TY - JOUR
T1 - Relations Among Suicidal Ideation, Depressive Symptoms, and Functional Independence During the 10 Years After Traumatic Brain Injury
T2 - A Model Systems Study
AU - Perrin, Paul B.
AU - Klyce, Daniel W.
AU - Fisher, Lauren B.
AU - Juengst, Shannon B.
AU - Hammond, Flora M.
AU - Gary, Kelli W.
AU - Niemeier, Janet P.
AU - Bergquist, Thomas F.
AU - Bombardier, Charles H.
AU - Rabinowitz, Amanda R.
AU - Zafonte, Ross D.
AU - Wagner, Amy K.
N1 - Funding Information:
Supported by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR): Virginia Commonwealth University TBI Model System (#90DPTB0005); Spaulding/Harvard TBI Model System (#90DPTB0011); Indiana University TBI Model System (#90DRTB0002); North Texas TBI Model System (#90DPTB0013); Mayo Clinic TBI Model System (#90DPTB0012); Moss TBI Model System (#90DPTB0004); University of Washington TBI Model System(#90DPTB0008); and University of Alabama TBI Model System (#90DPTB0015), a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this publication do not necessarily represent the policy of NIDILRR, ACL, HHS, and you should not assume endorsement by the Federal Government. The TBI Model Systems National Database is a multicenter study of the TBI Model Systems Centers Program and is supported by NIDILRR of the US Department of Human Services. However, these contents do not necessarily reflect the opinions or views of the TBI Model Systems Centers, NIDILRR, or the US Department of Human Services.
Funding Information:
The TBI Model Systems National Database is a multicenter study of the TBI Model Systems Centers Program and is supported by NIDILRR of the US Department of Human Services. However, these contents do not necessarily reflect the opinions or views of the TBI Model Systems Centers, NIDILRR, or the US Department of Human Services.
Funding Information:
Supported by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR): Virginia Commonwealth University TBI Model System (#90DPTB0005); Spaulding/Harvard TBI Model System (#90DPTB0011); Indiana University TBI Model System (#90DRTB0002); North Texas TBI Model System (#90DPTB0013); Mayo Clinic TBI Model System (#90DPTB0012); Moss TBI Model System (#90DPTB0004); University of Washington TBI Model System(#90DPTB0008); and University of Alabama TBI Model System (#90DPTB0015), a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this publication do not necessarily represent the policy of NIDILRR, ACL, HHS, and you should not assume endorsement by the Federal Government.
Publisher Copyright:
© 2021
PY - 2022/1
Y1 - 2022/1
N2 - Objective: To investigate relative causality in relations among suicidal ideation (SI), depressive symptoms, and functional independence over the first 10 years after traumatic brain injury (TBI). Design: Prospective longitudinal design with data collected through the Traumatic Brain Injury Model Systems (TBIMS) network at acute rehabilitation hospitalization as well as 1, 2, 5, and 10 years after injury. Setting: United States Level I/II trauma centers and inpatient rehabilitation centers with telephone follow-up. Participants: Individuals enrolled into the TBIMS National Database (N=9539) with at least 1 SI score at any follow-up data collection (72.1% male; mean age, 39.39y). Interventions: Not applicable. Main Outcome Measures: Patient Health Questionnaire-9 and FIM at years 1, 2, 5, and 10 post injury. Results: A cross-lagged panel structural equation model, which is meant to indirectly infer causality through longitudinal correlational data, suggested that SI, depressive symptoms, and functional independence each significantly predicted themselves over time. Within the model, bivariate correlations among variables were all significant within each time point. Between years 1 and 2 and between years 2 and 5, depressive symptoms had a larger effect on SI than SI had on depressive symptoms. Between years 5 and 10, there was reciprocal causality between the 2 variables. Functional independence more strongly predicted depressive symptoms than the reverse between years 1 and 2 as well as years 2 and 5, but its unique effects on SI over time were extremely marginal or absent after controlling for depressive symptoms. Conclusions: A primary goal for rehabilitation and mental health providers should be to monitor and address elevated symptoms of depression as quickly as possible before they translate into SI, particularly for individuals with TBI who have reduced functional independence. Doing so may be a key to breaking the connection between low functional independence and SI.
AB - Objective: To investigate relative causality in relations among suicidal ideation (SI), depressive symptoms, and functional independence over the first 10 years after traumatic brain injury (TBI). Design: Prospective longitudinal design with data collected through the Traumatic Brain Injury Model Systems (TBIMS) network at acute rehabilitation hospitalization as well as 1, 2, 5, and 10 years after injury. Setting: United States Level I/II trauma centers and inpatient rehabilitation centers with telephone follow-up. Participants: Individuals enrolled into the TBIMS National Database (N=9539) with at least 1 SI score at any follow-up data collection (72.1% male; mean age, 39.39y). Interventions: Not applicable. Main Outcome Measures: Patient Health Questionnaire-9 and FIM at years 1, 2, 5, and 10 post injury. Results: A cross-lagged panel structural equation model, which is meant to indirectly infer causality through longitudinal correlational data, suggested that SI, depressive symptoms, and functional independence each significantly predicted themselves over time. Within the model, bivariate correlations among variables were all significant within each time point. Between years 1 and 2 and between years 2 and 5, depressive symptoms had a larger effect on SI than SI had on depressive symptoms. Between years 5 and 10, there was reciprocal causality between the 2 variables. Functional independence more strongly predicted depressive symptoms than the reverse between years 1 and 2 as well as years 2 and 5, but its unique effects on SI over time were extremely marginal or absent after controlling for depressive symptoms. Conclusions: A primary goal for rehabilitation and mental health providers should be to monitor and address elevated symptoms of depression as quickly as possible before they translate into SI, particularly for individuals with TBI who have reduced functional independence. Doing so may be a key to breaking the connection between low functional independence and SI.
KW - Brain injuries, traumatic
KW - Depression
KW - Functional status
KW - Rehabilitation
KW - Suicidal ideation
UR - http://www.scopus.com/inward/record.url?scp=85115126445&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85115126445&partnerID=8YFLogxK
U2 - 10.1016/j.apmr.2021.07.790
DO - 10.1016/j.apmr.2021.07.790
M3 - Article
C2 - 34364849
AN - SCOPUS:85115126445
SN - 0003-9993
VL - 103
SP - 69
EP - 74
JO - Archives of Physical Medicine and Rehabilitation
JF - Archives of Physical Medicine and Rehabilitation
IS - 1
ER -