( n = 1,141,593) and for 1:1 matched controls without TBI ( n = 1,141,593). Patients under 18 years old or with a history of depression were excluded. TBI was used as a time-varying exposure and a time-dependent Cox regression model was adopted. Age, sex, insurance premium and type, region of residence, past psychiatric diseases, and Charlson Comorbidity Index were adjusted. The incidence of depression in the patients with TBI and matched controls was 34.60 and 21.42 per 1000 person-years, respectively. The risk of depression was higher in the patients with TBI (hazard ratio [HR] 1.19, 95% confidence interval [CI] = 1.18-1.20) than in the matched control group. After stratification by sex and age, the risk was higher in men and the younger age group. In subgroup analyses, patients with skull fracture showed the highest risk of depression. Notably, during the first year after TBI, the depression risk was almost 11 times higher than that in the matched control group (HR 11.71, 95% CI = 11.54-11.87). Our findings highlight a significant association of TBI with an increased risk of subsequent depression. Therefore, continuous awareness with regard to patients' mental health is needed.

Incidence of Traumatic Brain Injury by Severity Among Work-Related Injured Workers From 2010 to 2019

“…The diagnoses and priorities according to the diagnostic codes are shown in Supplementary Table 1, http://links.lww.com/JOM/B190. In this study, concussion was classified under mild TBI, whereas cranial fracture and intracranial injury were considered moderate-to-severe TBIs 6,25–27 . Finally, a total of 48,166 patients were included in this study.…”

“…In this study, concussion was classified under mild TBI, whereas cranial fracture and intracranial injury were considered moderate-to-severe TBIs. 6,[25][26][27] Finally, a total of 48,166 patients were included in this study.…”

Treatment and Rehabilitation for Traumatic Brain Injury: Current Update

“…The prevalence of depression after TBI ranges between 6% and 77% [ 52 ]. According to two recent nationwide longitudinal studies related to the risk of depression after TBI, the risk of depression post-TBI increased by 1.83 times in a study involving the US population (hazard ratio [HR], 1.83; 95% confidence interval [CI], 1.79–1.86) than in the matched controls without TBI [ 53 ], and it was found to increase by 1.19 times in a study based on data from the National Health Insurance Service in Korea (HR, 1.19; 95% CI, 1.18–1.20) than in the matched controls without TBI [ 54 ]. The male gender was identified as a common predictor of post-TBI depression in both the studies.…”

Long-term health-related quality of life after trauma with and without traumatic brain injury: a prospective cohort study

“…Post-traumatic changes, such as neuroinflammation and neuroendocrine dysregulation are suggested to play an important role in the development of depression 26 . Choi et al 27 showed a long-term higher incidence of depression in TBI, compared to a control with other hospital encounters. Depression is also common after trauma without TBI 28 – 30 .…”