Citation

Albrecht JS, Kiptanui Z, Tsang Y, Khokhar B, Smith G, Zuckerman I, Simoni-Wastila L. J. Neurotrauma 2014; 32(16): 1223-1229.

Affiliation

Univeristy of Maryland, Epidemiology and Public Health, Baltimore, Maryland, United States ; jalbrecht@epi.umaryland.edu.

Copyright

(Copyright © 2014, Mary Ann Liebert Publishers)

DOI

10.1089/neu.2014.3651

PMID

25526613

Abstract

There are no clinical guidelines addressing the treatment of depression following traumatic brain injury (TBI). The objectives of this study were to 1) describe depression treatment patterns among Medicare beneficiaries newly diagnosed with depression post-TBI; 2) compare them to depression treatment patterns among beneficiaries diagnosed with depression pre-TBI; and 3) quantify the difference in prevalence of use. We conducted a retrospective analysis of Medicare beneficiaries hospitalized with TBI during 2006-2010. We created two cohorts: beneficiaries newly diagnosed with depression pre-TBI (n=4,841) and beneficiaries newly diagnosed with depression post-TBI (n=4,668). We searched for antidepressant medications in Medicare Part D drug event files and created variables indicating antidepressant use in each 30-day period following diagnosis of depression. We used provider specialty and current procedural terminology to identify psychotherapy in any location. We used generalized estimating equations to quantify the effect of TBI on receipt of depression treatment during the year following diagnosis of depression. Average monthly prevalence of antidepressant use was 42% among beneficiaries diagnosed with depression pre-TBI and 36% among those diagnosed post-TBI (p<0.001). Beneficiaries diagnosed with depression post-TBI were less likely to receive antidepressants compared to those diagnosed with depression pre-TBI (adjusted odds ratio (OR) 0.87 (95% confidence interval (CI) 0.82, 0.92). There was no difference in receipt of psychotherapy between the two groups (OR 1.08; 95% CI 0.93, 1.26). Depression following TBI is undertreated among older adults. Knowledge about reasons for this disparity and its long-term effects on post-TBI outcomes is limited and should be examined in future work.

Language: en