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Observational Study
. 2025 Jan 15;28(1):e301181.
doi: 10.1136/bmjment-2024-301181.

Prognostic models for depression and post-traumatic stress disorder symptoms following traumatic brain injury: a CENTER-TBI study

Ana Mikolić  1   2 , David van Klaveren  3 , Mathilde Jost  3 , Andrew Ir Maas  4   5 , Shuyuan Shi  2 , Noah D Silverberg  2   6 , Lindsay Wilson  7 , Hester F Lingsma  3 , Ewout W Steyerberg  8 ; CENTER-TBI Participants and Investigators
Collaborators, Affiliations
Observational Study

Prognostic models for depression and post-traumatic stress disorder symptoms following traumatic brain injury: a CENTER-TBI study

Ana Mikolić et al. BMJ Ment Health. .

Abstract

Background: Traumatic brain injury (TBI) is associated with an increased risk of major depressive disorder (MDD) and post-traumatic stress disorder (PTSD). We aimed to identify predictors and develop models for the prediction of depression and PTSD symptoms at 6 months post-TBI.

Methods: We analysed data from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury study. We used linear regression to model the relationship between predictors and depression (Patient Health Questionnaire-9) and PTSD symptoms (PTSD Checklist for Diagnostic and Statistical Manual for Mental Health Disorders Fifth Edition). Predictors were selected based on Akaike's Information Criterion. Additionally, we fitted logistic models for the endpoints 'probable MDD' and 'probable PTSD'. We also examined the incremental prognostic value of 2-3 weeks of symptoms.

Results: We included 2163 adults (76% Glasgow Coma Scale=13-15). Depending on the scoring criteria, 7-18% screened positive for probable MDD and about 10% for probable PTSD. For both outcomes, the selected models included psychiatric history, employment status, sex, injury cause, alcohol intoxication and total injury severity; and for depression symptoms also preinjury health and education. The performance of the models was modest (proportion of explained variance=R2 8% and 7% for depression and PTSD, respectively). Symptoms assessed at 2-3 weeks had a large incremental prognostic value (delta R2=0.25, 95% CI 0.24 to 0.26 for depression symptoms; delta R2=0.30, 95% CI 0.29 to 0.31 for PTSD).

Conclusion: Preinjury characteristics, such as psychiatric history and unemployment, and injury characteristics, such as violent injury cause, can increase the risk of mental health problems after TBI. The identification of patients at risk should be guided by early screening of mental health.

Keywords: Adult psychiatry; Data Interpretation, Statistical; Depression.

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Conflict of interest statement

Competing interests: AMikolić reports the University of British Columbia Institute of Mental Health Marshall Fellows Program Postdoctoral fellowship. NDS reports grants from the Canadian Institutes of Health Research, Canadian Foundation for Innovation, Ontario Brain Institute, Weston Brain Institute, Heart and Stroke Foundation of Canada, MITACS, VGH+UBC Hospital Foundation and WorkSafeBC; clinical consulting fees from the National Hockey League and Major League Soccer, and speakers fees from NYU Langone, WorkSafeBC, Yukon Workers’ Safety and Compensation Board, International Academy of Independent Medical Examiners and Canadian Concussion Network. AMaas declares personal fees from NeuroTrauma Sciences and Novartis and participation on the DSMB of PresSura Neuro. LW reports consulting fees for Neurotrauma Sciences, Novartis and Mass General Brigham. ES reports royalties for text book with Springer: Clinical Prediction Models.

Figures

Figure 1
Figure 1. Prediction of depression and post-traumatic stress disorder symptoms: selection of predictors based on the Akaike information criterion for the pooled residual χ2. Selected predictors are indicated with black circles. Predictors selected for both outcomes are shown with larger circles. GCS, Glasgow Coma Score; ISS, Injury Severity Score; LOC, loss of consciousness; PTA, post-traumatic amnesia; PTSD, post-traumatic stress disorder; RGA, retrograde amnesia; TBI, traumatic brain injury.
See this image and copyright information in PMC

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