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Relationship of Preinjury Depressive Symptoms to Outcomes 3 mos After Complicated and Uncomplicated Mild Traumatic Brain Injury

Kumar, Raj G. MPH; Bracken, Michael B. PhD; Clark, Allison N. PhD; Nick, Todd G. PhD; Melguizo, Maria S. MS; Sander, Angelle M. PhD

American Journal of Physical Medicine & Rehabilitation: August 2014 - Volume 93 - Issue 8 - p 687–702
doi: 10.1097/PHM.0000000000000077
CME Article

Objective This study examines the effect of preinjury depressive symptoms on outcomes 3 mos after complicated and uncomplicated cases of mild traumatic brain injury.

Design Preinjury depressive symptoms, experienced in the 30 days before injury, as measured by retrospective self-report, were assessed within the first 2 wks after injury. The outcome measures assessed at 3 mos after injury included affective/behavioral, cognitive, and physical problems and health-related quality-of-life.

Results There were 177 patients who completed both the baseline and 3-mo follow-up interviews. The sample was categorized by severity of depressive symptoms in the month before injury as normal, mild, or moderate-severe. Compared with those reporting no preinjury depressive symptoms, persons reporting moderate-severe depressive symptoms had significantly worse outcomes on the Affective and Behavioral and the Cognitive subscales of the Head Injury-Family Interview Problem Checklist and on the 36-item Short-Form Health Survey Mental Component Summary score. The group reporting mild preinjury depressive symptoms scored worse on a measure of cognitive symptoms compared with those with no preinjury depressive symptoms. There was no interaction between preinjury depressive symptoms and severity of the mild traumatic brain injury (complicated or uncomplicated) for any of the outcomes.

Conclusion Moderate to severe depressive symptoms in the month before injury seems to be a possible risk factor for poor affective/behavioral, cognitive, and mental health-related quality-of-life outcomes at 3 mos after mild traumatic brain injury. Clinicians and researchers should consider the impact of preinjury depression on the recovery process to provide at-risk patients adequate treatment soon after injury.

From the Yale School of Public Health (RGK); Yale School of Public Health, Yale Center for Perinatal, Pediatric, and Environmental Epidemiology, and Department of Neurology, Yale Medical School (MBB), New Haven, Connecticut; Department of Physical Medicine and Rehabilitation, Baylor College of Medicine/Harris Health System & Brain Injury Research Center, TIRR Memorial Hermann (ANC, AMS), Houston, Texas; and Department of Pediatrics and Department of Biostatistics, College of Public Health, University of Arkansas for Medical Sciences (TGN, MSM), Little Rock, Arkansas.

Supported, in part, by grants from the National Institute on Disability and Rehabilitation Research, United States Department of Education (grant nos. H133B990014, H133B090023, H133A120020).

Presented as a poster (abstract) at the 3rd Annual Traumatic Brain Injury Conference in Washington, DC, on March 6–7. This project was also used as a master’s thesis project for the Yale School of Public Health.

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

All correspondence and requests for reprints should be addressed to: Angelle M. Sander, PhD, TIRR Memorial Hermann Research Center, 1333 Moursund, Houston, TX 77030.

Copyright © 2014 Wolters Kluwer Health, Inc. All rights reserved.