title: Comorbidity of pain and depression among persons with traumatic brain injury.
abstract: OBJECTIVE
  To assess the prevalence of pain, depression, and comorbid pain and depression among a civilian sample of persons with traumatic brain injury (TBI).
  
  
  METHODS
  Longitudinal survey design with 1-year follow-up.
  
  
  METHODS
  Inpatient rehabilitation and the community.
  
  
  METHODS
  Participants (N=158) admitted to inpatient rehabilitation after moderate to severe TBI.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Depression was assessed with the Patient Health Questionnaire-9 (PHQ-9); pain was assessed with a numerical rating scale from 0 (no pain) to 10 (worst pain). Participants who reported average pain ≥ 4 were classified as having pain, and participants with PHQ-9 scores ≥ 10 were classified as depressed.
  
  
  RESULTS
  Both pain and depression were more prevalent at baseline assessment (pain: 70%; depression: 31%) than at year 1 (pain: 34%; depression: 22%). Comorbid pain and depression declined from 27% at baseline to 18% at year 1. Pain was significantly associated with depression at baseline (relative risk: 2.62, P=.003) and at year 1 (relative risk: 7.98, P<.001).
  
  
  CONCLUSIONS
  Pain and depression are common and frequently co-occur in persons with TBI. Although their frequency declined over the first year after injury, the strength of their association increased. Assessment and treatment of both conditions simultaneously may lead to improved outcomes, both early after TBI and over time.
authors.affiliation: Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA. Electronic address: sarahsullivansingh@gmail.com.
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Sullivan-Singh
authors.affiliation: Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Sawyer
authors.affiliation: Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA.
authors.forename: Dawn M
authors.initials: DM
authors.lastname: Ehde
authors.affiliation: Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA.
authors.forename: Kathleen R
authors.initials: KR
authors.lastname: Bell
authors.affiliation: Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA; Department of Neurological Surgery, University of Washington School of Medicine, Seattle, WA; Department of Biostatistics, University of Washington School of Medicine, Seattle, WA.
authors.forename: Nancy
authors.initials: N
authors.lastname: Temkin
authors.affiliation: Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA; Department of Neurological Surgery, University of Washington School of Medicine, Seattle, WA; Department of Psychiatry and Biobehavioral Sciences, University of Washington School of Medicine, Seattle, WA.
authors.forename: Sureyya
authors.initials: S
authors.lastname: Dikmen
authors.affiliation: Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA; Rehabilitation Care Service, Veterans Affairs Puget Sound Healthcare System, Seattle, WA.
authors.forename: Rhonda M
authors.initials: RM
authors.lastname: Williams
authors.affiliation: Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA.
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: Hoffman
mesh_terms: D000328:Adult; D017677:Age Distribution; D001930:Brain Injuries / Q000175:diagnosis / Q000453:epidemiology* / Q000534:rehabilitation; D015897:Comorbidity; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale; D006801:Humans; D015601:Injury Severity Score; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000175:diagnosis / Q000453:epidemiology* / Q000534:rehabilitation*; D015995:Prevalence; D017678:Sex Distribution; D011795:Surveys and Questionnaires; D013997:Time Factors; D055815:Young Adult
keywords: Brain injuries; Depression; Pain; Rehabilitation