Research Reports - Depression trajectories during the first year after traumatic brain injury

J Neurotrauma. 2016 May 6. [Epub ahead of print]

Bombardier CH(1), Hoekstra T(2), Dikmen S(1), Fann JR(3).

Major depression is prevalent after traumatic brain injury (TBI) and associated
with poor outcomes. Little is known about the course of depression after TBI.
Participants were 559 consecutively admitted patients with mild to severe TBI
recruited from inpatient units at Harborview Medical Center, a Level I trauma
center in Seattle, WA. Participants were assessed with the Patient Health
Questionnaire-9 (PHQ-9) depression measure at months 1-6, 8, 10, and 12
post-injury. We used linear latent class growth mixture modeling (LCGMM) of PHQ-9
total scores to identify homogeneous subgroups with distinct longitudinal
trajectories. A four-class LCGMM had good fit indices and clinical
interpretability. Trajectory groups were: low depression (70.1%), delayed
depression (13.2%), depression recovery (10.4%), and persistent depression
(6.3%). Multinomial logistic regression analyses were used to distinguish
trajectory classes based on baseline demographic, psychiatric history, and
clinical variables. Relative to the low depression group, the other three groups
were consistently more likely to have a pre-injury history of other mental health
disorders or major depressive disorder, a positive toxicology screen for cocaine
or amphetamines at the time of injury, and a history of alcohol dependence. They
were less likely to be on Medicare versus commercial insurance. Trajectories
based on LCGMM are an empirical and clinically meaningful way to characterize
distinct courses of depression after TBI. When combined with baseline predictors,
this line of research may improve our ability to predict prognosis and target
groups who may benefit from treatment or secondary prevention efforts (e.g.,
proactive telephone counseling). 

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