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The nature, frequency and course of psychiatric disorders in the first year after traumatic brain injury: a prospective study

  • K. R. Gould (a1) (a2), J. L. Ponsford (a1) (a2), L. Johnston (a1) and M. Schönberger (a1) (a2) (a3)
Abstract
Background

Psychiatric disorders are common following traumatic brain injury (TBI). However, few studies have examined the course of disorder development and the influence of pre-injury psychiatric history. The present study aimed to examine the frequency of, and association between, psychiatric disorders occurring pre- and post-injury, and to examine the post-injury course of disorders.

Method

Participants were 102 adults (75.5% male) with predominantly moderate-severe TBI. Participants were initially assessed for pre-injury and current disorders, and reassessed at 3, 6 and 12 months post-injury using the Structured Clinical Interview for DSM-IV Disorders (SCID).

Results

Over half of the participants had a pre-injury psychiatric disorder; predominantly substance use, mood, and anxiety disorders. In the first year post-injury, 60.8% of participants had a psychiatric disorder, commonly anxiety and mood disorders. Post-injury disorders were associated with the presence of a pre-injury history (p<0.01), with 74.5% of participants with a pre-injury psychiatric history experiencing a post-injury disorder, which commonly presented at initial assessment or in the first 6 months. However, 45.8% of participants without a pre-injury history developed a novel post-injury disorder, which was less likely to emerge at the initial assessment and generally developed later in the year.

Conclusions

Despite evidence that most post-injury psychiatric disorders represent the continuation of pre-existing disorders, a significant number of participants developed novel psychiatric disorders. This study demonstrates that the timing of onset may differ according to pre-injury history. There seem to be different trajectories for anxiety and depressive disorders. This research has important implications for identifying the time individuals are most at risk of psychiatric disorders post-injury.

Copyright
Corresponding author
*Address for correspondence: Professor J. L. Ponsford, School of Psychology and Psychiatry, Monash University, Clayton, VIC 3800, Australia. (Email: jennie.ponsford@med.monash.edu.au)
References
Hide All
ABS (2009). National Survey of Mental Health and Wellbeing 2007. Basic CURF, CD-ROM. Findings based on use of Australian Bureau of Statistics (ABS) CURF data, November Re-Issue.
Anson K, Ponsford J (2006). Coping and emotional adjustment following traumatic brain injury. Journal of Head Trauma Rehabilitation 21, 248259.
APA (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th edn, text revision. American Psychiatric Association: Washington, DC.
Ashman TA, Spielman LA, Hibbard MR, Silver JM, Chandna T, Gordon WA (2004). Psychiatric challenges in the first 6 years after traumatic brain injury: cross-sequential analyses of Axis I disorders. Archives of Physical Medicine and Rehabilitation 85, 3642.
Bombardier CH, Fann JR, Temkin NR, Esselman PC, Barber J, Dikmen SS (2010). Rates of major depressive disorder and clinical outcomes following traumatic brain injury. Journal of the American Medical Association 303, 19381945.
Bombardier CH, Temkin NR, Machamer J, Dikmen SS (2003). The natural history of drinking and alcohol-related problems after traumatic brain injury. Archives of Physical Medicine and Rehabilitation 84, 185191.
Deb S, Lyons I, Koutzoukis C, Ali I, McCarthy G (1999). Rate of psychiatric illness 1 year after traumatic brain injury. American Journal of Psychiatry 156, 374378.
Fann JR, Bombardier CH, Dikmen S, Esselman P, Warms CA, Pelzer E, Rau H, Temkin N (2005). Validity of the Patient Health Questionnaire-9 in assessing depression following traumatic brain injury. Journal of Head Trauma Rehabilitation 20, 501511.
Fann JR, Burington B, Leonetti A, Jaffe KM, Katon W, Thompson RS (2004). Psychiatric illness following traumatic brain injury in an adult health maintenance organization population. Archives of General Psychiatry 61, 5361.
Fann JR, Katon WJ, Uomoto JM, Esselman PC (1995). Psychiatric disorders and functional disability in outpatients with traumatic brain injuries. American Journal of Psychiatry 152, 14931499.
Fedoroff JP, Starkstein SE, Forrester AW, Geisler FH, Jorge RE, Arndt SV, Robinson RG (1992). Depression in patients with acute traumatic brain injury. American Journal of Psychiatry 149, 918923.
First MB, Spitzer RL, Gibbon M, Williams JBW (2002). Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Non-Patient Edition (SCID-I/NP). Biometrics Research, New York State Psychiatric Institute: New York.
Fujii D, Ahmed I (2002). Characteristics of psychotic disorder due to traumatic brain injury: an analysis of case studies in the literature. Journal of Neuropsychiatry and Clinical Neurosciences 14, 130140.
Godfrey HP, Partridge FM, Knight RG, Bishara S (1993). Course of insight disorder and emotional dysfunction following closed head injury: a controlled cross-sectional follow-up study. Journal of Clinical and Experimental Neuropsychology 15, 503515.
Haro JM, Arbabzadeh-Bouchez S, Brugha TS, Girolamo GD, Guyer ME, Jin R, Lepine JP, Mazzi F, Reneses B, Vilagut G, Sampson NA, Kessler RC (2006). Concordance of the Composite International Diagnostic Interview Version 3.0 (CIDI 3.0) with standardized clinical assessments in the WHO World Mental Health Surveys. International Journal of Methods in Psychiatric Research 15, 167180.
Härter M, Baumeister H, Reuter K, Jacobi F, Höfler M, Bengel J, Wittchen HU (2007). Increased 12-month prevalence rates of mental disorders in patients with chronic somatic diseases. Psychotherapy and Psychosomatics 76, 354360.
Hibbard MR, Uysal S, Kepler K, Bogdany J, Silver J (1998). Axis I psychopathology in individuals with traumatic brain injury. Journal of Head Trauma Rehabilitation 13, 2439.
Hoofien D, Gilboa A, Vakil E, Donovick PJ (2001). Traumatic brain injury (TBI) 10–20 years later: a comprehensive outcome study of psychiatric symptomatology, cognitive abilities and psychosocial functioning. Brain Injury 15, 189209.
Jablensky A, McGrath J, Herrman H, Castle D, Gureje O, Evans M, Carr V, Morgan V, Korten A, Harvey C (2000). Psychotic disorders in urban areas: an overview of the Study on Low Prevalence Disorders. Australian and New Zealand Journal of Psychiatry 34, 221236.
Jorge RE, Robinson RG, Arndt SV, Forrester AW, Geisler F, Starkstein SE (1993 a). Comparison between acute- and delayed-onset depression following traumatic brain injury. Journal of Neuropsychiatry and Clinical Neurosciences 5, 4349.
Jorge RE, Robinson RG, Moser D, Tateno A, Crespo-Facorro B, Arndt SV (2004). Major depression following traumatic brain injury. Archives of General Psychiatry 61, 4250.
Jorge RE, Robinson RG, Starkstein SE, Arndt SV (1993 b). Depression and anxiety following traumatic brain injury. Journal of Neuropsychiatry and Clinical Neurosciences 5, 369374.
Jorge RE, Robinson RG, Starkstein SE, Arndt SV, Forrester AW, Geisler FH (1993 c). Secondary mania following traumatic brain injury. American Journal of Psychiatry 150, 916921.
Jorge RE, Starkstein SE, Arndt S, Moser D, Crespo-Facorro B (2005). Alcohol misuse and mood disorders following traumatic brain injury. Archives of General Psychiatry 62, 742749.
Kashluba S, Hanks RA, Casey JE, Millis SR (2008). Neuropsychologic and functional outcome after complicated mild traumatic brain injury. Archives of Physical Medicine and Rehabilitation 89, 904911.
Kim E, Lauterbach EC, Reeve A, Arciniegas DB, Coburn KL, Mendez MF, Rummans TA, Coffey EC (2007). Neuropsychiatric complications of traumatic brain injury: a critical review of the literature (a report by the ANPA Committee on Research). Journal of Neuropsychiatry and Clinical Neurosciences 19, 106127.
Koponen S, Taiminen T, Portin R, Himanen L, Isoniemi H, Heinonen H, Hinkka S, Tenovuo O (2002). Axis I and II psychiatric disorders after traumatic brain injury: a 30-year follow-up study. American Journal of Psychiatry 159, 13151321.
Kroenke K, Spitzer RL, Williams JBW (2001). The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine 16, 606613.
Lewis A (1942). Discussion on differential diagnosis and treatment of post-contusional states. Proceedings of the Royal Society of Medicine 35, 607614.
Lishman WA (1988). Physiogenesis and psychogenesis in the ‘post-concussional syndrome’. British Journal of Psychiatry 153, 460469.
Moldover JE, Goldberg KB, Prout MF (2004). Depression after traumatic brain injury: a review of evidence for clinical heterogeneity. Neuropsychology Review 14, 143154.
Nelson HE (1982). National Adult Reading Test. NFER-Nelson: Windsor, UK.
O'Donnell ML, Creamer MP, Pattison PP, Atkin CF (2004). Psychiatric morbidity following injury. American Journal of Psychiatry 161, 507514.
Ponsford J, Sloan S, Snow P (1995). Traumatic Brain Injury: Rehabilitation for Everyday Adaptive Living. Lawrence Erlbaum Associates: Hove, UK.
Ponsford J, Whelan-Goodinson R, Bahar-Fuchs A (2007). Alcohol and drug use following traumatic brain injury: a prospective study. Brain Injury 21, 13851392.
Rutherford WH, Merrett JD, McDonald JR (1977). Sequelae of concussion caused by minor head injuries. Lancet 309, 14.
Saha S, Chant D, Welham J, McGrath J (2005). A systematic review of the prevalence of schizophrenia. PLoS Medicine 2, e141.
Sbordone RJ, Liter JC, Pettler-Jennings P (1995). Recovery of function following severe traumatic brain injury: a retrospective 10-year follow-up. Brain Injury 9, 285299.
Spitzer RL (1983). Psychiatric diagnosis: are clinicians still necessary? Comprehensive Psychiatry 24, 399411.
van Reekum R, Bolago I, Finlayson MAJ, Garner S, Links PS (1996). Psychiatric disorders after traumatic brain injury. Brain Injury 10, 319328.
Wade TD, Bergin JL, Tiggemann M, Bulik CM, Fairburn CG (2006). Prevalence and long-term course of lifetime eating disorders in an adult Australian twin cohort. Australian and New Zealand Journal of Psychiatry 40, 121128.
Watt KJ, O'Carroll RE (1999). Evaluating methods for estimating premorbid intellectual ability in closed head injury. Journal of Neurology, Neurosurgery, and Psychiatry 66, 474479.
Wells JE, Browne MAO, Scott KM, McGee MA, Baxter J, Kokaua J; New Zealand Mental Health Survey Research Team (2006). Prevalence, interference with life and severity of 12 month DSM-IV disorders in Te Rau Hinengaro: the New Zealand Mental Health Survey. Australian and New Zealand Journal of Psychiatry 40, 845854.
Whelan-Goodinson R, Ponsford J, Johnston L, Grant F (2009). Psychiatric disorders following traumatic brain injury: their nature and frequency. Journal of Head Trauma Rehabilitation 24, 324332.
Williams DH, Levin HS, Eisenberg HM (1990). Mild head injury classification. Neurosurgery 27, 422428.
Williams WH, Evans JJ, Needham P, Wilson BA (2002). Neurological, cognitive and attributional predictors of posttraumatic stress symptoms after traumatic brain injury. Journal of Traumatic Stress 15, 397400.
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Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
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