In the Journals

Mild TBI linked to PTSD, depression in some patients

Some patients were more likely to develop PTSD and/or major depressive disorder following mild traumatic brain injury, or TBI particularly those with a history of mental health problems and those with TBI resulting from assault or violence, according to study findings.

“Preexisting mental disorder and mental health sequelae have been shown to be important determinants of overall functioning and quality of life after [mild] TBI,” Murray B. Stein, MD, MPH, from the department of psychiatry, University of California San Diego, and colleagues wrote in JAMA Psychiatry. “Although MDD and PTSD are prevalent after TBI, little is known about which patients are at risk for developing them.”

Researchers conducted a prospective longitudinal cohort study to determine the prevalence of and risk factors (ie preinjury and injury characteristics) for PTSD and among 1,155 adult patients with mild TBI and 230 patients with non-head orthopedic trauma injuries evaluated in the ED at 11 U.S. hospitals.

Stein and colleagues examined PTSD and MDD symptoms at 3, 6 and 12months post-injury using the PTSD Checklist for DSM-5 and the Patient Health Questionnaire-9 Item. They evaluated the associations with PTSD and MDD using propensity score weights-adjusted multivariable logistic regression models.

Analysis revealed that the prevalence of PTSD and/or MDD was 20% in the mild TBI group vs 8.7% in the orthopedic trauma comparison group (P < .001) at 3 months and 21.2% vs 12.1% (P = .03) at 6 months.

The results showed that certain preinjury—like prior mental health problems—and injury-related—like assault or other violent cause of injury in PTSD cases—were linked to increased risk among participants with mild TBI. After evaluating for risk factors, the investigators found that participants were more likely to have PTSD 6 months following mild TBI if they:

  • less education (adjusted OR = 0.89; 95% CI, 0.82-0.97 per year);
  • black (aOR = 5.11; 95% CI, 2.89-9.05);
  • self-reported psychiatric history (aOR = 3.57; 95% CI, 2.09-6.09); and
  • had injury resulting from assault or other violence (aOR = 3.43; 95%CI, 1.56-7.54).

The risk factors for after mild TBI were similar, excluding cause of injury, according to the results.

“Our findings may have implications for surveillance and treatment of mental disorders after TBI,” Stein and colleagues wrote. “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.”

The researchers suggested that clinicians consider watchful waiting for patients with prior mental health problems as well as antidepressant treatment and/or cognitive behavioral therapies on an individual patient-by-patient basis.

“Clearly, more work needs to be done to determine for whom such treatments are effective and to develop more broadly efficacious treatments,” they wrote. – by Savannah Demko

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 the study for all other authors’ relevant financial disclosures.

Some patients were more likely to develop PTSD and/or major depressive disorder following mild traumatic brain injury, or TBI particularly those with a history of mental health problems and those with TBI resulting from assault or violence, according to study findings.

“Preexisting mental disorder and mental health sequelae have been shown to be important determinants of overall functioning and quality of life after [mild] TBI,” Murray B. Stein, MD, MPH, from the department of psychiatry, University of California San Diego, and colleagues wrote in JAMA Psychiatry. “Although MDD and PTSD are prevalent after TBI, little is known about which patients are at risk for developing them.”

Researchers conducted a prospective longitudinal cohort study to determine the prevalence of and risk factors (ie preinjury and injury characteristics) for PTSD and among 1,155 adult patients with mild TBI and 230 patients with non-head orthopedic trauma injuries evaluated in the ED at 11 U.S. hospitals.

Stein and colleagues examined PTSD and MDD symptoms at 3, 6 and 12months post-injury using the PTSD Checklist for DSM-5 and the Patient Health Questionnaire-9 Item. They evaluated the associations with PTSD and MDD using propensity score weights-adjusted multivariable logistic regression models.

Analysis revealed that the prevalence of PTSD and/or MDD was 20% in the mild TBI group vs 8.7% in the orthopedic trauma comparison group (P < .001) at 3 months and 21.2% vs 12.1% (P = .03) at 6 months.

The results showed that certain preinjury—like prior mental health problems—and injury-related—like assault or other violent cause of injury in PTSD cases—were linked to increased risk among participants with mild TBI. After evaluating for risk factors, the investigators found that participants were more likely to have PTSD 6 months following mild TBI if they:

  • less education (adjusted OR = 0.89; 95% CI, 0.82-0.97 per year);
  • black (aOR = 5.11; 95% CI, 2.89-9.05);
  • self-reported psychiatric history (aOR = 3.57; 95% CI, 2.09-6.09); and
  • had injury resulting from assault or other violence (aOR = 3.43; 95%CI, 1.56-7.54).

The risk factors for after mild TBI were similar, excluding cause of injury, according to the results.

“Our findings may have implications for surveillance and treatment of mental disorders after TBI,” Stein and colleagues wrote. “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.”

The researchers suggested that clinicians consider watchful waiting for patients with prior mental health problems as well as antidepressant treatment and/or cognitive behavioral therapies on an individual patient-by-patient basis.

“Clearly, more work needs to be done to determine for whom such treatments are effective and to develop more broadly efficacious treatments,” they wrote. – by Savannah Demko

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 the study for all other authors’ relevant financial disclosures.