Natural history of depression in traumatic brain injury.
OBJECTIVE
To examine prospectively the rates, risk factors, and phenomenology of depression over 3 to 5 years after traumatic brain injury (TBI).


METHODS
Inception cohort longitudinal study.


METHODS
Level I trauma center.


METHODS
Consecutive admissions of 283 adults with moderate to severe TBI.


METHODS
Not applicable.


METHODS
Center for Epidemiologic Studies Depression (CES-D) Scale.


RESULTS
The rates of moderate to severe depression ranged from 31% at 1 month to 17% at 3 to 5 years. With 1 exception, the relation between brain injury severity and depression was negligible. Less than high school education, preinjury unstable work history, and alcohol abuse predicted depression after injury. Examination of CES-D factors indicate that, in addition to somatic symptoms, both depressed affect and lack of positive affect contribute to elevated CES-D scores.


CONCLUSIONS
High rates of depressive symptoms cannot be dismissed on grounds that somatic symptoms related to brain injury are mistaken for depression. Depressed affect and lack of positive affect are also elevated in persons with TBI. Preinjury psychosocial factors are predictive of depression and knowing them should facilitate efforts to detect, prevent, and treat depression after TBI.
Dikmen
Sureyya S
SS
Department of Rehabilitation Medicine, University of Washington, Seattle 98195, USA. dikmen@u.washington.edu
Bombardier
Charles H
CH
Machamer
Joan E
JE
Fann
Jesse R
JR
Temkin
Nancy R
NR
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000009:adverse effects / Q000453:epidemiology; D000704:Analysis of Variance; D001930:Brain Injuries / Q000150:complications* / Q000175:diagnosis / Q000523:psychology; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D018450:Disease Progression; D004522:Educational Status; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D014193:Trauma Centers; D014478:Unemployment / Q000706:statistics & numerical data; D014861:Washington / Q000453:epidemiology