Risk of Depression after Traumatic Brain Injury in a Large National Sample

Abstract

Depression is associated with poorer recover after traumatic brain injury (TBI), yet awareness of depression risk post-TBI among providers and patients is low. The aim of this study was to estimate risk of depression post-TBI among adults 18 years of age and older and to identify risk factors associated with developing depression post-TBI. We conducted a retrospective, matched cohort study using claims data for privately insured and Medicare Advantage enrollees in a large U.S. health plan. Adults ≥18 years of age diagnosed with TBI (n = 207,354) with 12 months continuous insurance coverage pre-TBI and 24 months post-TBI were matched to controls without TBI (n = 414,708). We identified the presence of depression on any in- or outpatient claim occurring during the study period (both before and after TBI). Of the initial 622,062 individuals, 62,963 (10%) had depression pre-TBI and were excluded from incidence calculations. Incidence of depression post-TBI was 79.5 (95% confidence interval [CI], 78.5,80.5) per 1,000 person-years compared to 33.5 (95% CI, 33.1,34.0) per 1,000 person-years for those without TBI. The adjusted hazard ratio for depression post-TBI was 1.83 (95% CI, 1.79,1.86). We observed effect modification by sex and age, with males and older adults at increased risk. History of neuropsychiatric disturbances pre-TBI was the strongest predictor of depression post-TBI. Risk of depression increases substantially post-TBI. Groups at increased risk include those with a history of neuropsychiatric disturbances, older adults, and men. This study highlights the importance of long-term monitoring for depression post-TBI.

Characterizing the Risk of Depression Following Mild Traumatic Brain Injury: A Meta-Analysis of the Literature Comparing Chronic mTBI to Non-mTBI Populations

“…The true prevalence of depression in the chronic period following mTBI is uncertain, with most studies focusing on mTBI in the acute phase (days-weeks) as part of a constellation of post-concussive symptoms or on moderate-to-severe injuries. Suggested risk factors for post-TBI depression are heterogeneous across available data; indeed, no clear consensus has emerged regarding such factors such as female sex (11)(12)(13) and age at injury (14,15). Moreover, the likelihood of depression following mTBI sustained via different injury modalities has not been investigated.…”

The Road Less Traveled: Integrating Neurotherapy with Holistic Neuropsychological Rehabilitation After Severe Head Injury

“…About 50-60% of patients with severe TBI often exhibit these disturbances and have difficulties impacting multiple domains of functioning such as occupation, interpersonal relationships, and sexual functioning. Depression and anxiety are the most commonly reported emotional disturbances after TBI and can negatively affect the long term outcomes (Albrecht, Barbour, Abariga, Rao, & Perfetto, 2019;Scholten et al, 2016;War, Jamuna, & Arivazhagan, 2014). The loss of employment secondary to TBI can have further cascading effects on finances, interpersonal relationships, and quality of life (Ahmed et al, 2017;Benedictus, Spikman, & van der Naalt, 2010).…”

Analysing Joker: an attempt to establish diagnosis for a film icon

“…A number of studies have established that TBI increases the risk of mood disorders, personality changes and substance use disorders. [13][14][15] A study by Tateno et al revealed that the prevalence of pathological laughing and crying (PLC) during the first year after TBI was 10.9%, and that compared with patients without PLC, patients with PLC had significantly more depressive, anxious and aggressive behaviours and had poorer social functioning. 16 This conclusion is consistent with a recently published article that considers neurological aspects of Joker's disease and assumes that he suffers from neuropsychiatric sequelae related to childhood TBI involving the frontotemporal regions and, in particular, the lateral aspect of the left frontal lobe.…”