Research Reports - Early trajectory of psychiatric symptoms after traumatic brain injury: relationship to patient and injury characteristics

J Neurotrauma. 2014 Jan 10

Hart T, Benn EK, Bagiella E, Arenth P, Dikmen S, Hesdorffer DC, Novack TA, Ricker, JH, Zafonte R

Abstract Psychiatric disturbance is common and disabling after traumatic brain
injury (TBI). Few studies have investigated the trajectory of psychiatric
symptoms in the first 6 months postinjury, when monitoring and early treatment
might prevent persistent difficulties. The aim of this study was to examine the
trajectory of psychiatric symptoms 1-6 months post-TBI, the patient/injury
characteristics associated with changes, and characteristics predictive of
persisting symptoms. A secondary analysis was performed on data from a clinical
trial with three data collection points. Across eight centers, 872 participants
with complicated mild to severe TBI were administered the Brief Symptom Inventory
(BSI) at 30, 90, and 180 days postinjury. Mixed-effects models were used to
assess longitudinal changes in the BSI Global Severity Index (GSI). Multi-variate
logistic regression was used to assess predictors of clinically significant GSI
elevations persisting to 6 months post-TBI. In general, GSI scores improved over
time. Women improved faster than men; race/ethnicity was also significantly
associated with rate of change, with Hispanics showing the most and African
Americans the least improvement. Clinically significant psychiatric symptoms
(caseness) occurred in 42% of the sample at 6 months, and more than one type of
symptom was common. Significant predictors of caseness included African American
race, age from 30 to 60 years, longer post-traumatic amnesia (PTA) duration,
pre-TBI unemployment, and pre-TBI risky alcohol use. Findings indicate that
psychiatric symptoms are common in the first 6 months post-TBI and frequently
extend beyond the depression and anxiety symptoms that may be most commonly
screened. Patients with longer PTA and preinjury alcohol misuse may need more
intensive monitoring for symptom persistence.

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