Research Reports - Prevalence, risk factors, and correlates of anxiety at one year after traumatic brain injury

Arch Phys Med Rehabil. 2015 Dec 18. pii: S0003-9993(15)01495-1. doi:
10.1016/j.apmr.2015.08.436. [Epub ahead of print]

Hart T(1), Fann JR(2), Chervoneva I(3), Juengst SB(4), Rosenthal JA(5), Krellman
JW(6), Dreer LE(7), Kroenke K(8).

OBJECTIVE: To determine at 1 year post moderate to severe traumatic brain injury
(1) the rate of clinically significant anxiety; (2) rates of specific symptoms of
anxiety; (3) risk factors for anxiety; and (4) associations of anxiety with other
1-year outcomes including participation and quality of life.
DESIGN: Prospective longitudinal observational study.
SETTING: Inpatient rehabilitation centers, with data capture at injury and 1-year
followup.
PARTICIPANTS: 1838 persons with moderate to severe traumatic brain injury who
were enrolled in the Traumatic Brain Injury Model Systems database.
INTERVENTIONS: Not applicable.
MAIN OUTCOME MEASURES: Generalized Anxiety Disorder-7 item scale, Patient Health
Questionnaire-9 item scale of depression, FIM, Participation Assessment with
Recombined Tools-Objective, Satisfaction with Life Scale.
RESULTS: Clinically significant anxiety was reported by 21% of participants. Of
these, more than 80% reported interference with daily activities, with most
common symptoms being excessive worry and irritability. A common pattern was
comorbid anxiety and depression, with smaller proportions reporting either
disorder alone. Anxiety had large effect sizes with respect to life satisfaction
and cognitive disability, and medium to small effects relative to societal
participation and self-care. Middle age, African-American race, lower
socio-economic status, preinjury mental health treatment, and at least 1
traumatic brain injury prior to the index injury were all risk factors for later
anxiety.
CONCLUSIONS: Anxiety should be screened, fully evaluated, and treated after
moderate/ severe TBI. Worry and irritability might be treated with pharmacologic
agents or with relatively simple behavioral interventions, which should be
further researched in this population. 

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