Psychiatric Disorders and Health-Related Quality of Life after Severe Traumatic Brain Injury: A Prospective Study

Abstract

Traumatic brain injury (TBI) is a major cause of death and disability and impairs health-related quality of life (HRQOL). Psychiatric disorders have been recognized as major components of TBI morbidity, yet few studies have addressed the relationship between these outcomes. Sample size, selection bias, and retrospective design, are methodological limitations for TBI-related psychiatric studies. For this study, 33 patients with severe TBI were evaluated prospectively regarding demographic, clinical, radiological, neurosurgical, laboratory, and psychosocial characteristics, as well as psychiatric manifestations and HRQOL, 18 months after hospitalization. Psychiatric manifestations were assessed using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), the Hospital Anxiety and Depression Scale (HADS), the Brief Psychiatric Rating Scale (BPRS), and the Apathy Evaluation Scale (AES). HRQOL was determined using the Medical Outcomes Study's 36-item Short-Form Health Survey (SF-36). Following TBI, a significant increase in the prevalence of major depressive disorder (MDD) and generalized anxiety disorder (p=0.02), and a significant decrease in the prevalence of alcohol and cannabinoid abuse (p=0.001) were observed. The most frequent psychiatric disorders following severe TBI were found to be MDD (30.3%), and personality changes (33.3%). In comparison to patients without personality changes, patients with personality changes experienced a decline in general health and impairments in physical and social functioning. Patients with MDD showed impairment in all SF-36 domains compared to non-depressed patients. This prospective TBI-related psychiatric study is the first to demonstrate a significant association between MDD, personality changes, and HRQOL, following severe TBI in a well-defined sample of patients.

Validity and screening properties of three depression rating scales in a prospective sample of patients with severe traumatic brain injury

“…Improvements in diagnosis and treatment of depression may reduce the overall burden of TBI, because depression is frequent in these patients and strongly affects health-related quality of life. 3 The frequencies of psychiatric disorders in the present study were similar to those reported in the literature, with depression and personality changes as the most frequent psychiatric disorders following TBI. 1 A trend toward association between depression and anxiety disorders was found, reflecting a high comorbidity which has been already reported in patients with TBI and is well known in the general population.…”

“…1 In addition, the occurrence of a first major depressive episode is disproportionately high after head injury. 2,3 Depression can be then considered a sequela of TBI, although its psychosocial determinants and biological mechanisms remain largely unknown. Depression after TBI has been associated with poor functional, social, and occupational outcomes as well as decreased health-related quality of life, even when compared with other neurobehavioral sequelae.…”

“…Depression after TBI has been associated with poor functional, social, and occupational outcomes as well as decreased health-related quality of life, even when compared with other neurobehavioral sequelae. 3,4 Improving diagnosis and treatment of depression has the potential to mitigate the general burden of TBI.…”

Predictors of quality of life after moderate to severe traumatic brain injury

“…Nowadays, many tools have been created with the aim of assessing the physical, mental and social-related QOL, and to evaluate the impact of a disease on this 22 . Within this reality, we decided to use the WHOQOL-brief because it is a free access instrument, available in twenty languages and have good psychometric qualities.…”

Cross-cultural adaptation of the SCATBI instrument for cognitive-linguistic abilities after traumatic brain injury

“…This rapid deformation of brain anatomy and physiology results in clinical neurological and neurobehavioral impairments ultimately affecting an individual's cognition, vegetative and emotional functions, as well as social behavior abilities 3,5,6,7,8 . The TBI may result in multiple cognitive deficits.…”