TY - JOUR
T1 - Risk of Posttraumatic Stress Disorder and Major Depression in Civilian Patients after Mild Traumatic Brain Injury
T2 - A TRACK-TBI Study
AU - Stein, Murray B.
AU - Jain, Sonia
AU - Giacino, Joseph T.
AU - Levin, Harvey
AU - Dikmen, Sureyya
AU - Nelson, Lindsay D.
AU - Vassar, Mary J.
AU - Okonkwo, David O.
AU - Diaz-Arrastia, Ramon
AU - Robertson, Claudia S.
AU - Mukherjee, Pratik
AU - McCrea, Michael
AU - Mac Donald, Christine L.
AU - Yue, John K.
AU - Yuh, Esther
AU - Sun, Xiaoying
AU - Campbell-Sills, Laura
AU - Temkin, Nancy
AU - Manley, Geoffrey T.
AU - Adeoye, Opeolu
AU - Badjatia, Neeraj
AU - Boase, Kim
AU - Bodien, Yelena
AU - Bullock, M. Ross
AU - Chesnut, Randall
AU - Corrigan, John D.
AU - Crawford, Karen
AU - Duhaime, Ann Christine
AU - Ellenbogen, Richard
AU - Feeser, V. Ramana
AU - Ferguson, Adam
AU - Foreman, Brandon
AU - Gardner, Raquel
AU - Gaudette, Etienne
AU - Gonzalez, Luis
AU - Gopinath, Shankar
AU - Gullapalli, Rao
AU - Hemphill, J. Claude
AU - Hotz, Gillian
AU - Korley, Frederick
AU - Kramer, Joel
AU - Kreitzer, Natalie
AU - Lindsell, Chris
AU - Machamer, Joan
AU - Madden, Christopher
AU - Martin, Alastair
AU - McAllister, Thomas
AU - Merchant, Randall
AU - Noel, Florence
AU - Palacios, Eva
AU - Perl, Daniel
AU - Puccio, Ava
AU - Rabinowitz, Miri
AU - Rosand, Jonathan
AU - Sander, Angelle
AU - Satris, Gabriela
AU - Schnyer, David
AU - Seabury, Seth
AU - Sherer, Mark
AU - Taylor, Sabrina
AU - Toga, Arthur
AU - Valadka, Alex
AU - Vespa, Paul
AU - Wang, Kevin
AU - Zafonte, Ross
N1 - Publisher Copyright:
© 2019 American Medical Association. All rights reserved.
PY - 2019/3
Y1 - 2019/3
N2 - Importance: Traumatic brain injury (TBI) has been associated with adverse mental health outcomes, such as posttraumatic stress disorder (PTSD) and major depressive disorder (MDD), but little is known about factors that modify risk for these psychiatric sequelae, particularly in the civilian sector. Objective: To ascertain prevalence of and risk factors for PTSD and MDD among patients evaluated in the emergency department for mild TBI (mTBI). Design, Setting, and Participants: Prospective longitudinal cohort study (February 2014 to May 2018). Posttraumatic stress disorder and MDD symptoms were assessed using the PTSD Checklist for DSM-5 and the Patient Health Questionnaire-9 Item. Risk factors evaluated included preinjury and injury characteristics. Propensity score weights-adjusted multivariable logistic regression models were performed to assess associations with PTSD and MDD. A total of 1155 patients with mTBI (Glasgow Coma Scale score, 13-15) and 230 patients with nonhead orthopedic trauma injuries 17 years and older seen in 11 US hospitals with level 1 trauma centers were included in this study. Main Outcomes and Measures: Probable PTSD (PTSD Checklist for DSM-5 score, ≥33) and MDD (Patient Health Questionnaire-9 Item score, ≥15) at 3, 6, and 12 months postinjury. Results: Participants were 1155 patients (752 men [65.1%]; mean [SD] age, 40.5 [17.2] years) with mTBI and 230 patients (155 men [67.4%]; mean [SD] age, 40.4 [15.6] years) with nonhead orthopedic trauma injuries. Weights-adjusted prevalence of PTSD and/or MDD in the mTBI vs orthopedic trauma comparison groups at 3 months was 20.0% (SE, 1.4%) vs 8.7% (SE, 2.2%) (P <.001) and at 6 months was 21.2% (SE, 1.5%) vs 12.1% (SE, 3.2%) (P =.03). Risk factors for probable PTSD at 6 months after mTBI included less education (adjusted odds ratio, 0.89; 95% CI, 0.82-0.97 per year), being black (adjusted odds ratio, 5.11; 95% CI, 2.89-9.05), self-reported psychiatric history (adjusted odds ratio, 3.57; 95% CI, 2.09-6.09), and injury resulting from assault or other violence (adjusted odds ratio, 3.43; 95% CI, 1.56-7.54). Risk factors for probable MDD after mTBI were similar with the exception that cause of injury was not associated with increased risk. Conclusions and Relevance: After mTBI, some individuals, on the basis of education, race/ethnicity, history of mental health problems, and cause of injury were at substantially increased risk of PTSD and/or MDD. These findings should influence recognition of at-risk individuals and inform efforts at surveillance, follow-up, and intervention..
AB - Importance: Traumatic brain injury (TBI) has been associated with adverse mental health outcomes, such as posttraumatic stress disorder (PTSD) and major depressive disorder (MDD), but little is known about factors that modify risk for these psychiatric sequelae, particularly in the civilian sector. Objective: To ascertain prevalence of and risk factors for PTSD and MDD among patients evaluated in the emergency department for mild TBI (mTBI). Design, Setting, and Participants: Prospective longitudinal cohort study (February 2014 to May 2018). Posttraumatic stress disorder and MDD symptoms were assessed using the PTSD Checklist for DSM-5 and the Patient Health Questionnaire-9 Item. Risk factors evaluated included preinjury and injury characteristics. Propensity score weights-adjusted multivariable logistic regression models were performed to assess associations with PTSD and MDD. A total of 1155 patients with mTBI (Glasgow Coma Scale score, 13-15) and 230 patients with nonhead orthopedic trauma injuries 17 years and older seen in 11 US hospitals with level 1 trauma centers were included in this study. Main Outcomes and Measures: Probable PTSD (PTSD Checklist for DSM-5 score, ≥33) and MDD (Patient Health Questionnaire-9 Item score, ≥15) at 3, 6, and 12 months postinjury. Results: Participants were 1155 patients (752 men [65.1%]; mean [SD] age, 40.5 [17.2] years) with mTBI and 230 patients (155 men [67.4%]; mean [SD] age, 40.4 [15.6] years) with nonhead orthopedic trauma injuries. Weights-adjusted prevalence of PTSD and/or MDD in the mTBI vs orthopedic trauma comparison groups at 3 months was 20.0% (SE, 1.4%) vs 8.7% (SE, 2.2%) (P <.001) and at 6 months was 21.2% (SE, 1.5%) vs 12.1% (SE, 3.2%) (P =.03). Risk factors for probable PTSD at 6 months after mTBI included less education (adjusted odds ratio, 0.89; 95% CI, 0.82-0.97 per year), being black (adjusted odds ratio, 5.11; 95% CI, 2.89-9.05), self-reported psychiatric history (adjusted odds ratio, 3.57; 95% CI, 2.09-6.09), and injury resulting from assault or other violence (adjusted odds ratio, 3.43; 95% CI, 1.56-7.54). Risk factors for probable MDD after mTBI were similar with the exception that cause of injury was not associated with increased risk. Conclusions and Relevance: After mTBI, some individuals, on the basis of education, race/ethnicity, history of mental health problems, and cause of injury were at substantially increased risk of PTSD and/or MDD. These findings should influence recognition of at-risk individuals and inform efforts at surveillance, follow-up, and intervention..
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U2 - 10.1001/jamapsychiatry.2018.4288
DO - 10.1001/jamapsychiatry.2018.4288
M3 - Article
C2 - 30698636
AN - SCOPUS:85061011263
SN - 2168-622X
VL - 76
SP - 249
EP - 258
JO - JAMA Psychiatry
JF - JAMA Psychiatry
IS - 3
ER -