Poster 55: Self-Assessment of Impairment, Impaired Self-Awareness, and Depression After Traumatic Brain Injury

Abstract

Objective: To identify patient features that are associated with early and late depression after traumatic brain injury (TBI). Design: Multiple regression analyses of data from an inception cohort. Setting: Inpatient and outpatient medical and rehabilitation facility. Participants: Cohort of 3 clinical trauma groups (mild TBI, moderate to severe TBI, orthopedic injury) and their significant others. Interventions: Not applicable. Main Outcome Measures: Preinjury: age, education, substance abuse, and psychiatric history; injury severity: classification using the Glasgow Coma Scale and cranial computed tomography scan; posttraumatic amnesia; early impairment: Neurobehavioral Functioning Inventory (NFI); impaired self-awareness; social and family support: Multidimensional Scale of Perceived Social Support, Family Assessment Device; and depression: NFI depression scale. Regression analyses of predictor variables on early and late measures of depression. Results: Depression rates did not differ among the 3 trauma groups. Preinjury level of education, previous psychiatric history, and perceived level of social support explained a small portion of the variance on depressive symptoms. Patients’ self-assessment of their impairment at discharge correlated most strongly with both early and late depression. Impaired self-awareness was associated with reduced self-report of depressive symptoms. However, when those with impaired self-awareness were excluded from the analysis, self-assessment of impairment remained strongly associated with depression. Conclusions: Patients’ assessment of their own overall impairment was strongly associated with early and late depression. Presence and severity of TBI does not appear to play a direct role in depression but does appear related to impaired self-awareness, which serves as a barrier to the development of depression. Focusing on impairment appears to be a cardinal feature of depression in both patients with TBI and a non-neurologic orthopedic trauma group.