Rates of major depressive disorder and clinical outcomes following traumatic brain injury

Abstract

Context: Uncertainties exist about the rates, predictors, and outcomes of major depressive disorder (MDD) among individuals with traumatic brain injury (TBI).

Objective: To describe MDD-related rates, predictors, outcomes, and treatment during the first year after TBI.

Design: Cohort from June 2001 through March 2005 followed up by structured telephone interviews at months 1 through 6, 8, 10, and 12 (data collection ending February 2006).

Setting: Harborview Medical Center, a level I trauma center in Seattle, Washington.

Participants: Five hundred fifty-nine consecutively hospitalized adults with complicated mild to severe TBI.

Main outcome measures: The Patient Health Questionnaire (PHQ) depression and anxiety modules were administered at each assessment and the European Quality of Life measure was given at 12 months.

Results: Two hundred ninety-seven of 559 patients (53.1%) met criteria for MDD at least once in the follow-up period. Point prevalences ranged between 31% at 1 month and 21% at 6 months. In a multivariate model, risk of MDD after TBI was associated with MDD at the time of injury (risk ratio [RR], 1.62; 95% confidence interval [CI], 1.37-1.91), history of MDD prior to injury (but not at the time of injury) (RR, 1.54; 95% CI, 1.31-1.82), age (RR, 0.61; 95% CI, 0.44-0.83 for > or = 60 years vs 18-29 years), and lifetime alcohol dependence (RR, 1.34; 95% CI, 1.14-1.57). Those with MDD were more likely to report comorbid anxiety disorders after TBI than those without MDD (60% vs 7%; RR, 8.77; 95% CI, 5.56-13.83). Only 44% of those with MDD received antidepressants or counseling. After adjusting for predictors of MDD, persons with MDD reported lower quality of life at 1 year compared with the nondepressed group.

Conclusions: Among a cohort of patients hospitalized for TBI, 53.1% met criteria for MDD during the first year after TBI. Major depressive disorder was associated with history of MDD and was an independent predictor of poorer health-related quality of life.

Figure 1

Subject Flow Note: At each assessment time, the fraction interviewed is the number interviewed divided by 559 minus the number for which an interview was not attempted.

Figure 2

The rate and cumulative rate of major depression depending on time since TBI Note: These values may underestimate the true rates because not all participants were assessed at each time

Figure 3

Cumulative rate of major depression after TBI as a function of pre-injury depression history Note: There were significant differences in depression rates between groups as shown in Table 1