Pharmacologic Treatment for Depression at Injury Is Associated With Fewer Clinician Visits for Persistent Symptoms After Mild Traumatic Brain Injury: A Medical Record Review Study

Abstract

BackgroundDepression and traumatic brain injury (TBI) substantially contribute to the U.S. health care burden. Depression is a known risk factor for prolonged recovery after TBI. However, the effect of depression treatment on health care utilization has yet to be studied. ObjectiveTo examine whether an association exists between pharmacologic treatment of depression at the time of mild or concussive TBI and the number of subsequent clinician visits for persistent injury-related symptoms. DesignRetrospective medical record review. SettingTertiary care medical center. ParticipantsA total of 120 patients (mean age 45.6 years) with a history of depression who subsequently experienced a mild or concussive TBI were included. MethodsIndividuals were identified with co-occurring diagnoses of depression and mild or concussive TBI by retrospective electronic medical record review. The diagnosis of depression must have preceded the diagnosis of TBI. Main OutcomeThe number of clinician visits for postinjury symptoms were counted at 3, 6, and 12 months postinjury. ResultsClinician visits for persistent injury-related symptoms were significantly fewer at all 3 time points for the group treated for depression at time of injury. ConclusionsDepressed individuals who were pharmacologically treated for depression at the time of TBI had significantly fewer clinician visits for persistent postinjury symptoms than those not pharmacologically treated for depression at the time of injury. Routine depression screening in patients with a high risk for TBI may identify a mood disorder that could contribute to persistent symptoms if left untreated, with its effective management potentially reducing health-related costs. Level of EvidenceIII