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Depression Strongly Influences Postconcussion Symptom Reporting Following Mild Traumatic Brain Injury

Lange, Rael T. PhD; Iverson, Grant L. PhD; Rose, Alice OT

Section Editor(s): Bruce, Caplan PhD, ABPP; Bogner, Jennifer PhD, ABPP

Journal of Head Trauma Rehabilitation: March/April 2011 - Volume 26 - Issue 2 - p 127–137
doi: 10.1097/HTR.0b013e3181e4622a
Focus on Clinical Research and Practice, Part 1

Objective: To examine the influence of depression on postconcussion symptom reporting in patients following mild traumatic brain injury (MTBI).

Participants: Sixty patients referred to a specialty clinic following MTBI, 58 outpatients with Structured Clinical Interview for DSM-diagnosed depression, and 72 healthy community control participants.

Procedure: Participants with MTBI were divided into 2 subgroups on the basis of self-reported symptoms of depression (23 MTBI-depressed, 37 MTBI-not depressed). All participants completed a postconcussion symptom questionnaire.

Main outcome measure: British Columbia Post-concussion Symptom Inventory.

Results: There were significant differences in total reported postconcussion symptoms among all 4 groups (all P < .002; Cohen's d = 0.68–3.24, large to very large effect sizes; MTBI-depressed > depressed outpatients > MTBI-no depression > healthy controls). There were significant differences in the number of symptoms endorsed (P < .05), with the highest number of symptoms endorsed by the MTBI-depressed group, followed by depressed outpatients, MTBI-no depression, and healthy controls.

Conclusions: Patients who experience MTBIs and who have a postinjury recovery course complicated by significant depression report more postconcussion symptoms, and more severe symptoms, than (a) outpatients with depression, and (b) patients with MTBIs who do not have significant symptoms of depression.

British Columbia Mental Health and Addiction Services and University of British Columbia (Drs Lange and Iverson); and GF Strong Rehab Center (Ms Rose), Vancouver, British Columbia, Canada.

Corresponding Author: Rael T. Lange, PhD, British Columbia Mental Health and Addiction Services, PHSA Research and Networks, Ste 201, 601 West Broadway St, Vancouver, British Columbia, Canada V5Z 4C2 (

A portion of these data were presented at the International Neuropsychological Society conference, February 2010, Acapulco, Mexico.

This research was granted ethical clearance by the University of British Columbia Behavioral Research Ethics Board.

© 2011 Lippincott Williams & Wilkins, Inc.