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.
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.
Authors: Richard A Bryant; Angela Nickerson; Mark Creamer; Meaghan O'Donnell; David Forbes; Isaac Galatzer-Levy; Alexander C McFarlane; Derrick Silove Journal: Br J Psychiatry Date: 2015-02-05 Impact factor: 9.319
Authors: S Vuletic; K R Bell; S Jain; N Bush; N Temkin; J R Fann; K E Stanfill; S Dikmen; J A Brockway; F He; K Ernstrom; R Raman; G Grant; M B Stein; G A Gahm Journal: J Head Trauma Rehabil Date: 2016 Mar-Apr Impact factor: 2.710
Authors: Katherine E Porter; Murray B Stein; Brian Martis; Kimberly M Avallone; Lauren B McSweeney; Erin R Smith; Naomi M Simon; Sean Gargan; Israel Liberzon; Charles W Hoge; Sheila A M Rauch Journal: J Psychiatr Res Date: 2018-03-10 Impact factor: 4.791
Authors: Jody L Manners; Robert D Forsten; Russ S Kotwal; R J Elbin; Michael W Collins; Anthony P Kontos Journal: J Neurotrauma Date: 2016-03-30 Impact factor: 5.269
Authors: John K Yue; Mary J Vassar; Hester F Lingsma; Shelly R Cooper; David O Okonkwo; Alex B Valadka; Wayne A Gordon; Andrew I R Maas; Pratik Mukherjee; Esther L Yuh; Ava M Puccio; David M Schnyer; Geoffrey T Manley Journal: J Neurotrauma Date: 2013-09-24 Impact factor: 5.269
Authors: Richard A Bryant; Meaghan L O'Donnell; Mark Creamer; Alexander C McFarlane; C Richard Clark; Derrick Silove Journal: Am J Psychiatry Date: 2010-01-04 Impact factor: 18.112
Authors: Karen Schwab; Heidi P Terrio; Lisa A Brenner; Renee M Pazdan; Henry P McMillan; Margaret MacDonald; Sidney R Hinds; Ann I Scher Journal: Neurology Date: 2017-03-17 Impact factor: 9.910
Authors: Gary B Kaplan; Kimberly A Leite-Morris; Lei Wang; Kendra K Rumbika; Stephen C Heinrichs; Xiang Zeng; Liquan Wu; Danielle T Arena; Yang D Teng Journal: J Neurotrauma Date: 2017-11-03 Impact factor: 5.269
Authors: John K Yue; Harvey S Levin; Catherine G Suen; Molly Rose Morrissey; Sarah J Runyon; Ethan A Winkler; Ross C Puffer; Hansen Deng; Caitlin K Robinson; Jonathan W Rick; Ryan R L Phelps; Sourabh Sharma; Sabrina R Taylor; Mary J Vassar; Maryse C Cnossen; Hester F Lingsma; Raquel C Gardner; Nancy R Temkin; Jason Barber; Sureyya S Dikmen; Esther L Yuh; Pratik Mukherjee; Murray B Stein; Tene A Cage; Alex B Valadka; David O Okonkwo; Geoffrey T Manley Journal: Neurol Res Date: 2019-04-21 Impact factor: 2.448
Authors: Natalie Kreitzer; Sonia Jain; Jacob S Young; Xiaoying Sun; Murray B Stein; Michael A McCrea; Harvey S Levin; Joseph T Giacino; Amy J Markowitz; Geoffrey T Manley; Lindsay D Nelson Journal: J Neurotrauma Date: 2021-10-18 Impact factor: 5.269
Authors: Guido I Guberman; Marie-Pier Robitaille; Peter Larm; Alain Ptito; Frank Vitaro; Richard E Tremblay; Sheilagh Hodgins Journal: Can J Psychiatry Date: 2019-10-17 Impact factor: 4.356
Authors: Paul MacMullin; Nathaniel Hodgson; Ugur Damar; Henry Hing Cheong Lee; Mustafa Q Hameed; Sameer C Dhamne; Damon Hyde; Grace M Conley; Nicholas Morriss; Jianhua Qiu; Rebekah Mannix; Takao K Hensch; Alexander Rotenberg Journal: Cereb Cortex Date: 2020-11-03 Impact factor: 5.357