Research Reports - Axis I psychiatric disorders in the first 5 years following moderate to severe traumatic brain injury

Psychol Med. 2016 Apr;46(6):1331-41. doi: 10.1017/S0033291715002986. Epub 2016
Feb 12.

Alway Y(1), Gould KR(1), Johnston L(2), McKenzie D(3), Ponsford J(1).

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. 

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