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Less education, black race increase risk for PTSD, depression after TBI

Certain preinjury and injury-related characteristics, including education status, race and history of mental health problems, heighten the risk for PTSD and/or major depressive disorder after mild traumatic brain injury, according to findings published in JAMA Psychiatry.

“Traumatic brain injury (TBI) has been associated with adverse mental health outcomes, such as [PTSD] and major depressive disorder (MDD), but little is known about factors that modify risk for these psychiatric sequelae, particularly in the civilian sector,” Murray B. Stein, MD, MPH, from the department of psychiatry, University of California San Diego, and colleagues wrote.

Between February 2014 and May 2018, Stein and colleagues conducted a prospective longitudinal cohort study to determine which patients are at the greatest risk for developing PTSD or MDD after suffering a mild TBI, defined as a Glasgow Coma Scale score between 13 and 15. The researchers enrolled patients aged 17 years and older who presented to an ED for mild TBI (n = 1,155; 65.1% men; mean age, 40.5 years) or nonhead orthopedic trauma injuries (n = 230; 67.4% men; mean age, 40.4 years).

PTSD Checklist for DSM-5 and the Patient Health Questionnaire-9 Item were used to evaluate symptoms of PTSD and MDD. Preinjury and injury characteristics were evaluated as potential risk factors. Propensity score weights-adjusted multivariable logistic regression models were used to determine the association between TBI and PTSD and MDD.

Adjusted analysis indicated that at 3 months, PTSD and/or MDD was prevalent in 20% of patients in the mild TBI group, compared with 8.7% of those in the orthopedic trauma comparison group. At 6 months, the prevalence of PTSD and/or MDD increased slightly in both the mild TBI group (21.2%) and orthopedic trauma comparison group (12.1%).

Patients who reported less education (adjusted OR = 0.89; 95% CI, 0.82-0.97 per year), black race (aOR = 5.11; 95% CI, 2.89-9.05), a psychiatric history (aOR = 3.57; 95% CI, 2.09-6.09) and injury resulting from assault or other violence (aOR = 3.43; 95% CI, 1.56-7.54) were more likely to suffer from PTSD after mild TBI at 6 months. These factors, except for cause of injury, also increased the risk for MDD after mild TBI.

“Our findings may have implications for surveillance and treatment of mental disorders after TBI,” Stein and colleagues concluded. “The emergence and long-term course of PTSD after TBI is variable, and our findings show that PTSD and MDD, although common, occur in only a minority of patients post-[mild] TBI but especially those with prior mental health problems. Consequently, we may want to consider watchful waiting (ie, active vigilance with planned follow-up) of patients with prior mental health problems and intervene when it is apparent that symptoms are persisting or worsening.” – by Alaina Tedesco

Disclosures: Stein reports consulting for Actelion, Aptinyx, Bionomics, Dart Neuroscience, Healthcare Management Technologies, Janssen, Neurocrine Biosciences, Oxeia Biopharmaceuticals, Pfizer, and Resilience Therapeutics. He also owns founders shares and stock options in Resilience Therapeutics and has stock options in Oxeia Biopharmaceuticals. Please see study for all other authors’ relevant financial disclosures.