Self-assessment of impairment, impaired self-awareness, and depression after traumatic brain injury.
OBJECTIVE
To identify patient features associated with early and late depression after traumatic brain injury (TBI).


METHODS
3 clinical trauma groups (mild TBI, moderate-severe TBI, orthopedic injury) and their significant others.


METHODS
Preinjury: age, education, substance abuse, and psychiatric history; Injury severity: classification using Glasgow Coma Scale and cranial CT scan, posttraumatic amnesia; Early impairment: Neurobehavioral Functioning Inventory (NFI), Impaired Self-Awareness (ISA); Social and family support: Multidimensional Scale of Perceived Social Support, Family Assessment Device; Depression: NFI Depression Scale.


METHODS
Regression analyses of predictor variables on early and late measures of depression.


RESULTS
Depression rates did not differ among the 3 trauma groups. Preinjury level of education, previous psychiatric history, and perceived level of social support explained a small portion of the variance in depressive symptoms. Patients' self-assessment of their impairment at discharge was most strongly correlated with both early and late depression. ISA was associated with reduced self-report of depressive symptoms. However, when those with ISA were excluded from the analysis, self-assessment of impairment remained strongly associated with depression.


CONCLUSIONS
Patients' self-assessment of impairment is strongly associated with early and late depression. Presence and severity of TBI does not appear to play a direct role in depression but does appear related to ISA, which serves as a barrier to the development of depression. Focusing on impairment appears to be a cardinal feature of depression in both patients with TBI and an orthopedic trauma group.
Malec
James F
JF
Department of Psychiatry & Psychology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA. malec.james@mayo.edu
Testa
Julie A
JA
Rush
Beth K
BK
Brown
Allen W
AW
Moessner
Anne M
AM
D000328:Adult; D000367:Age Factors; D000647:Amnesia / Q000523:psychology; D001930:Brain Injuries / Q000145:classification / Q000523:psychology*; D003863:Depression / Q000523:psychology*; D004522:Educational Status; D005195:Family Relations; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000523:psychology; D012649:Self Concept; D012647:Self-Assessment; D012944:Social Support; D019966:Substance-Related Disorders / Q000523:psychology; D013997:Time Factors; D014057:Tomography, X-Ray Computed