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. 2019 Mar 1;76(3):249-258.
doi: 10.1001/jamapsychiatry.2018.4288.

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

Murray B Stein  1   2   3 , Sonia Jain  2 , Joseph T Giacino  4   5 , Harvey Levin  6 , Sureyya Dikmen  7 , Lindsay D Nelson  8 , Mary J Vassar  9   10 , David O Okonkwo  11 , Ramon Diaz-Arrastia  12 , Claudia S Robertson  6 , Pratik Mukherjee  9   13   14 , Michael McCrea  8 , Christine L Mac Donald  15 , John K Yue  9 , Esther Yuh  9   13   14 , Xiaoying Sun  2 , Laura Campbell-Sills  1 , Nancy Temkin  15   16 , Geoffrey T Manley  9   10 ; TRACK-TBI Investigators; Opeolu Adeoye  17 , Neeraj Badjatia  18 , Kim Boase  7 , Yelena Bodien  19 , M Ross Bullock  20 , Randall Chesnut  15 , John D Corrigan  21 , Karen Crawford  22 , Ramon Diaz-Arrastia  12 , Sureyya Dikmen  7 , Ann-Christine Duhaime  23 , Richard Ellenbogen  15 , V Ramana Feeser  24 , Adam Ferguson  10 , Brandon Foreman  17 , Raquel Gardner  25 , Etienne Gaudette  22 , Joseph T Giacino  4   5 , Luis Gonzalez  26 , Shankar Gopinath  27 , Rao Gullapalli  18 , J Claude Hemphill  25 , Gillian Hotz  20 , Sonia Jain  2 , Frederick Korley  28 , Joel Kramer  25 , Natalie Kreitzer  17 , Harvey Levin  6 , Chris Lindsell  29 , Joan Machamer  7 , Christopher Madden  30 , Alastair Martin  13 , Thomas McAllister  31 , Michael McCrea  8 , Randall Merchant  32 , Pratik Mukherjee  9   13   14 , Lindsay D Nelson  8 , Florence Noel  33 , David O Okonkwo  11 , Eva Palacios  13 , Daniel Perl  34 , Ava Puccio  11 , Miri Rabinowitz  12 , Claudia S Robertson  6 , Jonathan Rosand  19 , Angelle Sander  6 , Gabriela Satris  9 , David Schnyer  35 , Seth Seabury  22 , Mark Sherer  26 , Murray B Stein  1   2   3 , Sabrina Taylor  10 , Arthur Toga  22 , Nancy Temkin  15   16 , Alex Valadka  36 , Mary J Vassar  9   10 , Paul Vespa  37 , Kevin Wang  38 , John K Yue  9 , Esther Yuh  9   13   14 , Ross Zafonte  4
Affiliations

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

Murray B Stein et al. JAMA Psychiatry. .

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.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Stein has been a consultant for Actelion, Aptinyx, Bionomics, Dart Neuroscience, Healthcare Management Technologies, Janssen, Neurocrine Biosciences, Oxeia Biopharmaceuticals, Pfizer, and Resilience Therapeutics in the past 3 years; owns founders shares and stock options in Resilience Therapeutics; and has stock options in Oxeia Biopharmaceuticals. Dr Manley discloses grants from the US Department of Defense (TBI Endpoints Development Initiative, grant #W81XWH-14-2-0176; TRACK-TBI Precision Medicine, grant #TBD; and TRACK-TBI Network, grant # W81XWH-15-9-0001); a grant from National Institutes of Health–National Institute of Neurological Disorders and Stroke (TRACK-TBI, grant #U01NS086090); reports being on the National Football League (NFL) scientific advisory board; reports support from the US Department of Energy for a traumatic brain injury precision medicine collaboration; has received an unrestricted gift from the NFL to the University of California, San Francisco Foundation to support research efforts of the TRACK-TBI Network; and has also received funding from NeuroTruama Sciences LLC to support TRACK-TBI data curation efforts. Dr Foreman reports speaking fees from UCB Pharma. Dr McAllister reports grants from University of California, San Francisco, during the conduct of the study. Dr Seabury is a consultant for Precision Health Economics, which provides consulting services to pharmaceutical manufacturers and other companies in the life sciences industry; has received research funding through unrestricted gifts to the Schaeffer Center for Health Policy and Economics at the University of Southern California from Alkermes and Verily; reports that partial support for his work is provided through an unrestricted grant to the Department of Ophthalmology from Research to Prevent Blindness; and reports grants from National Institute of Neurological Disorders and Stroke. Dr Vespa reports grants from National Institutes of Health during the conduct of the study. Dr Zafonte received royalties from Oakstone Publishing for an educational CD, “Physical Medicine and Rehabilitation: A Comprehensive Review”; serves on the scientific advisory board of Myomo, Oxeia Biopharmaceuticals, ElMindA, and BioDirection; and evaluates patients in the Massachusetts General Hospital Brain and Body TRUST Program funded by the NFL Players Association and receives funding from the Football Players Health Study at Harvard University, which is funded by the NFL Players Association. No other disclosures were reported.

Figures

Figure.
Figure.. Status of Individual Patients With Mild Traumatic Brain Injury at Each Outcome Assessment Time Point
Data shown are for the 628 patients who completed all outcome assessments. MDD indicates major depressive disorder; PTSD, posttraumatic stress disorder.
See this image and copyright information in PMC

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