Research Reports - Depression following traumatic brain injury: Impact on post-hospital residential rehabilitation outcomes
NeuroRehabilitation. 2017 Feb 8. doi: 10.3233/NRE-161427. [Epub ahead of print]
Lewis FD(1), Horn GJ(2).
BACKGROUND: A need exists to better understand the impact of depression on
functional outcomes following TBI.
OBJECTIVES: To evaluate the prevalence and severity of depression among a large
group of chronic TBI adults; to determine the impact of depression on outcomes of
post-hospital residential rehabilitation programs; and to assess effectiveness of
post-hospital residential rehabilitation programs in treating depression.
METHODS: 820 adults with moderate to severe traumatic brain injury (TBI) were
assigned to one of four groups based on MPAI- 4 depression ratings: (1) Not
Depressed, (2) Mildly Depressed, (3) Moderately Depressed, and (4) Severely
Depressed. Functional status was assessed at admission and discharge with the
MPAI-4 Participation Index. Differences among groups were evaluated using
conventional parametric tests. Rasch analysis established reliability and
validity of MPAI-4 data.
RESULTS: Rasch analysis demonstrated satisfactory construct validity and internal
consistency (Person reliability = 0.89-0.92, Item reliability = 0.99). Of the 820
subjects, 39% presented with moderate to severe depressive symptoms at admission,
These subjects demonstrated significantly higher MPAI-4 Participation scores than
the mild and not depressed groups. Depressed groups realized significant
improvement in symptoms, but, those remaining depressed at discharge had
significantly greater disability than those who improved.
CONCLUSIONS: Depressive symptoms had a deleterious impact on outcome. Remediation
of symptoms during rehabilitation significantly improved outcomes.