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Association of Depressive Symptoms With Functional Outcome After Traumatic Brain Injury

Hudak, A. M. MD; Hynan, L. S. PhD; Harper, C. R. MS; Diaz-Arrastia, R. MD, PhD

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

The Journal of Head Trauma Rehabilitation: March/April 2012 - Volume 27 - Issue 2 - p 87–98
doi: 10.1097/HTR.0b013e3182114efd
Focus on Clinical Research and Practice, Part 1

Objective: To test whether improved functional status correlates with more depressive symptoms after traumatic brain injury(TBI). This is based on the concept that increasing awareness of deficits may exacerbate depression, even while survivors are making functional improvements.

Participants: A total of 471 individuals with TBI (72% white; 71% men; median Glasgow Coma Scale (GCS) score = 11) enrolled during acute care or inpatient rehabilitation and followed up at a median of 6 months.

Main Measure: Beck Depression Inventory-II (BDI-II), Glasgow Outcome Scale-Extended, and Functional Status Examination (FSE).

Results: We found significant Spearman rank order correlations between BDI-II scores and the total FSE as well as all domains of the FSE. Lower functional levels correlated with more depressive symptoms. Modeling of predictive factors, including subject characteristics, injury-related characteristics, and outcome measures, resulted in 2 models, both containing age and GCS along with other factors.

Conclusion: The relation between depressive symptoms and functional outcomes is complex and a fertile area for further research. The authors would encourage clinicians to monitor patients for depressive symptoms to help to prevent the detrimental impact on recovery.

Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University (Dr Hudak), Departments of Clinical Sciences (Division of Biostatistics) and Psychiatry (Dr Hynan), and Department of Neurology (Ms Harper), University of Texas Southwestern Medical Center, Dallas, Department of Neurology (Dr Diaz-Arrastia), Uniformed Services University of the Health Sciences, Rockville, Maryland.

Corresponding Author: A. M. Hudak, MD, Virginia Commonwealth University, Department of Physical Medicine and Rehabilitation, 730 East Broad St, Box 843038, Richmond, VA 23298-3038 (

This work was supported in part by grants NIH 5 KL2 RR024983-02, NIH R01 HD48179, NIH U01 HD42652, and NIDRR H133AO252604.

The authors declare no conflicts of interest.

© 2012 Lippincott Williams & Wilkins, Inc.