Risk of Depression after Traumatic Brain Injury in a Large National Sample

J Neurotrauma. 2019 Jan 15;36(2):300-307. doi: 10.1089/neu.2017.5608. Epub 2018 Aug 10.


Depression is associated with poorer recovery after traumatic brain injury (TBI), yet awareness of depression risk post-TBI among providers and patients is low. The aim of this study was to estimate risk of depression post-TBI among adults 18 years of age and older and to identify risk factors associated with developing depression post-TBI. We conducted a retrospective, matched cohort study using claims data for privately insured and Medicare Advantage enrollees in a large U.S. health plan. Adults ≥18 years of age diagnosed with TBI (n = 207,354) with 12 months continuous insurance coverage pre-TBI and 24 months post-TBI were matched to controls without TBI (n = 414,708). We identified the presence of depression on any in- or outpatient claim occurring during the study period (both before and after TBI). Of the initial 622,062 individuals, 62,963 (10%) had depression pre-TBI and were excluded from incidence calculations. Incidence of depression post-TBI was 79.5 (95% confidence interval [CI], 78.5,80.5) per 1,000 person-years compared to 33.5 (95% CI, 33.1,34.0) per 1,000 person-years for those without TBI. The adjusted hazard ratio for depression post-TBI was 1.83 (95% CI, 1.79,1.86). We observed effect modification by sex and age, with males and older adults at increased risk. History of neuropsychiatric disturbances pre-TBI was the strongest predictor of depression post-TBI. Risk of depression increases substantially post-TBI. Groups at increased risk include those with a history of neuropsychiatric disturbances, older adults, and men. This study highlights the importance of long-term monitoring for depression post-TBI.

Keywords: depression; epidemiology; traumatic brain injury.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Brain Injuries, Traumatic / complications*
  • Brain Injuries, Traumatic / psychology*
  • Depression / epidemiology*
  • Depression / etiology*
  • Female
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Retrospective Studies
  • Risk Factors
  • United States