Research Reports - The association between psychiatric comorbidities and outcomes for inpatients with traumatic brain injury

J Neurotrauma. 2016 Aug 29. [Epub ahead of print]

Brandel MG(1), Hirshman BR(2,)(3), McCutcheon BA(4), Tringale K(5), Carroll K(6),
Richtand NM(7,)(8), Perry W(9), Chen C(10), Carter B(11).

It is well-established that traumatic brain injury is associated with the
development of psychiatric disorders. However, the impact of psychiatric
disorders on TBI outcome is less well understood. We examined the outcomes of
patients who experienced a traumatic subdural hemorrhage and whether a comorbid
psychiatric disorder was associated with a change in outcome. A retrospective
observational study was performed in the California Office of Statewide Health
Planning and Development (OSHPD) and the Nationwide Inpatient Sample (NIS).
Patients hospitalized for acute subdural hemorrhage were identified using ICD-9
diagnosis codes. Patients with coexisting psychiatric diagnoses were identified.
Outcomes studied included mortality and adverse discharge disposition. In OSPHD,
diagnoses of depression (OR=0.64, p<0.001), bipolar disorder (OR=0.45, p<0.05)
and anxiety (OR=0.37, p<0.001) were associated with reduced mortality during
hospitalization for TBI, with a trend for psychosis (OR=0.56, p=0.08).
Schizophrenia had no effect. Diagnoses of psychosis (OR=2.12, p<0.001) and
schizophrenia (OR=2.60, p<0.001) were associated with increased adverse
discharge. Depression and bipolar disorder had no effect, and anxiety was
associated with reduced adverse discharge (OR=0.73, p=0.01). Results were
confirmed using the NIS. Analysis revealed novel associations between coexisting
psychiatric diagnoses and TBI outcomes, with some subgroups having decreased
mortality and increased adverse discharge. Potential mechanisms include
pharmacological effects of frequently prescribed psychiatric medications, the
pathophysiology of individual psychiatric disorders, or undercoding of
psychiatric illness in the most severely injured patients. Because
pharmacological mechanisms, if validated, might lead to improved outcome in TBI
patients, further studies may provide significant public health benefit. 

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