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Depression Treatment Preferences After Traumatic Brain Injury

Fann, Jesse R. MD, MPH; Jones, Audrey L. BA; Dikmen, Sureyya S. PhD; Temkin, Nancy R. PhD; Esselman, Peter C. MD; Bombardier, Charles H. PhD

Section Editor(s): Bell, Kathleen R. MD; Hart, Tessa PhD; Caplan, Bruce PhD, ABPP (Senior Editor); Bogner, Jennifer PhD (Associate Editor)

The Journal of Head Trauma Rehabilitation: July-August 2009 - Volume 24 - Issue 4 - p 272–278
doi: 10.1097/HTR.0b013e3181a66342
Focus on Clinical Research and Practice

Objective To determine preferences for depression treatment modalities and settings among persons with traumatic brain injury (TBI).

Design Telephone survey. Depression status was determined using the Patient Health Questionnaire-9.

Setting Harborview Medical Center, Seattle, Washington, the level I trauma center serving Washington, Idaho, Montana, and Alaska.

Participants One hundred forty-five adults, English-speaking consecutive patients admitted with complicated mild to severe TBI.

Main Outcome Measures Telephone survey within 12 months post-TBI ascertaining preferences for depression treatment modalities and settings.

Results More patients favored physical exercise or counseling as a depression treatment than other treatment modalities. Group therapy was the least favored modality. Patients favored speaking with a clinician in the clinic or over the telephone and were less likely to communicate with a clinician over the Internet. Subjects with probable major depression or a history of antidepressant use or outpatient mental health treatment were more likely to express a preference for antidepressants for treatment of depression.

Conclusions This study underscores the importance of understanding patient preferences and providing patient education in selecting a treatment for depression after TBI. Future studies should examine psychotherapy and alternative treatment modalities and delivery models for the management of depression in this vulnerable population.

Departments of Psychiatry & Behavioral Sciences (Drs Fann and Dikmen), Rehabilitation Medicine (Drs Fann, Esselman, Dikmen and Bombardier, Ms Jones), and Neurological Surgery (Drs Dikmen and Temkin), School of Medicine, and Departments of Biostatistics (Dr Temkin) and Epidemiology (Dr Fann), School of Public Health and Community Medicine, University of Washington, Seattle.

Corresponding Author: Jesse R. Fann, MD, MPH, Department of Psychiatry & Behavioral Sciences, University of Washington, 1959 NE Pacific St, Box 356560, Seattle, WA 98195 (

Data from this paper were presented at the 52nd annual meeting of the Academy of Psychosomatic Medicine; November 2005; Albuquerque, New Mexico.

This study was supported by grant R-01 HD39415 from the National Center for Medical Rehabilitation Research, National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH). The authors thank Erika Pelzer, Meghan Keough, and Holly Rau for their assistance with data collection, and Jason Barber for his assistance with data analysis.

© 2009 Lippincott Williams & Wilkins, Inc.