Research Reports - Growth mixture modeling of depression symptoms following traumatic brain injury

Front Psychol. 2017 Aug 22;8:1320. doi: 10.3389/fpsyg.2017.01320. eCollection
2017.

Gomez R(1), Skilbeck C(2), Thomas M(3), Slatyer M(2).

Growth Mixture Modeling (GMM) was used to investigate the longitudinal trajectory
of groups (classes) of depression symptoms, and how these groups were predicted
by the covariates of age, sex, severity, and length of hospitalization following
Traumatic Brain Injury (TBI) in a group of 1074 individuals (696 males, and 378
females) from the Royal Hobart Hospital, who sustained a TBI. The study began in
late December 2003 and recruitment continued until early 2007. Ages ranged from
14 to 90 years, with a mean of 35.96 years (SD = 16.61). The study also examined
the associations between the groups and causes of TBI. Symptoms of depression
were assessed using the Hospital Anxiety and Depression Scale within 3 weeks of
injury, and at 1, 3, 6, 12, and 24 months post-injury. The results revealed three
groups: low, high, and delayed depression. In the low group depression scores
remained below the clinical cut-off at all assessment points during the 24-months
post-TBI, and in the high group, depression scores were above the clinical
cut-off at all assessment points. The delayed group showed an increase in
depression symptoms to 12 months after injury, followed by a return to initial
assessment level during the following 12 months. Covariates were found to be
differentially associated with the three groups. For example, relative to the low
group, the high depression group was associated with more severe TBI, being
female, and a shorter period of hospitalization. The delayed group also had a
shorter period of hospitalization, were younger, and sustained less severe TBI.
Our findings show considerable fluctuation of depression over time, and that a
non-clinical level of depression at any one point in time does not necessarily
mean that the person will continue to have non-clinical levels in the future. As
we used GMM, we were able to show new findings and also bring clarity to
contradictory past findings on depression and TBI. Consequently, we recommend the
use of this approach in future studies in this area. 

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