Citation

Fann JR, Bombardier CH, Vannoy S, Dyer J, Ludman E, Dikmen S, Marshall K, Barber J, Temkin N. J. Neurotrauma 2014; 32(1): 45-57.

Affiliation

University of Washington, Psychiatry & Behavioral Sciences , Box 356560 , 1959 NE Pacific Street , Seattle, Washington, United States , 98195-6560 , 206-685-4280 , 206-221-5414 ; fann@u.washington.edu.

Copyright

(Copyright © 2014, Mary Ann Liebert Publishers)

DOI

10.1089/neu.2014.3423

PMID

25072405

Abstract

Major depressive disorder (MDD) is prevalent after TBI, yet there is a lack of evidence regarding effective treatment approaches. We conducted a choice-stratified randomized controlled trial in 100 adults with MDD within 10 years of complicated mild to severe TBI to test the effectiveness of brief cognitive behavioral therapy administered over the telephone (CBT-T, n=40) or in-person (CBT-IP, n=18), compared to usual care (UC, n=42). Participants were recruited from clinical and community settings throughout the United States. The main outcomes were change in depression severity on the clinician-rated 17-item Hamilton Depression Rating Scale (HAMD-17) and the patient-reported Symptom Checklist-20 (SCL-20) over 16 weeks. There was no significant difference between the combined CBT and UC groups over 16 weeks on the HAMD-17 (Treatment effect=1.2, 95% CI: -1.5 to 4.0; P=0.37) and a non-significant trend favoring CBT on the SCL-20 (Treatment effect= 0.28, 95% CI: -0.03 to 0.59; P=0.074). In follow-up comparisons, the CBT-T group had significantly greater improvement on the SCL-20 compared to the UC group (Treatment effect= 0.36, 95% CI: 0.01 to 0.70; P=0.043) and completers of >8 CBT sessions had significantly improved SCL-20 scores compared to the UC group (Treatment effect = 0.43, 95% CI: 0.10 to 0.76; P=0.011). CBT participants reported significantly greater symptom improvement (P=0.010) and greater satisfaction with depression care (P<0.001), compared to UC. In-person and telephone administered CBT are acceptable and feasible in persons with TBI. Although further research is warranted, telephone CBT holds particular promise for enhancing access and adherence to effective depression treatment.

Language: en