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. 2010 May 19;303(19):1938-45.
doi: 10.1001/jama.2010.599.

Rates of major depressive disorder and clinical outcomes following traumatic brain injury

Charles H Bombardier  1 , Jesse R Fann, Nancy R Temkin, Peter C Esselman, Jason Barber, Sureyya S Dikmen
Affiliations

Rates of major depressive disorder and clinical outcomes following traumatic brain injury

Charles H Bombardier et al. JAMA. .

Abstract

Context: Uncertainties exist about the rates, predictors, and outcomes of major depressive disorder (MDD) among individuals with traumatic brain injury (TBI).

Objective: To describe MDD-related rates, predictors, outcomes, and treatment during the first year after TBI.

Design: Cohort from June 2001 through March 2005 followed up by structured telephone interviews at months 1 through 6, 8, 10, and 12 (data collection ending February 2006).

Setting: Harborview Medical Center, a level I trauma center in Seattle, Washington.

Participants: Five hundred fifty-nine consecutively hospitalized adults with complicated mild to severe TBI.

Main outcome measures: The Patient Health Questionnaire (PHQ) depression and anxiety modules were administered at each assessment and the European Quality of Life measure was given at 12 months.

Results: Two hundred ninety-seven of 559 patients (53.1%) met criteria for MDD at least once in the follow-up period. Point prevalences ranged between 31% at 1 month and 21% at 6 months. In a multivariate model, risk of MDD after TBI was associated with MDD at the time of injury (risk ratio [RR], 1.62; 95% confidence interval [CI], 1.37-1.91), history of MDD prior to injury (but not at the time of injury) (RR, 1.54; 95% CI, 1.31-1.82), age (RR, 0.61; 95% CI, 0.44-0.83 for > or = 60 years vs 18-29 years), and lifetime alcohol dependence (RR, 1.34; 95% CI, 1.14-1.57). Those with MDD were more likely to report comorbid anxiety disorders after TBI than those without MDD (60% vs 7%; RR, 8.77; 95% CI, 5.56-13.83). Only 44% of those with MDD received antidepressants or counseling. After adjusting for predictors of MDD, persons with MDD reported lower quality of life at 1 year compared with the nondepressed group.

Conclusions: Among a cohort of patients hospitalized for TBI, 53.1% met criteria for MDD during the first year after TBI. Major depressive disorder was associated with history of MDD and was an independent predictor of poorer health-related quality of life.

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Figures

Figure 1
Figure 1
Subject Flow Note: At each assessment time, the fraction interviewed is the number interviewed divided by 559 minus the number for which an interview was not attempted.
Figure 2
Figure 2
The rate and cumulative rate of major depression depending on time since TBI Note: These values may underestimate the true rates because not all participants were assessed at each time
Figure 3
Figure 3
Cumulative rate of major depression after TBI as a function of pre-injury depression history Note: There were significant differences in depression rates between groups as shown in Table 1
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