Association of remote traumatic brain injury and military employment with late-life trajectories of depressive symptom severity

Abstract

Background: Traumatic brain injury (TBI) and military service are common lifetime exposures among current older adults that may affect late-life mental health. The objective of the present study was to evaluate the association between TBI with loss of consciousness (LOC) and military employment and late-life depressive symptom severity trajectory.

Methods: 1445 males and 2096 females adults at least 65 years old without dementia or recent TBI were enrolled and followed biennially for up to 10 years in the Adult Changes in Thought study from Kaiser Permanente Washington in Seattle, Washington.

Results: Using group-based trajectory modeling, we documented four distinct depressive symptom severity trajectories that followed a similar course in males and females (Minimal, Decreasing, Increasing, and Persistent). In multinomial regression analyses, TBI with LOC in males was associated with greater likelihood of Persistent versus Minimal depressive symptom severity compared to individuals without TBI (OR = 1.51, 95% CI: 1.01, 2.27; p=0.046). Males reporting past military employment had greater likelihood of Decreasing versus Minimal depressive symptom severity compared to individuals without past military employment (OR = 1.54, 95% CI: 1.03, 2.31; p=0.035). There was no association between TBI or military employment and depression trajectories in females, and no evidence of effect modification by age or between exposures.

Limitations: Lifetime history of TBI was ascertained retrospectively and may be subject to recall bias. Also, past military employment does not presuppose combat exposure.

Conclusions: Remote TBI and past military employment are relevant to late-life trajectories of depressive symptom severity in dementia-free older males.

Keywords: Depression; Geriatrics; Military veteran health; Traumatic Brain Injury.

Figure 1.

The study flow diagram of 1445 males and 2096 females included in the analytic cohort.

Figure 2:

The Mean (standard error) of CES-D 10 summary scores over the study period by trajectory group among males. Trajectory groups were developed using IRT-standardized scores, but plotted using CES-D summary scores for interpretation-purposes.

Figure 3:

The Mean (standard error) of CES-D 10 summary scores over the study period by trajectory group among females. Trajectory groups were developed using IRT-standardized scores, but plotted using CES-D summary scores for interpretation-purposes.