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Cited by 308Traumatic Brain Injury ResearchPosttraumatic Stress Disorder ResearchTraumatic Brain Injury and Neurovascular Disturbances

Risk of Posttraumatic Stress Disorder and Major Depression in Civilian Patients After Mild Traumatic Brain Injury: A TRACK-TBI Study

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Stein, Murray B., Jain, Sonia, Giacino, Joseph T., Levin, Harvey, Dikmen, Sureyya, Nelson, Lindsay D., Vassar, Mary J., Okonkwo, David O. +73 more·2019·JAMA Psychiatry
DOI 10.1001/jamapsychiatry.2018.4288PMC PMC6439818
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Abstract

Importance: Traumatic brain injury (TBI) has been associated with adverse mental health outcomes, such as posttraumatic stress disorder (PTSD) and major depressive disorder (MDD), but little is known about factors that modify risk for these psychiatric sequelae, particularly in the civilian sector. Objective: To ascertain prevalence of and risk factors for PTSD and MDD among patients evaluated in the emergency department for mild TBI (mTBI). Design, Setting, and Participants: Prospective longitudinal cohort study (February 2014 to May 2018). Posttraumatic stress disorder and MDD symptoms were assessed using the PTSD Checklist for DSM-5 and the Patient Health Questionnaire-9 Item. Risk factors evaluated included preinjury and injury characteristics. Propensity score weights-adjusted multivariable logistic regression models were performed to assess associations with PTSD and MDD. A total of 1155 patients with mTBI (Glasgow Coma Scale score, 13-15) and 230 patients with nonhead orthopedic trauma injuries 17 years and older seen in 11 US hospitals with level 1 trauma centers were included in this study. Main Outcomes and Measures: Probable PTSD (PTSD Checklist for DSM-5 score, ≥33) and MDD (Patient Health Questionnaire-9 Item score, ≥15) at 3, 6, and 12 months postinjury. Results: Participants were 1155 patients (752 men [65.1%]; mean [SD] age, 40.5 [17.2] years) with mTBI and 230 patients (155 men [67.4%]; mean [SD] age, 40.4 [15.6] years) with nonhead orthopedic trauma injuries. Weights-adjusted prevalence of PTSD and/or MDD in the mTBI vs orthopedic trauma comparison groups at 3 months was 20.0% (SE, 1.4%) vs 8.7% (SE, 2.2%) (P < .001) and at 6 months was 21.2% (SE, 1.5%) vs 12.1% (SE, 3.2%) (P = .03). Risk factors for probable PTSD at 6 months after mTBI included less education (adjusted odds ratio, 0.89; 95% CI, 0.82-0.97 per year), being black (adjusted odds ratio, 5.11; 95% CI, 2.89-9.05), self-reported psychiatric history (adjusted odds ratio, 3.57; 95% CI, 2.09-6.09), and injury resulting from assault or other violence (adjusted odds ratio, 3.43; 95% CI, 1.56-7.54). Risk factors for probable MDD after mTBI were similar with the exception that cause of injury was not associated with increased risk. Conclusions and Relevance: After mTBI, some individuals, on the basis of education, race/ethnicity, history of mental health problems, and cause of injury were at substantially increased risk of PTSD and/or MDD. These findings should influence recognition of at-risk individuals and inform efforts at surveillance, follow-up, and intervention.

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Research works printed but not linked: 42

  1. McMahon P, Hricik A, Yue JK, et al; TRACK-TBI Investigators. Symptomatology and functional outcome in mild traumatic brain injury: results from the prospective TRACK-TBI study. J Neurotrauma. 2014;31(1):26-33. doi:10.1089/neu.2013.2984 · DOI
  2. Levin HS, Diaz-Arrastia RR. Diagnosis, prognosis, and clinical management of mild traumatic brain injury. Lancet Neurol. 2015;14(5):506-517. doi:10. 1016/S1474-4422(15)00002-2 · DOI · Paper page
  3. Seabury SA, Gaudette É, Goldman DP, et al. Assessment of follow-up care after emergency department presentation for mild traumatic brain injury and concussion: results from the TRACK-TBI study. JAMA Netw Open. 2018;1(1):e180210. doi:10. 1001/jamanetworkopen.2018.0210
  4. Rabinowitz AR, Li X, McCauley SR, et al. Prevalence and predictors of poor recovery from mild traumatic brain injury. J Neurotrauma. 2015;32 (19):1488-1496. doi:10.1089/neu.2014.3555 · DOI
  5. Dikmen S, Machamer J, Temkin N. Mild traumatic brain injury: longitudinal study of cognition, functional status, and post-traumatic symptoms. J Neurotrauma. 2017;34(8):1524-1530. doi:10.1089/neu.2016.4618 · DOI
  6. Schwab K, Terrio HP, Brenner LA, et al. Epidemiology and prognosis of mild traumatic brain injury in returning soldiers: a cohort study. Neurology. 2017;88(16):1571-1579. doi:10.1212/WNL. 0000000000003839 · DOI
  7. McCrea MA, Nelson LD, Guskiewicz K. Diagnosis and management of acute concussion. Phys Med Rehabil Clin N Am. 2017;28(2):271-286. doi:10.1016/ j.pmr.2016.12.005 · DOI
  8. Hiploylee C, Dufort PA, Davis HS, et al. Longitudinal study of postconcussion syndrome: not everyone recovers. J Neurotrauma. 2017;34(8): 1511-1523. doi:10.1089/neu.2016.4677 · DOI · Paper page
  9. Radhakrishnan R, Garakani A, Gross LS, et al. Neuropsychiatric aspects of concussion. Lancet Psychiatry. 2016;3(12):1166-1175. doi:10.1016/S2215- 0366(16)30266-8 · DOI
  10. Roden-Foreman K, Solis J, Jones A, et al. Prospective evaluation of posttraumatic stress disorder and depression in orthopaedic injury patients with and without concomitant traumatic brain injury. J Orthop Trauma. 2017;31(9):e275-e280. doi:10.1097/BOT.0000000000000884 · DOI
  11. Pietrzak RH, Johnson DC, Goldstein MB, Malley JC, Southwick SM. Posttraumatic stress disorder mediates the relationship between mild traumatic brain injury and health and psychosocial functioning in veterans of Operations Enduring Freedom and Iraqi Freedom. J Nerv Ment Dis. 2009; 197(10):748-753. doi:10.1097/NMD. 0b013e3181b97a75 · DOI
  12. Schiehser DM, Twamley EW, Liu L, et al. The relationship between postconcussive symptoms and quality of life in veterans with mild to moderate traumatic brain injury. J Head Trauma Rehabil. 2015;30(4):E21-E28. doi:10.1097/HTR. 0000000000000065 · DOI
  13. Haagsma JA, Scholten AC, Andriessen TM, Vos PE, Van Beeck EF, Polinder S. Impact of depression and post-traumatic stress disorder on functional outcome and health-related quality of life of patients with mild traumatic brain injury. J Neurotrauma. 2015;32(11):853-862. doi:10.1089/ neu.2013.3283 · DOI
  14. Porter KE, Stein MB, Martis B, et al. Postconcussive symptoms (PCS) following combat-related traumatic brain injury (TBI) in veterans with posttraumatic stress disorder (PTSD): influence of TBI, PTSD, and depression on symptoms measured by the neurobehavioral symptom inventory (NSI). J Psychiatr Res. 2018; 102:8-13. doi:10.1016/j.jpsychires.2018.03.004 · DOI
  15. Bombardier CH, Fann JR, Temkin NR, Esselman PC, Barber J, Dikmen SS. Rates of major depressive disorder and clinical outcomes following traumatic brain injury. JAMA. 2010;303(19):1938-1945. doi:10. 1001/jama.2010.599
  16. Manners JL, Forsten RD, Kotwal RS, Elbin RJ, Collins MW, Kontos AP. Role of pre-morbid factors and exposure to blast mild traumatic brain injury on post-traumatic stress in United States military personnel. J Neurotrauma. 2016;33(19):1796-1801. doi:10.1089/neu.2015.4245 · DOI
  17. Cnossen MC, Scholten AC, Lingsma HF, et al. Predictors of major depression and posttraumatic stress disorder following traumatic brain injury: a systematic review and meta-analysis. J Neuropsychiatry Clin Neurosci. 2017;29(3):206-224. doi:10.1176/appi.neuropsych.16090165 · DOI · Paper page
  18. Stein MB, Ursano RJ, Campbell-Sills L, et al. Prognostic indicators of persistent post-concussive symptoms after deployment-related mild traumatic brain injury: a prospective longitudinal study in U.S. Army soldiers. J Neurotrauma. 2016;33(23):2125- 2132. doi:10.1089/neu.2015.4320 · DOI
  19. Cnossen MC, Winkler EA, Yue JK, et al. Development of a prediction model for post-concussive symptoms following mild traumatic brain injury: a TRACK-TBI pilot study [published online March 27, 2017]. J Neurotrauma. doi:10.1089/neu.2017.5486 · DOI
  20. Stein MB, McAllister TW. Exploring the convergence of posttraumatic stress disorder and mild traumatic brain injury. Am J Psychiatry. 2009; 166(7):768-776. doi:10.1176/appi.ajp.2009.08101604 · DOI · Paper page
  21. Wilk JE, Herrell RK, Wynn GH, Riviere LA, Hoge CW. Mild traumatic brain injury (concussion), posttraumatic stress disorder, and depression in U.S. soldiers involved in combat deployments: association with postdeployment symptoms. Psychosom Med. 2012;74(3):249-257. doi:10.1097/ PSY.0b013e318244c604 · DOI
  22. Yue JK, Vassar MJ, Lingsma HF, et al; TRACK-TBI Investigators. Transforming research and clinical knowledge in traumatic brain injury pilot: multicenter implementation of the common data elements for traumatic brain injury. J Neurotrauma. 2013;30(22):1831-1844. doi:10.1089/ neu.2013.2970 · DOI
  23. Teasdale G, Jennett B. Assessment and prognosis of coma after head injury. Acta Neurochir (Wien). 1976;34(1-4):45-55. doi:10.1007/BF01405862 · DOI
  24. Dyer JR, Williams R, Bombardier CH, Vannoy S, Fann JR. Evaluating the psychometric properties of 3 depression measures in a sample of persons with traumatic brain injury and major depressive disorder. J Head Trauma Rehabil. 2016;31(3):225-232. doi:10.1097/HTR.0000000000000177 · DOI
  25. Ioannidis JPA. The Proposal to Lower P Value Thresholds to. 005. JAMA. 2018;319(14):1429-1430. doi:10.1001/jama.2018.1536 · DOI
  26. Lagarde E, Salmi LR, Holm LW, et al. Association of symptoms following mild traumatic brain injury with posttraumatic stress disorder vs postconcussion syndrome. JAMA Psychiatry. 2014; 71(9):1032-1040. doi:10.1001/jamapsychiatry.2014. 666 · DOI
  27. Foks KA, Cnossen MC, Dippel DWJ, et al. Management of mild traumatic brain injury at the emergency department and hospital admission in Europe: a survey of 71 neurotrauma centers participating in the CENTER-TBI study [published online April 11, 2017]. J Neurotrauma. doi:10.1089/ neu.2016.4919 · DOI
  28. Nordström A, Nordström P. Traumatic brain injury and the risk of dementia diagnosis: a nationwide cohort study. PLoS Med. 2018;15(1): e1002496. doi:10.1371/journal.pmed.1002496 · DOI · Paper page
  29. Barnes DE, Kaup A, Kirby KA, Byers AL, Diaz-Arrastia R, Yaffe K. Traumatic brain injury and risk of dementia in older veterans. Neurology. 2014; 83(4):312-319. doi:10.1212/WNL. 0000000000000616 · DOI
  30. Fann JR, Ribe AR, Pedersen HS, et al. Long-term risk of dementia among people with traumatic brain injury in Denmark: a population-based observational cohort study. Lancet Psychiatry. 2018;5(5):424-431. doi:10.1016/ S2215-0366(18)30065-8 · DOI · Paper page
  31. Kaplan GB, Leite-Morris KA, Wang L, et al. Pathophysiological bases of comorbidity: traumatic brain injury and post-traumatic stress disorder. J Neurotrauma. 2018;35(2):210-225. doi:10.1089/neu. 2016.4953 · DOI
  32. Gordon EM, Scheibel RS, Zambrano-Vazquez L, et al. High-fidelity measures of whole-brain functional connectivity and white matter integrity mediate relationships between traumatic brain injury and post-traumatic stress disorder symptoms. J Neurotrauma. 2018;35(5):767-779. doi:10.1089/neu.2017.5428 · DOI
  33. Cnossen MC, van der Naalt J, Spikman JM, et al. Prediction of persistent post-concussion symptoms after mild traumatic brain injury. J Neurotrauma. 2018;35(22):2691-2698. doi:10.1089/ neu.2017.5486 · DOI
  34. O'Donnell ML, Creamer M, Bryant RA, Schnyder U, Shalev A. Posttraumatic disorders following injury: an empirical and methodological review. Clin Psychol Rev. 2003;23(4):587-603. doi: 10.1016/S0272-7358(03)00036-9 · DOI
  35. Fazel S, Wolf A, Pillas D, Lichtenstein P, Långström N. Suicide, fatal injuries, and other causes of premature mortality in patients with traumatic brain injury: a 41-year Swedish population study. JAMA Psychiatry. 2014;71(3):326-333. doi:10. 1001/jamapsychiatry.2013.3935
  36. Madsen T, Erlangsen A, Orlovska S, Mofaddy R, Nordentoft M, Benros ME. Association between traumatic brain injury and risk of suicide. JAMA. 2018;320(6):580-588. doi:10.1001/jama.2018.10211 · DOI · Paper page
  37. Holster JL, Bryan CJ, Heron EA, Seegmiller RA. Traumatic brain injury, sleep, and mental health: a longitudinal study of air force personnel pre-and postdeployment to Iraq. J Head Trauma Rehabil. 2017;32(1):25-33. doi:10.1097/HTR. 0000000000000237 · DOI
  38. Vuletic S, Bell KR, Jain S, et al; CONTACT Investigators. Telephone problem-solving treatment improves sleep quality in service members with combat-related mild traumatic brain injury: results from a randomized clinical trial. J Head Trauma Rehabil. 2016;31(2):147-157. doi:10. 1097/HTR.0000000000000221 · DOI
  39. Bell KR, Fann JR, Brockway JA, et al. Telephone problem solving for service members with mild traumatic brain injury: a randomized, clinical trial. J Neurotrauma. 2017;34(2):313-321. doi:10.1089/neu. 2016.4444 · DOI
  40. Bryant RA, Nickerson A, Creamer M, et al. Trajectory of post-traumatic stress following traumatic injury: 6-year follow-up. Br J Psychiatry. 2015;206(5):417-423. doi:10.1192/bjp.bp.114.145516 · DOI
  41. Fann JR, Bombardier CH, Temkin N, et al. Sertraline for major depression during the year following traumatic brain injury: a randomized controlled trial. J Head Trauma Rehabil. 2017;32(5): 332-342. doi:10.1097/HTR.0000000000000322 · DOI · Paper page
  42. Howlett JR, Stein MB. Post-Traumatic Stress Disorder: Relationship to Traumatic Brain Injury and Approach to Treatment. In: Laskowitz D, Grant G, eds. Translational Research in Traumatic Brain Injury. Boca Raton, FL: Taylor & Francis Group, LLC; 2016.

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Authors
Stein, M. B., Jain, S., Giacino, J. T., Levin, H., Dikmen, S., Nelson, L. D., Vassar, M. J., Okonkwo, D. O., Diaz-Arrastia, R., Robertson, C. S., Mukherjee, P., McCrea, M., Mac Donald, C. L., Yue, J. K., Yuh, E., Sun, X., Campbell-Sills, L., Temkin, N., Manley, G. T., and the TRACK-TBI Investigators, Adeoye, O., Badjatia, N., Boase, K., Bodien, Y., Bullock, M. R., Chesnut, R., Corrigan, J. D., Crawford, K., Diaz-Arrastia, R., Dikmen, S., Duhaime, A.-C., Ellenbogen, R., Feeser, V. R., Ferguson, A., Foreman, B., Gardner, R., Gaudette, E., Giacino, J. T., Gonzalez, L., Gopinath, S., Gullapalli, R., Hemphill, J. C., Hotz, G., Jain, S., Korley, F., Kramer, J., Kreitzer, N., Levin, H., Lindsell, C., Machamer, J., Madden, C., Martin, A., McAllister, T., McCrea, M., Merchant, R., Mukherjee, P., Nelson, L. D., Noel, F., Okonkwo, D. O., Palacios, E., Perl, D., Puccio, A., Rabinowitz, M., Robertson, C. S., Rosand, J., Sander, A., Satris, G., Schnyer, D., Seabury, S., Sherer, M., Stein, M. B., Taylor, S., Toga, A., Temkin, N., Valadka, A., Vassar, M. J., Vespa, P., Wang, K., Yue, J. K., Yuh, E., & Zafonte, R.
Affiliations
  • Department of Neurological Surgery, University of Washington, Seattle
  • University of California San Diego (US)
  • Department of Psychiatry, University of California San Diego, La Jolla
  • San Francisco General Hospital (US)
  • University of Cincinnati (US)
  • University of Washington (US)
  • University of Miami (US)
  • University of Southern California (US)
  • Virginia Commonwealth University (US)
  • University of California, San Francisco (US)
  • University of Southern California, Los Angeles
  • Memorial Hermann Institute for Rehabilitation and Research Foundation (US)
  • Baylor College of Medicine (US)
  • Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
  • Medical College of Wisconsin (US)
  • Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Texas
  • Uniformed Services University of the Health Sciences (US)
  • University of Pittsburgh Medical Center (US)
  • University of California, Los Angeles (US)
  • Harvard University (US)
ORCID
Venue
JAMA Psychiatry
Publisher
American Medical Association (AMA)
Published
2019-03-01
Volume
76
Issue
3
Pages
249
ISSN
2168-622X (ISSN-L)
DOI
10.1001/jamapsychiatry.2018.4288
PMC
PMC6439818
OpenAlex
W2912370667
Cited by
308
References
13
Citations by year
2026: 40 · 2025: 59 · 2024: 41 · 2023: 39 · 2022: 46 · 2021: 43 · 2020: 27 · 2019: 11
FWCI
24.36
Type
journal article
Language
en
Open access
Locations
  • JAMA Psychiatry (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • IUScholarWorks (Indiana University) (submittedVersion)
  • Purdue University Indianapolis (Indiana University) (submittedVersion)
Funders
National Institute of Neurological Disorders and Stroke (T32NS047996)
Topics
  • Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
  • Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
  • Health Sciences › Medicine › Neurology › Traumatic Brain Injury and Neurovascular Disturbances
Keywords
mild traumatic brain injury, post-traumatic stress disorder, major depressive disorder, psychiatric sequelae, risk factors, educational attainment, emergency department, PCL-5, PHQ-9, civilian patients, mental health outcomes, PTSD prevalence, depression prevalence
MeSH terms
Brain Injuries, Traumatic, Adolescent, Adult, Major Depressive Disorder, Depressive Disorder, Major, Emergency Service, Hospital, Female, Humans, Longitudinal Studies, Male, Prospective Studies, Risk Factors, Stress Disorders, Post-Traumatic, Glasgow Coma Scale, Comorbidity, Prevalence, Case-Control Studies, Young Adult

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