Axis I psychopathology in individuals with traumatic brain injury.
OBJECTIVE
To assess the incidence, comorbidity, and patterns of resolution of DSM-IV mood, anxiety, and substance use disorders in individuals with traumatic brain injury (TBI).


METHODS
The Structured Clinical Interview for DSM-IV Diagnoses (SCID) was utilized. Diagnoses were determined for three onset points relative to TBI onset: pre-TBI, post-TBI, and current diagnosis. Contrasts of prevalence rates with community-based samples, as well as chi-square analysis and analysis of variance were used. Demographics considered in analyses included gender, marital status, severity of injury, and years since TBI onset.


METHODS
Urban, suburban, and rural New York state.


METHODS
100 adults with TBI who were between the ages of 18 and 65 years and who were, on average, 8 years post onset at time of interview.


METHODS
SCID Axis I mood diagnoses of major depression, dysthymia, and bipolar disorder; anxiety diagnoses of panic disorder, obsessive-compulsive disorder (OCD), posttraumatic stress disorder (PTSD), generalized anxiety disorder (GAD), and phobia; and substance use disorders.


RESULTS
Prior to TBI, a significant percentage of individuals presented with substance use disorders. After TBI, the most frequent Axis I diagnoses were major depression and select anxiety disorders (ie, PTSD, OCD, and panic disorder). Comorbidity was high, with 44% of individuals presenting with two or more Axis I diagnoses post TBI. Individuals without a pre-TBI Axis I disorder were more likely to develop post-TBI major depression and substance use disorders. Rates of resolution were similar for individuals regardless of previous psychiatric histories. Major depression and substance use disorders were more likely than were anxiety disorders to remit.


CONCLUSIONS
TBI is a risk factor for subsequent psychiatric disabilities. The need for proactive psychiatric assessment and timely interventions in individuals post TBI is indicated.
Hibbard
M R
MR
Department of Rehabilitation Medicine, The Mount Sinai Medical Center, New York, New York 10029, USA.
Uysal
S
S
Kepler
K
K
Bogdany
J
J
Silver
J
J
D000328:Adult; D000368:Aged; D001008:Anxiety Disorders / Q000209:etiology*; D001930:Brain Injuries / Q000150:complications / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000209:etiology*; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000209:etiology*