Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2015 Aug 15;32(16):1223-9.
doi: 10.1089/neu.2014.3651. Epub 2015 Mar 25.

Patterns of Depression Treatment in Medicare Beneficiaries with Depression after Traumatic Brain Injury

Jennifer S Albrecht  1 , Zippora Kiptanui  2 , Yuen Tsang  3 , Bilal Khokhar  3 , Gordon S Smith  4 , Ilene H Zuckerman  2   3 , Linda Simoni-Wastila  3
Affiliations
Comparative Study

Patterns of Depression Treatment in Medicare Beneficiaries with Depression after Traumatic Brain Injury

Jennifer S Albrecht et al. J Neurotrauma. .

Abstract

There are no clinical guidelines addressing the management of depression after traumatic brain injury (TBI). The objectives of this study were to (1) describe depression treatment patterns among Medicare beneficiaries with a diagnosis of depression post-TBI; (2) compare them with depression treatment patterns among beneficiaries with a diagnosis of depression pre-TBI; and (3) quantify the difference in prevalence of use. We conducted a retrospective analysis of Medicare beneficiaries hospitalized with TBI during 2006-2010. We created two cohorts: beneficiaries with a new diagnosis of depression pre-TBI (n=4841) and beneficiaries with a new diagnosis of depression post-TBI (n=4668). We searched for antidepressant medications in Medicare Part D drug event files and created variables indicating antidepressant use in each 30-day period after diagnosis of depression. We used provider specialty and current procedural terminology to identify psychotherapy in any location. We used generalized estimating equations to quantify the effect of TBI on receipt of depression treatment during the year after diagnosis of depression. Average monthly prevalence of antidepressant use was 42% among beneficiaries with a diagnosis of depression pre-TBI and 36% among those with a diagnosis post-TBI (p<0.001). Beneficiaries with a diagnosis of depression post-TBI were less likely to receive antidepressants compared with a depression diagnosis pre-TBI (adjusted odds ratio [OR] 0.87; 95% confidence interval [CI] 0.82, 0.92). There was no difference in receipt of psychotherapy between the two groups (OR 1.08; 95% CI 0.93, 1.26). Depression after TBI is undertreated among older adults. Knowledge about reasons for this disparity and its long-term effects on post-TBI outcomes is limited and should be examined in future work.

Keywords: antidepressants; depression; older adults; traumatic brain injury.

PubMed Disclaimer

Figures

<b>FIG. 1.</b>
FIG. 1.
Average monthly prevalence of the most commonly used antidepressants over twelve months following diagnosis of depression by pre- or post-TBI status, n=9, 509. (p<0.001 for all except citalopram [p=0.35] and trazodone [p=0.035].)
See this image and copyright information in PMC

References

    1. Faul M., Xu L., Wald M.M., and Coronado V. Traumatic brain injury in the United States: emergency department visits, hospitalizations and deaths, 2002–2006. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2010. Atlanta, Ga: Available at: http://www.cdc.gov/traumaticbraininjury/pdf/blue_book.pdf Accessed December/15/13
    1. Livingston D.H., Lavery R.F., Mosenthal A.C., Knudson M.M., Lee S., Morabito D., Manley G.T., Nathens A., Jurkovich G., Hoyt D.B., and Coimbra R. (2005). Recovery at one year following isolated traumatic brain injury: a Western Trauma Association prospective multicenter trial. J. Trauma 59, 1298–1304 - PubMed
    1. Susman M., DiRusso S.M., Sullivan T., Risucci D., Nealon P., Cuff S., Haider A., and Benzil D. (2002). Traumatic brain injury in the elderly: increased mortality and worse functional outcome at discharge despite lower injury severity. J. Trauma 53, 219–224 - PubMed
    1. Utomo W.K., Gabbe B.J., Simpson P.M., and Cameron P.A. (2009). Predictors of in-hospital mortality and 6-month functional outcomes in older adults after moderate to severe traumatic brain injury. Injury 40, 973–977 - PubMed
    1. Selassie A.W., Zaloshnja E., Langlois J.A., Miller T., Jones P., and Steiner C. (2008). Incidence of long-term disability following traumatic brain injury hospitalization, United States, 2003. J. Head Trauma Rehabil. 23, 123–131 - PubMed

Publication types

MeSH terms

Substances

LinkOut - more resources