Psychiatric illness following traumatic brain injury in an adult health maintenance organization population

Arch Gen Psychiatry. 2004 Jan;61(1):53-61. doi: 10.1001/archpsyc.61.1.53.


Background: Psychiatric illness after traumatic brain injury (TBI) has been shown to be prevalent in hospitalized and tertiary care patient populations.

Objective: To determine the risk of psychiatric illness after TBI in an adult health maintenance organization population.

Design: Prospective cohort study.

Setting: Large staff-model health maintenance organization.

Participants: Nine hundred thirty-nine health plan members diagnosed as having TBI in 1993 and enrolled in the prior year, during which no TBI was ascertained. Three health plan members per TBI-exposed subject were randomly selected as unexposed comparisons, matched for age, sex, and reference date.

Main outcome measure: Psychiatric illness in the 3 years after the TBI reference date, determined using computerized records of psychiatric diagnoses according to the International Classification of Diseases, Ninth Revision, Clinical Modification, prescriptions, and service utilization.

Results: Prevalence of any psychiatric illness in the first year was 49% following moderate to severe TBI, 34% following mild TBI, and 18% in the comparison group. Among subjects without psychiatric illness in the prior year, the adjusted relative risk for any psychiatric illness in the 6 months following moderate to severe TBI was 4.0 (95% confidence interval [CI], 2.4-6.8) and following mild TBI was 2.8 (95% CI, 2.1-3.7; P<.001) compared with those without TBI. Among subjects with prior psychiatric illness, the adjusted relative risk for any psychiatric illness in the 6 months following moderate to severe TBI was 2.1 (95% CI, 1.3-3.3) and following mild TBI was 1.6 (95% CI, 1.2-2.0; P =.005). Prior psychiatric illness significantly modified the relationship between TBI and subsequent psychiatric illness (P =.04) and was a significant predictor (P<.001). Persons with mild TBI and prior psychiatric illness had evidence of persisting psychiatric illness.

Conclusions: Both moderate to severe and mild TBI are associated with an increased risk of subsequent psychiatric illness. Whereas moderate to severe TBI is associated with a higher initial risk, mild TBI may be associated with persistent psychiatric illness.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Brain Injuries / complications*
  • Brain Injuries / epidemiology*
  • Brain Injuries / psychology
  • Brain Injury, Chronic / complications
  • Brain Injury, Chronic / epidemiology
  • Brain Injury, Chronic / psychology
  • Causality
  • Cohort Studies
  • Comorbidity
  • Cross-Sectional Studies
  • Female
  • Follow-Up Studies
  • Health Maintenance Organizations / statistics & numerical data
  • Humans
  • Male
  • Mental Disorders / diagnosis
  • Mental Disorders / epidemiology*
  • Mental Disorders / etiology*
  • Mental Disorders / psychology
  • Middle Aged
  • Neurocognitive Disorders / diagnosis
  • Neurocognitive Disorders / epidemiology*
  • Neurocognitive Disorders / etiology*
  • Neurocognitive Disorders / psychology
  • Prospective Studies
  • Reference Values
  • Risk
  • Washington