title: A preliminary model for posttraumatic brain injury depression.
abstract: OBJECTIVE
  To develop, based on previous research, and evaluate a model for depression after traumatic brain injury (TBI).
  
  
  METHODS
  Cross-sectional structural equation modeling (SEM) of data from consecutively recruited patients.
  
  
  METHODS
  Acute hospital and inpatient rehabilitation units.
  
  
  METHODS
  Adult patients (N=158) after hospital admission for moderate to severe TBI.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  External appraisal of ability in participants was measured by the Mayo-Portland Adaptability Inventory (MPAI-4) Ability Index completed by a TBI clinical nurse specialist. Patient self-appraisal of post-TBI ability and depression were measured by the Awareness Questionnaire and Beck Depression Inventory-II. Functional outcome 1 year after injury was assessed with the MPAI-4 Participation Index.
  
  
  RESULTS
  Successive SEM resulted in a parsimonious model with excellent fit. Consistent with prior research, a moderately strong association between self-appraisal of post-TBI ability and depression was found. Injury severity, as measured by the duration of posttraumatic amnesia (PTA), was not significantly associated with post-TBI depression. The 1-year functional outcome was associated with depression and TBI severity.
  
  
  CONCLUSIONS
  The strong association between self-appraisal of post-TBI ability and depression is consistent with the cognitive-behavioral model of depression and recommends consideration and further study of cognitive-behavioral therapy for post-TBI depression. The lack of association between TBI severity and depression may represent the indirect and proxy nature of current measures of TBI severity such as PTA. Emerging neuroimaging techniques (eg, diffusion tensor imaging, magnetic resonance imaging spectroscopy) may provide the more direct measures of disruption of brain function after TBI that are needed to advance this line of research.
authors.affiliation: Rehabilitation Hospital of Indiana, Indianapolis, IN 46077, USA. jmalec@rhin.com
authors.forename: James F
authors.initials: JF
authors.lastname: Malec
authors.forename: Allen W
authors.initials: AW
authors.lastname: Brown
authors.forename: Anne M
authors.initials: AM
authors.lastname: Moessner
authors.forename: Timothy E
authors.initials: TE
authors.lastname: Stump
authors.forename: Patrick
authors.initials: P
authors.lastname: Monahan
mesh_terms: D000328:Adult; D000368:Aged; D001364:Awareness; D001930:Brain Injuries / Q000150:complications* / Q000534:rehabilitation*; D003430:Cross-Sectional Studies; D003625:Data Collection; D003863:Depression / Q000209:etiology* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015599:Trauma Severity Indices