Research Reports - Early trajectory of psychiatric symptoms after traumatic brain injury

J Neurotrauma. 2013 Nov 17

Hart T, Benn EK, Bagiella E, Arenth PM, Dikmen S Ph D, Hesdorffer DC, Novack TA, Ricker J, Zafonte R

Psychiatric disturbance is common and disabling after traumatic brain injury
(TBI). Few studies have investigated the trajectory of psychiatric symptoms in
the first 6 months post injury, when monitoring and early treatment might prevent
persistent difficulties. The objective of this study was to examine the
trajectory of psychiatric symptoms 1-6 months post TBI, the patient/ injury
characteristics associated with changes, and characteristics predictive of
persisting symptoms. A secondary analysis was performed on data from a clinical
trial with 3 data collection points. Across 8 centers, 872 participants with
complicated-mild to severe TBI were administered the Brief Symptom Inventory
(BSI) at 30, 90, and 180 days post injury. Mixed effects models were used to
assess longitudinal changes in the BSI Global Severity Index (GSI). Multivariate
logistic regression was used to assess predictors of clinically significant GSI
elevations persisting to 6 months post TBI. In general, GSI scores improved over
time. Women improved faster than men; race/ ethnicity was also significantly
associated with rate of change, with Hispanics showing the most and African
Americans the least improvement. Clinically significant psychiatric symptoms
(caseness) occurred in 42% of the sample at 6 months, and >1 type of symptom was
common. Significant predictors of caseness included African American race, age
from 30-60 years, longer post-traumatic amnesia (PTA) duration, pre-TBI
unemployment, and pre-TBI risky alcohol use. Findings indicate that psychiatric
symptoms are common in the first 6 months post TBI and frequently extend beyond
the depression and anxiety symptoms that may be most commonly screened. Patients
with longer PTA and pre-injury alcohol misuse may need more intensive monitoring
for symptom persistence.

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