Hostname: page-component-cd9895bd7-p9bg8 Total loading time: 0 Render date: 2024-12-23T00:08:00.643Z Has data issue: false hasContentIssue false
  • English
  • Français

A prospective examination of Axis I psychiatric disorders in the first 5 years following moderate to severe traumatic brain injury

Published online by Cambridge University Press:  12 February 2016

Y. Alway ,
K. R. Gould ,
L. Johnston ,
D. McKenzie  and
J. Ponsford
Y. Alway*
Affiliation:
School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Australia Monash-Epworth Rehabilitation Research Centre, Epworth Hospital, Melbourne, Australia
K. R. Gould
Affiliation:
School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Australia Monash-Epworth Rehabilitation Research Centre, Epworth Hospital, Melbourne, Australia National Trauma Research Institute, Melbourne, Australia
L. Johnston
Affiliation:
Monash-Epworth Rehabilitation Research Centre, Epworth Hospital, Melbourne, Australia
D. McKenzie
Affiliation:
Research Development and Governance, Epworth Healthcare, Melbourne, Australia School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
J. Ponsford
Affiliation:
School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Australia Monash-Epworth Rehabilitation Research Centre, Epworth Hospital, Melbourne, Australia National Trauma Research Institute, Melbourne, Australia
*
*Address for correspondence: Y. Alway, Monash-Epworth Rehabilitation Research Centre, 185–187 Hoddle Street, Richmond, Victoria 3121, Australia. (Email: [email protected]; [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Psychiatric disorders commonly emerge during the first year following traumatic brain injury (TBI). However, it is not clear whether these disorders soon remit or persist for long periods post-injury. This study aimed to examine, prospectively: (1) the frequency, (2) patterns of co-morbidity, (3) trajectory, and (4) risk factors for psychiatric disorders during the first 5 years following TBI.

Method

Participants were 161 individuals (78.3% male) with moderate (31.2%) or severe (68.8%) TBI. Psychiatric disorders were diagnosed using the Structured Clinical Interview for DSM-IV, administered soon after injury and 3, 6 and 12 months, and 2, 3, 4 and 5 years post-injury. Disorder frequencies and generalized estimating equations were used to identify temporal relationships and risk factors.

Results

In the first 5 years post-injury, 75.2% received a psychiatric diagnosis, commonly emerging within the first year (77.7%). Anxiety, mood and substance-use disorders were the most common diagnostic classes, often presenting co-morbidly. Many (56.5%) experienced a novel diagnostic class not present prior to injury. Disorder frequency ranged between 61.8 and 35.6% over time, decreasing by 27% [odds ratio (OR) 0.73, 95% confidence interval (CI) 0.65–0.83] with each year post-injury. Anxiety disorders declined significantly over time (OR 0.73, 95% CI 0.63–0.84), whilst mood and substance-use disorder rates remained stable. The strongest predictors of post-injury disorder were pre-injury disorder (OR 2.44, 95% CI 1.41–4.25) and accident-related limb injury (OR 1.78, 95% CI 1.03–3.07).

Conclusions

Findings suggest the first year post-injury is a critical period for the emergence of psychiatric disorders. Disorder frequency declines thereafter, with anxiety disorders showing greater resolution than mood and substance-use disorders.

Keywords

Anxietydepressionlongitudinal studiespsychiatric disorderstraumatic brain injury
Type
Original Articles
Information
Psychological Medicine , Volume 46 , Issue 6 , April 2016 , pp. 1331 - 1341
Copyright
Copyright © Cambridge University Press 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision. American Psychiatric Association: Washington, DC.Google Scholar
Ashman, TA, Spielman, LA, Hibbard, MR, Silver, JM, Chandna, T, Gordon, WA (2004). Psychiatric challenges in the first 6 years after traumatic brain injury: cross-sequential analyses of Axis I disorders. Archives of Physical Medicine and Rehabilitation 85, S36–S42.Google Scholar
Australian Bureau of Statistics (2009). National Survey of Mental Health and Wellbeing 2007. Basic CURF, CD-ROM. Findings based on use of Australian Bureau of Statistics (ABS) CURF data, November Re-Issue.Google Scholar
Baxter, AJ, Patton, G, Scott, KM, Degenhardt, L, Whiteford, HA (2013). Global epidemiology of mental disorders: what are we missing? PLOS ONE 8, e65514.Google Scholar
Bombardier, CH, Fann, JR, Temkin, NR, Esselman, PC, Barber, J, Dikmen, SS (2010). Rates of major depressive disorder and clinical outcomes following traumatic brain injury. JAMA: The Journal of the American Medical Association 303, 1938–1945.CrossRefGoogle ScholarPubMed
Bryant, RA, O'Donnell, ML, Creamer, M, McFarlane, AC, Clark, CR, Silove, D (2010). The psychiatric sequelae of traumatic injury. American Journal of Psychiatry 167, 312–320.Google Scholar
Burcusa, SL, Iacono, WG (2007). Risk for recurrence in depression. Clinical Psychology Review 27, 959–985.Google Scholar
Deb, S, Lyons, I, Koutzoukis, C, Ali, I, McCarthy, G (1999). Rate of psychiatric illness 1 year after traumatic brain injury. American Journal of Psychiatry 156, 374–378.Google Scholar
Diaz, AP, Schwarzbold, ML, Thais, ME, Hohl, A, Bertotti, MM, Schmoeller, R, Nunes, JC, Prediger, R, Linhares, MN, Guarnieri, R, Walz, R (2012). Psychiatric disorders and health-related quality of life after severe traumatic brain injury: a prospective study. Journal of Neurotrauma 29, 1029–1037.Google Scholar
Dikmen, SS, Bombardier, CH, Machamer, JE, Fann, JR, Temkin, NR (2004). Natural history of depression in traumatic brain injury. Archives of Physical Medicine and Rehabilitation 85, 1457–1464.CrossRefGoogle ScholarPubMed
Dikmen, SS, Corrigan, JD, Levin, HS, Machamer, J, Stiers, W, Weisskopf, MG (2009). Cognitive outcome following traumatic brain injury. Journal of Head Trauma Rehabilitation 24, 430–438.Google Scholar
Fann, JR, Burington, B, Leonetti, A, Jaffe, K, Katon, WJ, Thompson, RS (2004). Psychiatric illness following traumatic brain injury in an adult health maintenance organization population. Archives of General Psychiatry 61, 53–61.Google Scholar
Fann, JR, Katon, WJ, Uomoto, JM, Esselman, PC (1995). Psychiatric disorders and functional disability in outpatients with traumatic brain injuries. American Journal of Psychiatry 152, 1493–1499.Google Scholar
First, M, Spitzer, R, Gibbon, M, Williams, J (2002). Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Non-Patient Edition (SCID-I/NP) . Biometrics Research, New York State Psychiatric Institute: New York.Google Scholar
Fleiss, JL, Levin, B, Paik, MC (2003). Statistical Methods for Rates and Proportions, 3rd edn. Wiley: New York.CrossRefGoogle Scholar
Gibson, R, Purdy, SC (2015). Mental health disorders after traumatic brain injury in a New Zealand caseload. Brain Injury 29, 306–312.Google Scholar
Gil, S, Caspi, Y, Ben-Ari, IZ, Koren, D, Klein, E (2005). Does memory of a traumatic event increase the risk for posttraumatic stress disorder in patients with traumatic brain injury? A prospective study. American Journal of Psychiatry 162, 963–969.CrossRefGoogle ScholarPubMed
Gould, KR, Ponsford, JL, Johnston, L, Schonberger, M (2011 a). Relationship between psychiatric disorders and 1-year psychosocial outcome following traumatic brain injury. Journal of Head Trauma Rehabilitation 26, 79–89.CrossRefGoogle ScholarPubMed
Gould, KR, Ponsford, JL, Johnston, L, Schönberger, M (2011 b). The nature, frequency and course of psychiatric disorders in the first year after traumatic brain injury: a prospective study. Psychological Medicine 41, 2099–2109.Google Scholar
Gould, KR, Ponsford, JL, Johnston, L, Schönberger, M (2011 c). Predictive and associated factors of psychiatric disorders after traumatic brain injury: a prospective study. Journal of Neurotrauma 28, 1155–1163.CrossRefGoogle ScholarPubMed
Ham, TE, Bonnelle, V, Hellyer, P, Jilka, S, Robertson, IH, Leech, R, Sharp, DJ (2014). The neural basis of impaired self-awareness after traumatic brain injury. Brain 137, 586–597.Google Scholar
Hanley, JA, Negassa, A, Edwardes, MD, Forrester, JE (2003). Statistical analysis of correlated data using generalized estimating equations: an orientation. American Journal of Epidemiology 157, 364–375.CrossRefGoogle Scholar
Hart, T, Hoffman, JM, Pretz, C, Kennedy, R, Clark, AN, Brenner, LA (2012). A longitudinal study of major and minor depression following traumatic brain injury. Archives of Physical Medicine and Rehabilitation 93, 1343–1349.Google Scholar
Hibbard, MR, Uysal, S, Kepler, K, Bogdany, J, Silver, J (1998). Axis I psychopathology in individuals with traumatic brain injury. Journal of Head Trauma Rehabilitation 13, 24–39.CrossRefGoogle ScholarPubMed
Jablensky, A, McGrath, J, Herrman, H, Castle, D, Gureje, O, Evans, M, Carr, V, Morgan, V, Korten, A, Harvey, C (2000). Psychotic disorders in urban areas: an overview of the Study on Low Prevalence Disorders. Australian and New Zealand Journal of Psychiatry 34, 221–236.CrossRefGoogle Scholar
Jorge, RE, Arciniegas, DB (2014). Mood disorders after TBI. Psychiatric Clinics of North America 37, 13–29.Google Scholar
Jorge, RE, Robinson, RG, Moser, D, Tateno, A, Crespo-Facorro, B, Arndt, S (2004). Major depression following traumatic brain injury. Archives of General Psychiatry 61, 42–50.Google Scholar
Jorge, RE, Robinson, RG, Starkstein, SE, Arndt, SV (1993). Depression and anxiety following traumatic brain injury. Journal of Neuropsychiatry and Clinical Neurosciences 5, 369–374.Google Scholar
Jorge, RE, Starkstein, SE, Arndt, S, Moser, D, Crespo-Facorro, B, Robinson, RG (2005). Alcohol misuse and mood disorders following traumatic brain injury. Archives of General Psychiatry 62, 742–749.Google Scholar
Kessler, RC, Berglund, P, Demler, O, Jin, R, Merikangas, KR, Walters, EE (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry 62, 593–602.Google Scholar
Koponen, S, Taiminen, T, Hiekkanen, H, Tenovuo, O (2011). Axis I and II psychiatric disorders in patients with traumatic brain injury: a 12-month follow-up study. Brain Injury 25, 1029–1034.Google Scholar
Koponen, S, Taiminen, T, Portin, R, Himanen, L, Isoniemi, H, Heinonen, H, Hinkka, S, Tenovuo, O (2002). Axis I and II psychiatric disorders after traumatic brain injury: a 30-year follow-up study. American Journal of Psychiatry 159, 1315–1321.Google Scholar
Koskinen, S (1998). Quality of life 10 years after a very severe traumatic brain injury (TBI): the perspective of the injured and the closest relative. Brain Injury 12, 631–648.Google Scholar
Langlois, JA, Rutland-Brown, W, Wald, MM (2006). The epidemiology and impact of traumatic brain injury: a brief overview. Journal of Head Trauma Rehabilitation 21, 375–378.Google Scholar
Levin, HS, Brown, SA, Song, JX, McCauley, SR, Boake, C, Contant, CF, Goodman, H, Kotrla, KJ (2001). Depression and posttraumatic stress disorder at three months after mild to moderate traumatic brain injury. Journal of Clinical and Experimental Neuropsychology 23, 754–769.CrossRefGoogle ScholarPubMed
Mallya, S, Sutherland, J, Pongracic, S, Mainland, B, Ornstein, TJ (2015). The manifestation of anxiety disorders after traumatic brain injury: a review. Journal of Neurotrauma 32, 411–421.Google Scholar
McCauley, SR, Boake, C, Levin, HS, Contant, CF, Song, JX (2001). Postconcussional disorder following mild to moderate traumatic brain injury: anxiety, depression, and social support as risk factors and comorbidities. Journal of Clinical and Experimental Neuropsychology 23, 792–808.Google Scholar
Molloy, C, Conroy, RM, Cotter, DR, Cannon, M (2011). Is traumatic brain injury a risk factor for schizophrenia? A meta-analysis of case-controlled population-based studies. Schizophrenia Bulletin 37, 1104–1110.Google Scholar
Orlovska, S, Pedersen, MS, Benros, ME, Mortensen, PB, Agerbo, E, Nordentoft, M (2014). Head injury as risk factor for psychiatric disorders: a nationwide register-based follow-up study of 113,906 persons with head injury. American Journal of Psychiatry 171, 463–469.CrossRefGoogle ScholarPubMed
Osborn, AJ, Mathias, JL, Fairweather-Schmidt, AK (2014). Depression following adult, non-penetrating traumatic brain injury: a meta-analysis examining methodological variables and sample characteristics. Neuroscience and Biobehavioral Reviews 47, 1–15.Google Scholar
Rao, V, Bertrand, M, Rosenberg, P, Makley, M, Schretlen, DJ, Brandt, J, Mielke, MM (2010). Predictors of new-onset depression after mild traumatic brain injury. Journal of Neuropsychiatry and Clinical Neurosciences 22, 100–104.Google Scholar
Spitzer, RL (1983). Psychiatric diagnosis: are clinicians still necessary? Comprehensive Psychiatry 24, 399–411.Google Scholar
Traumatic Brain Injury Taskforce (2008). Report to the Army Surgeon General: Department of Defence and Department of Veteran Affairs (https://www.hsdl.org/?view&did=482727). Accessed January 2016.Google Scholar
van Reekum, R, Bolago, I, Finlayson, MA, Garner, S, Links, PS (1996). Psychiatric disorders after traumatic brain injury. Brain Injury 10, 319–327.CrossRefGoogle ScholarPubMed
Wei, W, Sambamoorthi, U, Crystal, S, Findley, PA (2005). Mental illness, traumatic brain injury, and Medicaid expenditures. Archives of Physical Medicine and Rehabilitation 86, 905–911.CrossRefGoogle ScholarPubMed
Wells, JE, Browne, MA, Scott, KM, McGee, MA, Baxter, J, Kokaua, J, New Zealand Mental Health Survey Research Team (2006). Prevalence, interference with life and severity of 12 month DSM-IV disorders in Te Rau Hinengaro: the New Zealand Mental Health Survey. Australian and New Zealand Journal of Psychiatry 40, 845–854.Google Scholar
Whelan-Goodinson, R, Ponsford, J, Johnston, L, Grant, F (2009). Psychiatric disorders following traumatic brain injury: their nature and frequency. Journal of Head Trauma Rehabilitation 24, 324–332.Google Scholar
Whelan-Goodinson, R, Ponsford, JL, Schönberger, M, Johnston, L (2010). Predictors of psychiatric disorders following traumatic brain injury. Journal of Head Trauma Rehabilitation 25, 320–329.Google Scholar
Supplementary material: File

Alway supplementary material

Table S1

Download Alway supplementary material(File)
File 47.1 KB
Supplementary material: File

Alway supplementary material

Figure S1 Legend

Download Alway supplementary material(File)
File 26.1 KB
Supplementary material: Image

Alway supplementary material

Figure S1

Download Alway supplementary material(Image)
Image 76.3 KB