Heterogeneity in Temporal Ordering of Depression and Participation After Traumatic Brain Injury

Amanda R. Rabinowitz, Inna Chervoneva, Tessa Hart, Therese M. O'Neil-Pirozzi, Shannon B. Juengst, Jeanne M. Hoffman

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


Objective: To examine heterogeneity in the temporal patterns of depression and participation over the first 2 years post traumatic brain injury (TBI). Design: Observational prospective longitudinal study. Setting: Inpatient rehabilitation centers, with 1- and 2-year follow-up conducted primarily by telephone. Participants: Persons with TBI (N=2307) enrolled in the Traumatic Brain Injury Model Systems database, followed at 1 and 2 years post injury. Interventions: Not applicable. Main Outcome Measure: Patient Health Questionnaire-9 (PHQ-9) and Participation Assessment With Recombined Tools–Objective (PART-O). Results: Using latent class modeling we examined heterogeneity in the longitudinal relationship between PHQ-9 and PART-O. The identified 6 classes were most distinct in terms of (1) level of PHQ-9 score and (2) association between the year 1 PART-O score and year 2 PHQ-9 score. For most participants, PART-O at year 1 predicted PHQ-9 at year 2 more than the reverse. However, there was a subgroup of participants that demonstrated the reverse pattern, PHQ-9 predicting later PART-O, who were on average, older and in the “other” employment category. Conclusions: Results suggest that links between participation and depression are stronger for some people living with TBI than for others and that variation in the temporal sequencing of these 2 constructs is associated with demographic characteristics. These findings illustrate the value in accounting for population heterogeneity when evaluating temporal among outcome domains.

Original languageEnglish (US)
Pages (from-to)1973-1979
Number of pages7
JournalArchives of physical medicine and rehabilitation
Issue number11
StatePublished - Nov 2020


  • Brain injuries
  • Depression
  • Latent class analysis
  • Mental health
  • Rehabilitation

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation


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