Post-traumatic epilepsy associations with mental health outcomes in the first two years after moderate to severe TBI: A TBI Model Systems analysis

Epilepsy Behav. 2017 Aug:73:240-246. doi: 10.1016/j.yebeh.2017.06.001. Epub 2017 Jun 26.


Purpose: Research suggests that there are reciprocal relationships between mental health (MH) disorders and epilepsy risk. However, MH relationships to post-traumatic epilepsy (PTE) have not been explored. Thus, the objective of this study was to assess associations between PTE and frequency of depression and/or anxiety in a cohort of individuals with moderate-to-severe TBI who received acute inpatient rehabilitation.

Methods: Multivariate regression models were developed using a recent (2010-2012) cohort (n=867 unique participants) from the TBI Model Systems (TBIMS) National Database, a time frame during which self-reported seizures, depression [Patient Health Questionnaire (PHQ)-9], and anxiety [Generalized Anxiety Disorder (GAD-7)] follow-up measures were concurrently collected at year-1 and year-2 after injury.

Results: PTE did not significantly contribute to depression status in either the year-1 or year-2 cohort, nor did it contribute significantly to anxiety status in the year-1 cohort, after controlling for other known depression and anxiety predictors. However, those with PTE in year-2 had 3.34 times the odds (p=.002) of having clinically significant anxiety, even after accounting for other relevant predictors. In this model, participants who self-identified as Black were also more likely to report clinical symptoms of anxiety than those who identified as White. PTE was the only significant predictor of comorbid depression and anxiety at year-2 (Odds Ratio 2.71; p=0.049).

Conclusions: Our data suggest that PTE is associated with MH outcomes 2years after TBI, findings whose significance may reflect reciprocal, biological, psychological, and/or experiential factors contributing to and resulting from both PTE and MH status post-TBI. Future work should consider temporal and reciprocal relationships between PTE and MH as well as if/how treatment of each condition influences biosusceptibility to the other condition.

Keywords: Anxiety; Depression; Mental health disorders; Post-traumatic epilepsy; Traumatic brain injury; Traumatic brain injury model system.

MeSH terms

  • Adult
  • Anxiety / complications*
  • Anxiety / psychology
  • Brain Injuries / complications*
  • Brain Injuries / psychology
  • Cohort Studies
  • Depression / complications*
  • Depression / psychology
  • Epilepsy, Post-Traumatic / complications*
  • Epilepsy, Post-Traumatic / psychology
  • Female
  • Humans
  • Inpatients
  • Male
  • Mental Disorders / complications*
  • Mental Disorders / psychology
  • Mental Health*
  • Middle Aged
  • Self Report
  • Systems Analysis
  • Time Factors
  • Young Adult