title: Traumatic brain injury and affective disorder: A nationwide cohort study in Taiwan, 2000-2010.
abstract: BACKGROUND
  Studies investigating the relationship between head injury and the subsequent onset of affective disorders often show conflicting results.
  
  
  OBJECTIVE
  To investigate the risk of affective disorders following traumatic brain injury in a large Taiwanese cohort.
  
  
  METHODS
  This retrospective cohort study makes use of the National Health Insurance Research Database. A cohort containing 68,376 individuals who experienced traumatic brain injury (TBI) during 2000-2010 and had no prior history of mental disorders before the injury was identified. Using Cox Proportional Hazards regression, the subsequent risk of affective disorders was determined.
  
  
  RESULTS
  TBI was associated with a higher risk of both bipolar disorder (Hazard Ratio [HR]=1.42, 95% Confidence Interval [CI]=[1.26, 1.59]) and major depression (HR=1.41, 95% CI=[1.28, 1.54]). More severe injury was associated with greater risk. The first year following the injury was the highest risk period for major depression, while the highest risk period for bipolar disorder was delayed until two to four years following the injury.
  
  
  CONCLUSIONS
  Using a claims database, we were unable to assess confounding variables that were not contained in the data set.
  
  
  CONCLUSIONS
  The elevated risks of affective disorders after TBI speak to the psychiatric need of individuals who suffer from brain injury. Early detection and timely intervention may help prevent secondary and tertiary disability associated with head trauma.
authors.affiliation: Department of Education & Research, Taipei City Hospital, Taipei City, Taiwan; Department of Information Management, University of Kang Ning, Taipei City, Taiwan.
authors.forename: Ying-Chen
authors.initials: YC
authors.lastname: Chi
authors.affiliation: National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan.
authors.forename: Hyun-Ling
authors.initials: HL
authors.lastname: Wu
authors.affiliation: Taipei City Psychiatric Center, Taipei City Hospital, Taipei City, Taiwan.
authors.forename: Chih-Pang
authors.initials: CP
authors.lastname: Chu
authors.affiliation: Taipei City Psychiatric Center, Taipei City Hospital, Taipei City, Taiwan; Department of Psychiatry, School of Medicine, Taipei Medical University, Taipei City, Taiwan.
authors.forename: Ming-Chyi
authors.initials: MC
authors.lastname: Huang
authors.affiliation: National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan. Electronic address: pcl0807@gmail.com.
authors.forename: Pei-Chen
authors.initials: PC
authors.lastname: Lee
authors.affiliation: Taipei City Psychiatric Center, Taipei City Hospital, Taipei City, Taiwan; Institute of Public Health and Department of Public Health, National Yang-Ming University, Taipei City, Taiwan. Electronic address: ychen@tpech.gov.tw.
authors.forename: Ying-Yeh
authors.initials: YY
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D001714:Bipolar Disorder / Q000453:epidemiology*; D001930:Brain Injuries / Q000453:epidemiology*; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult
keywords: Affective disorders; Bipolar disorder; Major depression; Taiwan; Traumatic brain injury