Citation

Hart T, Benn EK, Bagiella E, Arenth PM, Dikmen S, Hesdorffer DC, Novack TA, Ricker J, Zafonte RD. J. Neurotrauma 2014; 31(7): 610-617.

Affiliation

Moss Rehabilitation Research Institute, Elkins Park, Pennsylvania, United States ; THART@einstein.edu.

Copyright

(Copyright © 2014, Mary Ann Liebert Publishers)

DOI

10.1089/neu.2013.3041

PMID

24237113

Abstract

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.

Language: en