Trajectories and Predictors of Anxiety Over a Ten-year Duration after Traumatic Brain Injury: A TBIMS Study

Abstract

<h3>Research Objectives</h3> To determine anxiety trajectories across the first 10 years after traumatic brain injury (TBI), and to identify predictors of the longitudinal course of anxiety. <h3>Design</h3> Longitudinal cohort study. <h3>Setting</h3> Community. <h3>Participants</h3> 2836 participants with moderate to severe TBI enrolled in the Traumatic Brain Injury Model Systems (TBIMS) National Database who had anxiety outcomes for ≥2 data collection points over a 10-year follow-up period. <h3>Interventions</h3> N/A. <h3>Main Outcome Measures</h3> Generalized Anxiety Disorder-7 (GAD-7) at 1, 2, 5, and 10-year follow-ups. Relationships were examined with demographic variables, indicators of TBI severity, number of TBIs in addition to the index TBI, pre-morbid mental health, and substance abuse history. <h3>Results</h3> A latent class mixed model identified three anxiety trajectories: low-stable (n=2195), increasing (n=289), and decreasing (n=352). Higher GAD-7 scores were significantly associated with Black race, having public insurance, premorbid mental health problems, experiencing ≥2 additional TBIs with loss of consciousness (LOC), and increased years post-TBI. An interaction between follow-up year and age was also related to GAD-7 scores (p=.001). <h3>Conclusions</h3> Most individuals in the sample had low anxiety that was stable over time (77%). Smaller percentages of individuals had higher levels of anxiety, that either increased (10%) or decreased (13%) as time progressed. Multiple TBI's with LOC were related to greater anxiety up to 10 years after injury. Systemic economic and racial inequities likely contribute to long-term anxiety, as evidenced by greater anxiety in those who had public insurance and/or identified as Black. Younger individuals were more likely to experience an increase in their anxiety over time, suggesting a need for long-term anxiety surveillance, particularly for patients whose TBI occurred at an earlier stage in life. <h3>Author(s) Disclosures</h3> None.