Axis I and II psychiatric disorders after traumatic brain injury: a 30-year follow-up study

Am J Psychiatry. 2002 Aug;159(8):1315-21. doi: 10.1176/appi.ajp.159.8.1315.


Objective: Patients who had suffered traumatic brain injury were evaluated to determine the occurrence of psychiatric disorders during a 30-year follow-up.

Method: Sixty patients were assessed on average 30 years after traumatic brain injury. DSM-IV axis I disorders were diagnosed on a clinical basis with the aid of the Schedules for Clinical Assessment in Neuropsychiatry (version 2.1), and axis II disorders were diagnosed with the Structured Clinical Interview for DSM-III-R Personality Disorders. Cognitive impairment was measured with a neuropsychological test battery and the Mini-Mental State Examination.

Results: Of the 60 patients, 29 (48.3%) had had an axis I disorder that began after traumatic brain injury, and 37 (61.7%) had had an axis I disorder during their lifetimes. The most common novel disorders after traumatic brain injury were major depression (26.7%), alcohol abuse or dependence (11.7%), panic disorder (8.3%), specific phobia (8.3%), and psychotic disorders (6.7%). Fourteen patients (23.3%) had at least one personality disorder. The most prevalent individual disorders were avoidant (15.0%), paranoid (8.3%), and schizoid (6.7%) personality disorders. Nine patients (15.0%) had DSM-III-R organic personality syndrome.

Conclusions: The results suggest that traumatic brain injury may cause decades-lasting vulnerability to psychiatric illness in some individuals. Traumatic brain injury seems to make patients particularly susceptible to depressive episodes, delusional disorder, and personality disturbances. The high rate of psychiatric disorders found in this study emphasizes the importance of psychiatric follow-up after traumatic brain injury.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Brain Injuries / complications*
  • Brain Injuries / diagnosis
  • Cognition Disorders / diagnosis
  • Depressive Disorder / diagnosis
  • Depressive Disorder / epidemiology
  • Depressive Disorder / etiology
  • Female
  • Finland / epidemiology
  • Follow-Up Studies
  • Humans
  • Longitudinal Studies
  • Male
  • Mental Disorders / diagnosis*
  • Mental Disorders / epidemiology
  • Mental Disorders / etiology*
  • Middle Aged
  • Neuropsychological Tests
  • Personality Disorders / diagnosis
  • Personality Disorders / epidemiology
  • Personality Disorders / etiology
  • Psychiatric Status Rating Scales
  • Schizophrenia, Paranoid / diagnosis
  • Schizophrenia, Paranoid / epidemiology
  • Schizophrenia, Paranoid / etiology
  • Severity of Illness Index
  • Trauma Severity Indices