Research Reports - Depression among older adults after traumatic brain injury

Am J Geriatr Psychiatry. 2015 Jun;23(6):607-14

Albrecht JS(1), Kiptanui Z(2), Tsang Y(2), Khokhar B(2), Liu X(3), Simoni-Wastila
L(2), Zuckerman IH(4)

OBJECTIVE: Sequelae of traumatic brain injury (TBI) include depression, which
could exacerbate the poorer cognitive and functional recovery experienced by
older adults. The objective of this study was to estimate incidence rates of
depression after hospital discharge for TBI among Medicare beneficiaries aged at
least 65 years, quantify the increase in risk of depression after TBI, and
evaluate risk factors for incident depression post-TBI.
METHODS: Using a retrospective analysis, the authors studied Medicare
beneficiaries at least 65 years old hospitalized for TBI during 2006 to 2010 who
survived to hospital discharge and had no documented diagnosis of depression
before the study period (N = 67,347).
RESULTS: The annualized incidence rate of depression per 1,000 beneficiaries was
62.8 (95% confidence interval [CI]: 61.6, 64.1) pre-TBI and 123.9 (95% CI: 121.6,
126.2) post-TBI. Annualized incidence rates were highest immediately after
hospital discharge and declined over the 12 months post-TBI. TBI increased the
risk of incident depression in men (hazard ratio: 1.95; 95% CI: 1.84, 2.06; Wald
χ(2) = 511.4, df = 1, p <0.001) and in women (hazard ratio: 1.69; 95% CI: 1.62,
1.77; Wald χ(2) = 589.3, df = 1, p <0.001). The strongest predictor of depression
post-TBI for both men and women was discharge to a skilled nursing facility (men:
odds ratio, 1.91; 95% CI, 1.77, 2.06; Wald χ(2) = 277.1, df = 1, p <0.001; women:
odds ratio, 1.72; 95% CI, 1.63, 1.83; Wald χ(2) = 324.2, df = 1, p <0.001).
CONCLUSION: TBI significantly increased the risk of depression among older
adults, especially among men and those discharged to a skilled nursing facility.
Results from this study will help increase awareness of the risk of depression
post-TBI among older adults.

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