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Frequency, Timing, and Course of Depressive Symptomatology After Whiplash

Carroll, Linda J., PhD*; Cassidy, J David, PhD, DrMedSc†‡§; Côté, Pierre, PhD§∥

doi: 10.1097/01.brs.0000225979.26966.9e
Health Services Research

Study Design. Population-based incidence cohort.

Objective. To report the incidence, timing, and course of depressive symptoms after whiplash.

Summary of Background Data. Evidence is conflicting about the frequency, time of onset, and course of depressive symptoms after whiplash.

Methods. Adults making an insurance claim or seeking health care for traffic-related whiplash were followed by telephone interview at 6 weeks, and 3, 6, 9, and 12 months post-injury. Depressive symptoms were assessed at baseline and at each follow-up.

Results. Of the 5,211 subjects reporting no pre-injury mental health problems, 42.3% (95% confidence interval, 40.9–43.6) developed depressive symptoms within 6 weeks of the injury, with subsequent onset in 17.8% (95% confidence interval, 16.5–19.2). Depressive symptoms were recurrent or persistent in 37.6% of those with early post-injury onset. Pre-injury mental health problems increased the risk of later onset depressive symptoms and of a recurrent or persistent course of early onset depressive symptoms.

Conclusions. Depressive symptomatology after whiplash is common, occurs early after the injury, and is often persistent or recurrent. This suggests that, like neck pain and headache, depressed symptomatology is part of the cluster of acute whiplash symptoms. Clinicians should be aware of both physical and psychologic injuries after traffic collisions.

Depressive symptoms are common after whiplash, with the majority of cases occurring within the first 6 weeks after the injury. Of those with early onset depressive symptoms, almost 38% experience persistent or recurrent symptoms. Pre-injury mental health problems increase the risk that early onset depressive symptoms will fail to resolve.

From the *Department of Public Health Sciences, University of Alberta, Edmonton, Alberta, Canada; †Rehabilitation Solutions, University Health Network, Toronto, Ontario, Canada; ‡Division of Outcomes and Population Health, Toronto Western Research Institute, Toronto, Ontario, Canada; §Department of Public Health Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; and ∥Institute for Work & Health, Toronto, Ontario, Canada.

Acknowledgment date: January 15, 2005. First revision date: July 25, 2005. Second revision date: January 31, 2006. Acceptance date: February 6, 2006.

The manuscript submitted does not contain information about medical device(s)/drug(s).

Corporate/Industry funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to Linda J. Carroll, PhD, 13-106 Clinical Sciences Building, University of Alberta, Edmonton, Alberta, Canada; E-mail:

© 2006 Lippincott Williams & Wilkins, Inc.