Anxiety and Posttraumatic Stress Disorder Among Medicare Beneficiaries After Traumatic Brain Injury

J Head Trauma Rehabil. 2017 May/Jun;32(3):178-184. doi: 10.1097/HTR.0000000000000266.


Objective: To estimate rates of anxiety and posttraumatic stress disorder (PTSD) diagnoses after traumatic brain injury (TBI) among Medicare beneficiaries, quantify the increase in rates relative to the pre-TBI period, and identify risk factors for diagnosis of anxiety and PTSD.

Participants: A total of 96 881 Medicare beneficiaries hospitalized with TBI between June 1, 2006 and May 31, 2010.

Design: Retrospective cohort study.

Measures: Diagnosis of anxiety (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes 300.0x) and/or PTSD (ICD-9-CM code 309.81).

Results: After TBI, 16 519 (17%) beneficiaries were diagnosed with anxiety and 269 (0.3%) were diagnosed with PTSD. Rates of anxiety and PTSD diagnoses were highest in the first 5 months post-TBI and decreased over time. Pre-TBI diagnosis of anxiety disorder was significantly associated with post-TBI anxiety (risk ratio, 3.55; 95% confidence interval, 3.42-3.68) and pre-TBI diagnosis of PTSD was significantly associated with post-TBI PTSD (risk ratio 70.09; 95% confidence interval 56.29-111.12).

Conclusion: This study highlights the increased risk of anxiety and PTSD after TBI. Routine screening for anxiety and PTSD, especially during the first 5 months after TBI, may help clinicians identify these important and treatable conditions, especially among patients with a history of psychiatric illness.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Anxiety Disorders / epidemiology*
  • Anxiety Disorders / etiology
  • Anxiety Disorders / therapy
  • Brain Injuries, Traumatic / complications*
  • Brain Injuries, Traumatic / diagnosis
  • Brain Injuries, Traumatic / rehabilitation
  • Cohort Studies
  • Confidence Intervals
  • Female
  • Geriatric Assessment
  • Hospitalization / economics
  • Hospitalization / statistics & numerical data*
  • Humans
  • Incidence
  • Male
  • Medicare / statistics & numerical data*
  • Middle Aged
  • Odds Ratio
  • Prognosis
  • Retrospective Studies
  • Risk Assessment
  • Severity of Illness Index
  • Stress Disorders, Post-Traumatic / epidemiology*
  • Stress Disorders, Post-Traumatic / etiology
  • Stress Disorders, Post-Traumatic / therapy
  • United States