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The Efficacy of a Scheduled Telephone Intervention for Ameliorating Depressive Symptoms During the First Year After Traumatic Brain Injury

Bombardier, Charles H. PhD; Bell, Kathleen R. MD; Temkin, Nancy R. PhD; Fann, Jesse R. MD, MPH; Hoffman, Jeanne PhD; Dikmen, Sureyya PhD

Section Editor(s): Bell, Kathleen R. MD; Hart, Tessa PhD

The Journal of Head Trauma Rehabilitation: July-August 2009 - Volume 24 - Issue 4 - p 230–238
doi: 10.1097/HTR.0b013e3181ad65f0

Objective To determine whether an intervention designed to improve functioning after traumatic brain injury (TBI) also ameliorates depressive symptoms.

Design Single-blinded, randomized controlled trial comparing a scheduled telephone intervention to usual care.

Participants One hundred seventy-one persons with TBI discharged from an inpatient rehabilitation unit.

Methods The treatment group received up to 7 scheduled telephone sessions over 9 months designed to elicit current concerns, provide information, and facilitate problem solving in domains relevant to TBI recovery.

Outcome Measures Brief Symptom Inventory-Depression (BSI-D) subscale, Neurobehavioral Functioning Inventory-Depression subscale, and Mental Health Index-5 from the Short-Form-36 Health Survey.

Results Baseline BSI-D subscale and outcome data were available on 126 (74%) participants. Randomization was effective except for greater severity of depressive symptoms in the usual care (control) group at baseline. Outcome analyses were adjusted for these differences. Overall, control participants developed greater depressive symptom severity from baseline to 1 year than did the treatment group. The treated group reported significantly lower depression symptom severity on all outcome measures. For those more depressed at baseline, the treated group demonstrated greater improvement in symptoms than did the controls.

Conclusions Telephone-based interventions using problem-solving and behavioral activation approaches may be effective in ameliorating depressive symptoms following TBI. Proactive telephone calls, motivational interviewing, and including significant others in the intervention may have contributed to its effectiveness.

Departments of Rehabilitation Medicine (Drs Bombardier, Bell, Fann, Hoffman, and Dikmen), Biostatistics (Dr Temkin), Neurological Surgery (Drs Temkin and Dikmen), and Psychiatry and Behavioral Sciences (Drs Fann and Dikmen), University of Washington School of Medicine, Seattle.

Corresponding Author: Charles H. Bombardier, PhD, Department of Rehabilitation Medicine, University of Washington School of Medicine, Box 359740, Harborview Medical Center, 325 9th Ave, Seattle, WA 98104 (

This research was supported by the National Institute on Disability and Rehabilitation Research, grant number H133A020508, Traumatic Brain Injury Model Systems. The authors express their gratitude to Jason Barber, MS, for his assistance with data analysis and to the Issue Editor, Dr Tessa Hart, for her expert guidance.

© 2009 Lippincott Williams & Wilkins, Inc.