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Long-term Psychiatric Outcomes Following Traumatic Brain Injury: A Review of the Literature

Hesdorffer, Dale C. PhD; Rauch, Scott L. MD; Tamminga, Carol A. MD

Section Editor(s): Rutherford, George W. MD, Topical Editor

Journal of Head Trauma Rehabilitation: November-December 2009 - Volume 24 - Issue 6 - p 452–459
doi: 10.1097/HTR.0b013e3181c133fd

Objective To determine the relationship between traumatic brain injury (TBI) and long-term psychiatric health outcomes, occurring 6 months or more after TBI.

Participants Not applicable.

Design Systematic review of the published, peer-reviewed literature.

Primary Measures Not applicable.

Results We identified studies that examined psychiatric disorders following TBI. There was sufficient evidence of an association between TBI and depression and similarly compelling evidence of an association between TBI and aggression. There was limited/suggestive evidence of an association between TBI and subsequent completed suicide, decreased alcohol and drug use compared to preinjury levels, and psychosis. While there was also limited/suggestive evidence for posttraumatic stress disorder (PTSD) in military populations with TBI, there was inadequate evidence to reach a conclusion about whether TBI was associated with PTSD in civilian populations.

Conclusion TBI is associated with a wide range of psychiatric disorders among individuals surviving at least 6 months. The association between mild TBI and PTSD seems to differ in military and civilian populations.

Supplemental Digital Content is available in the text

Gertrude H Sergievsky Center, Columbia University, and Department of Epidemiology, Mailman School of Public Health, New York, New York (Dr Hesdorffer); Partners Psychiatry and Mental Health, McLean Hospital, Belmont, Massachusetts (Dr Rauch); Harvard Medical School, Boston, Massachusetts (Dr Rauch); and Department of Psychiatry, University of Texas Southwestern Medical Center at Dallas, Dallas (Dr Tamminga).

Corresponding Author: Dale C. Hesdorffer, PhD, Gertrude H Sergievsky Center, Columbia University, P & S Unit 16, 630 West 168th St, New York, NY 10032 (

The study was supported by a contract from the US Department of Veterans Affairs to the National Academy of Sciences, Institute of Medicine.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site ( The tables in supplemental digital content have been reprinted with permission from Gulf War and Health: Volume 7. Long Term Consequences of Traumatic Brain Injury. Copyright 2009, National Academy of Sciences, Washington, DC.

© 2009 Lippincott Williams & Wilkins, Inc.