Evaluation of the Neurobehavioral Functioning Inventory as a depression screening tool after traumatic brain injury.
OBJECTIVE
To examine the utility of the Neurobehavioral Functioning Inventory (NFI) for diagnosing depression in a rehabilitation setting.


METHODS
In a prospective study, a structured clinical interview (Structured Clinical Interview for DSM-IV-TR) was used to identify DSM-IV-defined major depressive disorder (MDD) symptoms among patients with traumatic brain injury (TBI). NFI Depression scale items were compared with DSM-IV diagnosis obtained by the Structured Clinical Interview for DSM-IV Axis I Disorders.


METHODS
Outpatient neuropsychology clinic at a university hospital, private outpatient physical medicine and rehabilitation clinic, and a long-term specialized living assistance program.


METHODS
Participants consisted of 78 patients with TBI who were at least 3 months postinjury and 18 years of age or older.


METHODS
Structured Clinical Interview for DSM-IV Axis I Disorders and the NFI.


RESULTS
Psychiatric diagnostic interview with the Structured Clinical Interview for DSM-IV Axis I Disorders indicated that 50% of patients with TBI in our sample had at least one of the following in their lifetime: MDD, MDD due to general medical condition, dysthymia, or adjustment disorder with depressed mood. Thirty percent met diagnostic criteria for current MDD with or without general medical condition. Analyses of the NFI items revealed that individuals with depression endorsed greater levels of problems than did those without depression on 14 of the 32 items related to the DSM-IV symptom domains for depression (P < .00156 with Bonferroni correction). In predicting the diagnosis of depression using individual NFI items, the classification rate based on the Random Forests estimate was 83%.


CONCLUSIONS
Findings indicate that the NFI items differentiated between depressed and nondepressed patients with TBI. Imposing minimal burden on patients and staff, the NFI appears to have good predictive value in diagnosing major depression. In clinical practice and research, the NFI is a potentially valuable screening tool for identifying major depression in persons with TBI.
Kennedy
Richard E
RE
Department of Psychiatry, Virginia Commonwealth University, Richmond 23298, USA. rkennedy@vcu.edu
Livingston
Lee
L
Riddick
Amy
A
Marwitz
Jennifer H
JH
Kreutzer
Jeffrey S
JS
Zasler
Nathan D
ND
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000704:Analysis of Variance; D001930:Brain Injuries / Q000150:complications* / Q000175:diagnosis; D015331:Cohort Studies; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology* / Q000209:etiology / Q000534:rehabilitation; D005260:Female; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale; D006801:Humans; D015601:Injury Severity Score; D007406:Interview, Psychological; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis* / Q000209:etiology / Q000534:rehabilitation; D008875:Middle Aged; D009483:Neuropsychological Tests; D011336:Probability; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D017678:Sex Distribution