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Abstract

Introduction: Depression after traumatic injury is poorly studied and may contribute to prolonged recovery. The purpose of this study was to determine risk factors for post-traumatic depression. Methods: A prospective, cohort study was performed evaluating depression among trauma patients admitted to a Level I, Trauma Center from June 2005 to February 2011. Eligibility criteria for the study included age >18 years of age, length of stay > 72 hours, and ability and willingness to complete the Beck Depression Inventory (BDI) [i.e., English language and adequate Glasgow Coma Score (GCS)]. Patients with a BDI score > 21 were considered "depressed" and were referred for psychological assistance. Multivariate logistic regression analysis was performed with statistical significance set at p<0.05. Results: A 608 patient convenience sample was screened during the study period. Two hundred eleven patients (depressed=43, non-depressed=168) were able to complete the BDI and had demographic data. Demographics, GCS, mechanism of injury, intensive care unit stay, hospital length of stay, and discharge disposition were similar between groups; however depressed patients tended to be younger (p=0.039), have a prior history of antidepressant use (p=0.027), and a lower Injury Severity Score (ISS) (p=0.002). Additionally, multivariable logistic regression confirmed that these variables were independently associated with depression. Conclusions: Prior history of antidepressants is highly associated with depression after trauma. While not surprising, attention to resuming home antidepressants and providing this population with psychological support is necessary. The finding that younger age is related to higher depression rates among trauma patients is unexpected and may relate to lower resilience in this population. Finally, the finding that lower ISS is related to higher depression rates may be related to selection bias. Further study to identify risk factors and assess benefits of early depression therapy is warranted.