Format

Send to

Choose Destination
JAMA Psychiatry. 2019 Jan 30. doi: 10.1001/jamapsychiatry.2018.4288. [Epub ahead of print]

Risk of Posttraumatic Stress Disorder and Major Depression in Civilian Patients After Mild Traumatic Brain Injury: A TRACK-TBI Study.

Author information

1
Department of Psychiatry, University of California San Diego, La Jolla.
2
Department of Family Medicine & Public Health, University of California San Diego, La Jolla.
3
VA San Diego Healthcare System, San Diego, California.
4
Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts.
5
Spaulding Rehabilitation Hospital, Charlestown, Massachusetts.
6
Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas.
7
Department of Rehabilitation Medicine, University of Washington, Seattle.
8
Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee.
9
Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California.
10
Department of Neurological Surgery, University of California, San Francisco.
11
Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
12
Department of Neurology, University of Pennsylvania, Philadelphia.
13
Department of Radiology & Biomedical Imaging, University of California, San Francisco.
14
Department of Bioengineering & Therapeutic Sciences, University of California, San Francisco.
15
Department of Neurological Surgery, University of Washington, Seattle.
16
Department of Biostatistics, University of Washington, Seattle.
17
University of Cincinnati, Cincinnati, Ohio.
18
University of Maryland, College Park.
19
Massachusetts General Hospital, Boston.
20
University of Miami, Coral Gables, Florida.
21
Ohio State University, Columbus.
22
University of Southern California, Los Angeles.
23
MassGeneral Hospital for Children, Boston.
24
Department of Emergency Medicine, Virginia Commonwealth University, Richmond.
25
Department of Neurology, University of California, San Francisco.
26
TIRR Memorial Hermann, Houston, Texas.
27
Department of Neurosurgery, Baylor College of Medicine, Houston, Texas.
28
Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor.
29
Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee.
30
Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, Texas.
31
Department of Psychiatry, Indiana University School of Medicine, Indianapolis.
32
Department of Anatomy and Neurobiology, Virginia Commonwealth University, Richmond.
33
Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Texas.
34
Department of Pathology, Uniformed Services University, Bethesda, Maryland.
35
Department of Psychology, University of Texas at Austin, Austin.
36
Department of Neurosurgery, Virginia Commonwealth University, Richmond.
37
Department of Neurology, University of California Los Angeles School of Medicine, Los Angeles.
38
Department of Psychiatry, University of Florida, Gainesville.

Abstract

Importance:

Traumatic brain injury (TBI) has been associated with adverse mental health outcomes, such as posttraumatic stress disorder (PTSD) and major depressive disorder (MDD), but little is known about factors that modify risk for these psychiatric sequelae, particularly in the civilian sector.

Objective:

To ascertain prevalence of and risk factors for PTSD and MDD among patients evaluated in the emergency department for mild TBI (mTBI).

Design, Setting, and Participants:

Prospective longitudinal cohort study (February 2014 to May 2018). Posttraumatic stress disorder and MDD symptoms were assessed using the PTSD Checklist for DSM-5 and the Patient Health Questionnaire-9 Item. Risk factors evaluated included preinjury and injury characteristics. Propensity score weights-adjusted multivariable logistic regression models were performed to assess associations with PTSD and MDD. A total of 1155 patients with mTBI (Glasgow Coma Scale score, 13-15) and 230 patients with nonhead orthopedic trauma injuries 17 years and older seen in 11 US hospitals with level 1 trauma centers were included in this study.

Main Outcomes and Measures:

Probable PTSD (PTSD Checklist for DSM-5 score, ≥33) and MDD (Patient Health Questionnaire-9 Item score, ≥15) at 3, 6, and 12 months postinjury.

Results:

Participants were 1155 patients (752 men [65.1%]; mean [SD] age, 40.5 [17.2] years) with mTBI and 230 patients (155 men [67.4%]; mean [SD] age, 40.4 [15.6] years) with nonhead orthopedic trauma injuries. Weights-adjusted prevalence of PTSD and/or MDD in the mTBI vs orthopedic trauma comparison groups at 3 months was 20.0% (SE, 1.4%) vs 8.7% (SE, 2.2%) (P < .001) and at 6 months was 21.2% (SE, 1.5%) vs 12.1% (SE, 3.2%) (P = .03). Risk factors for probable PTSD at 6 months after mTBI included less education (adjusted odds ratio, 0.89; 95% CI, 0.82-0.97 per year), being black (adjusted odds ratio, 5.11; 95% CI, 2.89-9.05), self-reported psychiatric history (adjusted odds ratio, 3.57; 95% CI, 2.09-6.09), and injury resulting from assault or other violence (adjusted odds ratio, 3.43; 95% CI, 1.56-7.54). Risk factors for probable MDD after mTBI were similar with the exception that cause of injury was not associated with increased risk.

Conclusions and Relevance:

After mTBI, some individuals, on the basis of education, race/ethnicity, history of mental health problems, and cause of injury were at substantially increased risk of PTSD and/or MDD. These findings should influence recognition of at-risk individuals and inform efforts at surveillance, follow-up, and intervention.

PMID:
30698636
PMCID:
PMC6439818
[Available on 2020-01-30]
DOI:
10.1001/jamapsychiatry.2018.4288

Supplemental Content

Full text links

Icon for Silverchair Information Systems
Loading ...
Support Center