Abstract
Depression and anxiety are common following traumatic brain injury (TBI). Understanding their prevalence and interplay within the first year after TBI with differing severities may improve patients’ outcomes after TBI. Individuals with a clinical diagnosis of TBI recruited for the large European collaborative longitudinal study CENTER-TBI were screened for patient-reported major depression (MD) and generalized anxiety disorder (GAD) at three, six, and twelve months post-injury (N = 1683). Data were analyzed using autoregressive cross-lagged models. Sociodemographic, premorbid and injury-related factors were examined as risk factors. 14.1–15.5% of TBI patients reported moderate to severe MD at three to twelve months after TBI, 7.9–9.5% reported GAD. Depression and anxiety after TBI presented high within-domain persistency and cross-domain concurrent associations. MD at three months post-TBI had a significant impact on GAD at six months post-TBI, while both acted bidirectionally at six to twelve months post-TBI. Being more severely disabled, having experienced major extracranial injuries, an intensive care unit stay, and being female were risk factors for more severe MD and GAD. Major trauma and the level of consciousness after TBI were additionally associated with more severe MD, whereas being younger was related to more severe GAD. Individuals after TBI should be screened and treated for MD and GAD early on, as both psychiatric disturbances are highly persistent and bi-directional in their impact. More severely disabled patients are particularly vulnerable, and thus warrant timely screening and intensive follow-up treatment.
Highlights
Worldwide, more than 50 million people experience a traumatic brain injury (TBI)every year, and it is estimated that about half the world’s population will suffer at least one TBI over their lifetime [1]
Based on a large European collaborative longitudinal study of patients with a clinical diagnosis of TBI, our findings provide new insights into the understanding of the longitudinal development and interplay of major depression (MD) and generalized anxiety disorder (GAD) over the first year after TBI
Our results indicate that patient-reported MD and GAD are highly persistent and correlated after TBI
Summary
More than 50 million people experience a traumatic brain injury (TBI)every year, and it is estimated that about half the world’s population will suffer at least one TBI over their lifetime [1]. Depression and anxiety are the most frequently observed mental health disorders after TBI [2,3,4]. Some plausible explanations of the emergence of post-injury depression and anxiety include the fear of higher mortality rate [5], heightened stress reactivity and enhanced fear sensitivity [6], disruption of neural circuits [7], and post-traumatic changes of neurotransmitters in the brain [8]. A large meta-analysis reported that 27% of patients were clinically diagnosed with depression following TBI and 38% of clinically significant levels of depression assessed with patient-reported outcome measures (PROMs) [9]. TBI were diagnosed with a generalized anxiety disorder (GAD) and 37% reported clinically significant levels of anxiety according to PROMs [10]. The neglect and undertreatment of such psychiatric problems is reported to hamper patients’ recovery, interfere with their mental health [11], and elevate the risk of a long-term chronic health condition [12], poorer social functioning [13], lower quality of life [14,15], and increased health-care costs [16]
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